Context: Shoulder impingement syndrome (SIS) is the most common shoulder injury among overhead athletes. The Constant score (CS) is a combined scoring system to evaluate functional status of the shoulder in patients with shoulder pain. Design: Cross-sectional study. Methods: Cultural adaptation of the Persian version of CS was conducted using Beaton’s guideline. Sixty-three overhead athletes (23.57 [7.50] y old) with SIS completed the final version for psychometric assessment. After 5 to 7 days, a group of 33 patients completed the Persian CS again to assess test—retest reliability. Internal consistency, floor/ceiling effects, and item-total correlation were evaluated in patients with SIS. Concurrent validity was assessed through comparison with the disability of the arm, shoulder, and hand questionnaire scores. Twenty-five healthy athletes (31.80 [7.32] y old) participated for determining discriminant validity. Results: The Persian CS demonstrated good test–retest reliability, with subjective and objective intraclass correlation coefficients of .79 and .80, respectively. The internal consistency was satisfactory (Cronbach alpha = .74). No ceiling or floor effects were noted. The Pearson correlation coefficient between CS and disability questionnaire was −.68. The mean total score for patients was 67.02, while for the healthy group was 96.99 (P = .000). The standard error of measurement was 1.51 for patients and 0.7 for healthy group. The smallest detectable change was 16.95 for patients and 5.71 for healthy group. Conclusion: The translation and cross-cultural adaptation of CS into Persian were successful. The Persian version demonstrates sufficient reliability and validity to evaluate shoulder function in overhead athletes with SIS.
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Persian Version of the Modified Constant Score in Overhead Athletes: A Reliability and Validation Study
Fariba Jafari, Leila Abbasi, and Alireza Motealleh
Validity and Reliability of the Spanish Version of the Athlete Psychological Strain Questionnaire
Jorge García-Rubio, Daniel González-Devesa, José Carlos Diz-Gómez, and Ayán-Pérez Carlos
Context: This study aims to provide data on the reliability and validity of an adapted Spanish version of the Athlete Psychological Strain Questionnaire (APSQ) when administered to Spanish athletes. Design: A cross-sectional study was developed. Methods: Data were collected from 128 athletes (males n = 71; females n = 57). The tools used in this study were the APSQ; Kessler Psychological Distress Scale; and Depression, Anxiety, and Stress Scales. The intraclass correlation coefficient was used to determine relative reliability, whereas standard error measurement and minimal detectable change were used to evaluate absolute reliability. Bland–Altman plots were employed to assess test–retest agreement and potential systematic bias. Results: Data indicate that the Spanish version of the APSQ demonstrated satisfactory internal consistency (α: .77–.85) and generally fair to good test–retest reliability (intraclass correlation coefficient: .702; 95% CI, .602–.780). Significant associations were found between the APSQ Spanish version and the Depression, Anxiety, and Stress Scales (ρ = .64–.82), with fair to good agreement, whereas fair to moderate levels of agreement were established between the APSQ Spanish version and the Kessler Psychological Distress Scale (ρ = .53–.75). Conclusions: These results provide preliminary evidence supporting the use of the APSQ Spanish version for mental health screening among Spanish athletes. However, the lack of absolute reliability raises concerns about its utility for assessing the effects of interventions aimed at improving mental well-being.
The Addition of Thoracic Spine Manipulation or Mobilization to Exercise in Adults With Subacromial Impingement Syndrome: A Critically Appraised Topic
Joan Vicente and Ryan Wooley
Clinical Scenario: Shoulder pain is the third most common musculoskeletal complaint. The most common type of shoulder pain is subacromial impingement syndrome (SIS). The concept of regional interdependence demonstrates that body regions are interrelated, affecting how they function. Previous studies have reported the influence of the thoracic spine on the shoulder. Clinical Question: Does adding thoracic spine manipulation or mobilization to exercise in adults with SIS improve shoulder range of motion (ROM), pain, and disability? Summary of Key Findings: The literature was searched for level 2 evidence or higher that examined the effects of the addition of thoracic mobilization or manipulation to exercises in shoulder ROM, pain, and disability in SIS. Twenty articles related to the clinical question, but only 3 met the inclusion and exclusion criteria. Two studies reported that the combination of thoracic mobilization or manipulation and exercises resulted in more significant improvements in shoulder ROM, pain, and disability compared to exercises alone. One study concluded that the combination of thoracic or shoulder mobilization to exercises was superior to ultrasound or exercises alone. Clinical Bottom Line: There is moderate evidence to support the addition of thoracic manipulation or mobilization to exercise in treating SIS to improve shoulder ROM, pain, and disability. Strength of Recommendation: Grade B evidence supports a multimodal approach using the combination of thoracic mobilization or manipulation and exercises in adults with SIS.
Unveiling the Distinctions: Computer Versus Sport-Specific Neurocognitive Tests
Benedict Gondwe, Pieter Heuvelmans, Anne Benjaminse, Daniel Büchel, Jochen Baumeister, and Alli Gokeler
Context: Traditional assessments of high-order neurocognitive functions are conducted using pen and paper or computer-based tests; this neglects the complex motor actions athletes have to make in team ball sports. Previous research has not explored the combination of neurocognitive functions and motor demands through complex tasks for team ball sport athletes. The primary aim of the present study was to determine the construct validity of agility-based neurocognitive tests of working memory (WM) and inhibition. Methods: Twenty-seven athletes (5 females; mean age 24.2 [4.7] y; height 183.6 [9.1] cm; body mass 77.5 [11.2] kg) participated in the construct validity assessments that included computer-based tests (working memory capacity and stop-signal reaction time) and sport-specific assessments performed on the SpeedCourt system. Results: Construct validity analysis of sport-specific working memory yielded acceptable construct validity (r = .465, P < .05), whereas the sport-specific stop-signal task resulted in low construct validity (r = .179, P > .05). The poor construct validity results highlight the large variance between computer-based and sport-specific neurocognitive assessments. Conclusion: Sport-specific assessments are more complex and include more degrees of freedom potentially due to athletes’ center of mass displacement during task execution. These findings suggest that future research should focus more on the development of sport-specific assessments. These should include the cognitive and motor demands encountered during practice and competition, not use computer-based/pen and paper assessments for return to play decisions.
Isometric Back Extensor Endurance and Chronic Low Back Pain in University Athletes: A Cross-Sectional Study
Sumbul Ansari and Saurabh Sharma
Context: Chronic low back pain (CLBP) is a common problem among university athletes, negatively affecting their performance and overall health. Deconditioned back muscles due to CLBP can reduce endurance. However, there is limited research on CLBP in university athletes, especially comparing those with and without the condition. Additionally, the connection between back muscle endurance and CLBP in university athletes is unclear, and there is insufficient data on normal levels of back muscle endurance. The present study aimed to establish normal back extensor muscle endurance values in university athletes, both with and without CLBP, and to investigate the link between back extensor endurance and CLBP. Design: Cross-sectional study. Methods: The study included 90 university-level athletes (45 with CLBP and 45 without CLBP; age: 18–30 y). Athletes underwent assessments on demographics, sports, and CLBP-related factors, as well as the Sorensen test. Appropriate statistical tests were applied to the obtained data. Results: Results showed a significant difference (P < .001) in Sorensen test holding duration between athletes with and without CLBP. The correlation analysis revealed a significant association (r = −.79, P = .02) between Sorensen test time and CLBP. Conclusions: University athletes with CLBP exhibit lesser back extensor endurance than those without CLBP. There is a significant association between CLBP and Sorensen test hold time. The study’s implications include using the Sorensen test for CLBP prediction and tracking therapeutic advancements in clinical practice.
Bone Stress Injury Epidemiology and Risk Factors in Female Off-Road Runners: A Systematic Review
Richard Stennett, Volker Scheer, and Kelly Kaulback
Background: Off-road running is a growing sport with little research investigating injury profiles of female participants. Bone stress injuries (BSIs) are a particularly detrimental injury with little known about their incidence and risk factors in female off-road runners. Objective: Collate and review the available evidence reporting epidemiological data and risk factors associated with BSI in female off-road runners. Design: Systematic literature review, without meta-analyses. Data Sources: MEDLINE OVID, PubMed, SPORTDiscus, and MEDLINE EBSCO. Searches were finalized in July 2024. Eligibility Criteria: Studies that reported injury surveillance statistics and/or risk factors associated with BSIs in female off-road runners. Results: Seventeen eligible studies were included, of which all reported surveillance statistics and 2 reported risk factors associated with BSI among 897 female runners. Owing to the scarcity of data, cross-country runners were included in the population of off-road runners. Most BSIs were high severity and in the lower leg, with an overall incidence ranging from 0 to 34.39 BSIs per 100,000 athlete-exposures and prevalence ranging from 0% to 40.9%. Study characteristics were reported alongside risk of bias, quality, and level of evidence assessment outcomes from varying tools. Eight significant intrinsic risk factors were associated with BSIs in female off-road runners: increasing age, disrupted menstruation, previous BSI, increased female triad risk, and lower calcium, vitamin D, and calorie intake. Discussion: Limited by the number of studies available reporting data on the specific target population, which highlights the need for performing high-quality prospective studies in the future, this review summarizes the current epidemiological data and risk factors associated with BSIs in female off-road runners.
Illnesses and Diseases Constitute a Quarter of Medical Conditions in an Under-21 National Football Team
Panu H. Nordback
Context: There is a minimal number of studies of under-21-year-old national football teams, and the literature is injury centric. Particularly, current knowledge is deficient regarding noninjurious medical conditions, such as illnesses and diseases. Design: The objectives of this study were to analyze the descriptive characteristics of injuries and illnesses or diseases encountered in an under-21 football team during 2 European championship qualification tournaments. Methods: Medical records of 2 consecutive men’s Union of European Football Associations European Under-21 Championship qualification competition tournaments were retrospectively analyzed for the study from September 2015 to October 2018. All match- and training-related injuries, illnesses, and diseases were analyzed and further categorized. Results: In the 20 international caps played within 13 separate events, the players encountered 81 injuries and 26 other conditions, illnesses, or diseases requiring medical attention. In total, 25 injuries and 5 diseases led to attendance inability. The incidence of injury was 0.6 per match and disease 0.3 per day. Many overuse injuries appeared during prematch training and in relation to previous history. Twenty-four percent of all medical conditions during 2 qualification tournaments were illnesses or diseases. The injury and disease incidences were low and mild or moderate rather than severe. Conclusions: A variety of illnesses and diseases constitute a quarter of conditions requiring medical attention in an under-21 national football team. Attendance at under-21 national team events can be stated as safe as the incidence and severity rates are low.
Psychological Responses Among Individuals Undergoing Anterior Cruciate Ligament Reconstruction Surgery
Airi Naoi, Yasukazu Yonetani, Yoshinari Tanaka, and Shuji Horibe
This study elucidated how previous surgery experience, coping, and optimism influenced the mood of patients who underwent anterior cruciate ligament (ACL) reconstruction surgery. Additionally, it examined the relationships among age, preoperative mood, and postoperative mood. Sixty-four patients (n = 42 men, n = 22 women; age range = 18–51 y) who underwent ACL reconstruction surgery at one hospital in western Japan completed questionnaires before and after surgery. Results revealed that patients who underwent previous ACL reconstruction surgery reported higher tension-anxiety (P < .01) and total mood disturbance (TMD) (P < .05) than did patients who underwent primary surgery. Additionally, tension-anxiety, anger-hostility, TMD (P < .001), depression-dejection, fatigue, and confusion (P < .01) assessed before surgery were significantly reduced after surgery, and preoperative mood was positively related to postoperative mood. Furthermore, positive interpretation was negatively related to TMD before surgery (P < .05), and evading one’s responsibility was positively related to TMD after surgery (P < .05). Therefore, psychological support might be necessary for patients who underwent previous ACL reconstruction surgery and patients who evade responsibility. The results of this study will help sport medicine professionals identify several individual factors that are related to psychological responses of patients who underwent ACL reconstruction surgery.
Comparing the Hip and Lumbar Joint Range of Motion in Patients With Lower Lumbar Disc Herniation and Healthy Subjects
Mahdieh Mirzapour, Omid Shahpari, Neda Mostafaee, Saeed Akhlaghi, and Majid Shahbazi
Background: One possible factor contributing to low back pain is hip range of motion (ROM). However, there is inconstancy in published studies, which may be due to the heterogeneity of patients. Therefore, the present study focuses on the relationship between hip ROM and lower lumbar disc herniation (LLDH). Method: A cross-sectional study involved 52 participants between 18 and 65 years old. Two digital inclinometers were utilized to measure the ROM of the lumbar and hip joints in all study participants. For each outcome, 2 measurements were conducted, and the mean of the 2 measurements was utilized for analysis. The level of statistical significance was established at P ≤ .05. Results: The difference in all ROM between the 2 groups is significant except for dominant hip flexion (P < .05). Lumbar flexion was reduced in LLDH compared with healthy individuals (P = .003). The findings manifested a significant correlation between right lumbar rotation and nondominant hip abduction (P = .05, R = .388) and between left lumbar lateral bending and nondominant hip flexion (P = .008, R = .510). Conclusion: Patients with LLDH have reduced hip ROM and lumbar flexion compared with healthy individuals. The study showed correlations between hip and lumbar ROM and emphasized the significance of evaluating hip ROM in LLDH for assessment and treatment planning.
The Effect of Myofascial Release Applied to Thoracolumbar Fascia on Flexibility, Muscular Endurance, and Balance in Healthy Young Adults: A Single-Blind Randomized Controlled Trial
Hatice Ozdemir, Ummuhan Bas Aslan, Hasan Atacan Tonak, and Ibrahim Cagda Kal
Context: Although cranial distant effects occur in self-myofascial release interventions for lower-extremity muscles and fascia, the results of caudal distant effects are still unclear. The aim of this study was to examine the distant effects of myofascial release applied to the thoracolumbar fascia together with exercise training on balance, lower-extremity flexibility, and muscular endurance in healthy young adults. Design: Single-blinded randomized control trial design. Methods: Thirty-six healthy participants aged 18–35 years were randomly divided into 3 groups: myofascial release and exercise group (group 1, n = 12), exercise group (group 2, n = 12), and control group (group 3, n = 12). Three days a week for 4 weeks, group 1 applied the thoracolumbar fascia foam roller massage together with the warm-up, muscular endurance, balance, and stretching exercise program, and group 2 applied the same exercise program except for the foam roller massage. No intervention was made in group 3. Flexibility was assessed with sit and reach test, muscular endurance with the 1-minute sit to stand test, and balance with star excursion balance test before the intervention and at the end of the fourth week. Results: Flexibility, muscular endurance, and dynamic balance values increased significantly in groups 1 and 2 after the intervention (P < .05). When the difference values (Δ) of groups 1 and 2 were compared, there was a difference in favor of group 1 for flexibility, muscular endurance, and dynamic balance (P < .05). Conclusions: The results of the study showed that the effect of the distant myofascial release technique added to the exercise training on flexibility, muscular endurance, and dynamic balance was greater than the exercise training alone.