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Context: Sport-related concussion management often requires referral to physical therapy (PT). Objectives: To (1) outline the role of PT in the management of sport-related concussion, (2) describe patients who underwent PT, and (3) discuss outcomes of athletes who underwent PT. Design: Retrospective cohort study. Setting: Single institution. Methods: Adolescent athletes aged 14–19 years old who sustained a sport-related concussion from November 2017 to April 2022 were evaluated. The cohort was dichotomized into 2 groups: PT versus no PT. The outcomes were days from initial PT visit to symptom resolution (SR) and return-to-play. Subgroup analyses compared recovery metrics between those initiating PT before and after 30 (1 mo) and 90 days (3 mo) of injury. A univariable and multivariable regression was used to determine predictors of recovery. Results: Of 1010 concussed athletes, 205 (20.3%) received referral for rehabilitation, and 58 (28.3%) patients received PT at the parent institution. Those who received PT had a higher number of prior concussions compared with those who did not (PT: 1.0 [1.2]; non-PT: 0.6 + 1.0; χ ² = 19.37, P = .007). A large proportion of PT recipients reported headache (n = 45, 81.0%); visual disturbances (n = 32, 65.5%); and vestibular (n = 37, 63.8%), cervical (n = 25, 43.1%), or oculomotor dysfunction (n = 25, 43.1%). Most patients received exertional therapy (n = 32, 55.1%), vestibular therapy (n = 31, 53.4%), and/or cervical therapy (n = 30, 51.7%). Those initiating PT before 1 and 3 months had significantly shorter median times to SR compared with those initiating after 1 and 3 months, respectively. Multivariable regression showed that a shorter time between injury and the initial PT visit was predictive of faster SR (β = 1.66, P = .048). Conclusions: Headache, dizziness, and visual disturbances were commonly reported symptoms by patients who received PT. Cervical, vestibular, and oculomotor deficits were common objective findings by physical therapists, and cervical, vestibular, and exertional therapy were common interventions. Delayed time to PT was independently associated with a longer time to SR.

Purpose: Poor posture has a negative impact on physical capability and is associated with changes in biomechanics and motor control. The purpose of this study was to assess the effect of corrective exercises on ground reaction forces (GRFs) in male student handball players with upper crossed syndrome (UCS) during throwing. Methods: Thirty male handball students with UCS participated in this single-blind randomized controlled trial (IRCT20200622047888N2; IR.HUMS.REC.1402.135). Fifteen received an 8-week corrective exercise intervention (exercise-intervention group [EG]), consisting of exercise targeting muscles involved in the UCS, and 15 served as the control group (CG). During handball throwing, GRF was measured by force plate. The forward head and rounded shoulder angles were measured with a photogrammetric method. All measurements were repeated 8 weeks later. Results: Significant interactions for virtually all parameters indicated that changes over 8 weeks differed between the CG and EG. A reduction in GRFs and a delayed occurrence of peak GRFs were observed in the EG, but not in the CG (P < .05). This was accompanied by a significant reduction in forward head (P < .03; effect size: 0.87; 95% confidence interval, −2.34 to 0.13), rounded shoulder (P < .05; effect size: 0.68; 95% confidence interval, 0.32 to 1.22) and thoracic kyphosis (P < .02; effect size: 0.64; 95% confidence interval, 0.54 to 1.25) angles in the EG (P < .05) with no significant change over 8 weeks in the CG. Conclusion: Corrective exercises targeting muscles directly involved in UCS induces functional and postural improvements in male student handball players with UCS.

Context: Clinical balance assessments vary in reliability due to subjectivity in their scoring. A valid and objective accelerometer-based smartphone evaluation could benefit patients, clinicians, and researchers. Objective: Our objective was to assess the validity and reliability of smartphone-based standing balance. Design: A repeated-measures study was conducted with 23 healthy young adult participants across 2 sessions ∼7 days apart. Methods: Participants completed 30-second standing trials during tandem-stance eyes-open, tandem-stance eyes-closed, single-leg eyes-open, and single-leg eyes-closed conditions. Android and iOS smartphones were placed vertically on the lower back via a belt with 3 retroreflective markers attached and tracked by an 8-camera motion capture system. Sway path, range, and area were calculated from smartphone accelerometer and marker data. We assessed reliability using intraclass correlation coefficients (ICC[_2,k]) and validity using Pearson r correlations between the marker and smartphones from visit 1. Results: Across eyes-open conditions, Android (ICC = .84–.96), iOS (ICC = .82–.98), and marker-based (ICC = .84–.95) assessments demonstrated good to excellent reliability. Across eyes-closed conditions, Android (ICC = .41–.87), iOS (ICC = .34–.79), and marker-based (ICC = .31–.87) assessments demonstrated poor to good reliability. Correlations between smartphones and the marker data were moderate to very high (r = .56–.97). Conclusions: The smartphone-based assessment was valid and reliable, indicating that clinicians and researchers can implement this method to measure balance with the opportunity for remote administration and increased patient tracking across various recovery timepoints.

Context: Variables associated with pain catastrophizing and beliefs in athletes presenting with musculoskeletal pain and/or sports-related injuries are largely unexplored. Objective : We aimed to evaluate which anthropometric, sociodemographic, sporting, injury history, and care-seeking characteristics were associated with the Pain Catastrophizing Scale (PCS) and Pain Beliefs and Perceptions Inventory (PBAPI) scores in athletes. Design: This study followed a cross-sectional design. Methods: Three hundred and twelve athletes (40% females) from different sports and levels completed a questionnaire including demographic information, details regarding sports practice, injury history, health care use, PCS, and PBAPI. Univariable associations between PCS and PBAPI scores and each variable were assessed using linear regression. Variables with univariable associations where P < .05 were entered into multivariable regression models. Results: The final multivariable model including gender, recurrent and persistent pain, a history of a severe atraumatic injury, and a history of more than 5 atraumatic injuries explained 14.9% of the variance in PBAPI scores. Performing a team sport and a history of more than 5 atraumatic injuries explained 5.1% of the variance in PCS scores. Conclusions: Gender, sporting, and injury history characteristics explained only a small portion of the variance in PCS and PBAPI scores, whereas having received healthcare support and the number of appointments did not. Most of the variance was left unexplained.

Context: Femoroacetabular impingement syndrome (FAIS) is a movement-related condition associated with pain and impaired function; yet the evidence for level ground walking hip biomechanics is limited and inconsistent. Challenging the hip with inclined walking for individuals with FAIS might be important for elucidating mechanically driven function loss and informing tailored rehabilitation. The purpose of this study was to determine the effects of progressive inclined walking on sagittal hip biomechanics and hip flexor and extensor activity in individuals with FAIS. Design: Cross-sectional. Methods: Fourteen participants (7 individuals with FAIS and 7 asymptomatic individuals) underwent motion capture and electromyographic analysis during 3 treadmill walking conditions (0°/5°/10°). Statistical parametric mapping was used to compare the sagittal hip kinematic waveforms and hip flexor (rectus femoris) and extensor (gluteus maximus) waveforms between groups and walking conditions. Results: Hip flexion was significantly increased throughout the gait cycle in individuals with FAIS compared with asymptomatic individuals (P < .01) but was not dependent on incline. Rectus femoris activation was significantly increased throughout stance in individuals with FAIS compared with asymptomatic individuals (P < .01). Gluteus maximus activity significantly increased with progressive inclination in asymptomatic individuals (P < .01), with no significant change in activity for individuals with FAIS. Conclusions: Hip biomechanics and muscle activity during inclined walking mirrored that of arthrogenic muscle inhibition, highlighted by a prominent flexor role and lack of hip extensor activity in individuals with FAIS. Future research investigating discordant activity between hip flexors and extensors during complex functional tasks may help identify rehabilitation targets.

Context: Understanding Paralympic athletes’ perspectives on the importance of sleep is the first step toward developing effective sleep hygiene (SH) strategies. We aim to describe and compare the knowledge about SH and sleep behaviors practiced by medalists and nonmedalists Paralympic athletes at the Tokyo 2020 Paralympic Games and between sexes (female vs male), identify whether the coaching staff encourages SH, and the perspective of these athletes on the importance of SH. Methods: 98 Paralympic athletes responded to the Sleep Beliefs Scale and the Athlete Sleep Behavior Questionnaire-BR. Results: Medalists (68%) and nonmedalists (78%) Paralympic athletes had low knowledge about SH (60% vs 55%; P = .20), with no difference between groups. The Athlete Sleep Behavior Questionnaire-BR score (48.7 [5.9]) for all Paralympic athletes (n = 98) indicated high practice of maladaptive sleep behaviors. Male athletes had significantly worse sleep behaviors than female athletes (49.1 [6.0] vs 39.5 [7.2]; P < .01) and less knowledge about behaviors that can affect sleep (64% vs 72%; P < .05), 26% of Paralympic athletes considered SH practices necessary, and the frequency of coaching staff encouraging SH was higher among medalists Paralympic athletes compared to nonmedalists athletes (29% vs 13%, P = .04). Conclusions: Most Paralympic athletes have inadequate sleep behaviors and knowledge about SH. There was no difference between knowledge about SH and sleep behaviors between medalists and nonmedalists Paralympic athletes, although medalists athletes were more encouraged to practice SH. Male Paralympic athletes had worse sleep behaviors and worse knowledge about SH than female athletes.

Context: Over 80% of patients anticipate fully returning to sport (RTS) within 1 year after anterior cruciate ligament reconstruction (ACLR), but only one quarter of patients succeed. Although several factors influence the RTS process, this study focused on how psychological responses to injury, such as injury-related fear and self-determined motivation, help to explain variation in rehabilitation experiences. There is limited information about how these meaningful psychological responses to injury are connected to responses such as athlete burnout or how patient perceptions of these responses relate to rehabilitation. The purpose of this qualitative study was to explore how patient perceptions of injury-related fear, self-determined motivation, and athlete burnout influence individual psychological and rehabilitation experiences at 4 to 6 months post-ACLR. Design: Qualitative study. Methods: Eight patients (female = 4, age = 16.3 ± 1.9) between 4 and 6 months post-ACLR who injured their knee playing or training for sports were included in the study. Patients completed the Sport Motivation Scale-6, Athlete Burnout Questionnaire, Perceived Stress Scale 4, and Tampa Scale of Kinesiophobia-11 to measure self-determined motivation, athlete burnout, stress, and injury fear. These questionnaires collected descriptive data used to guide audio- and video-recorded semistructured interviews. The interviews were transcribed and analyzed in a 6-stage process of thematic analysis. Results: Thematic analysis revealed 3 themes related to how participants perceived their rehabilitation experiences: (1) acknowledging recurring struggles during recovery, (2) finding motivation to RTS and normal life, and (3) successfully navigating the recovery process. In particular, participants described the impact of positive shifts in their psychological perceptions at 4 to 6 months post-ACLR. Conclusions: Patients 4 to 6 months post-ACLR described how struggles during their recovery and rehabilitation experiences were improved by positive shifts in their psychological perceptions. Increasing positive psychological awareness within a supportive rehabilitation environment may improve rehabilitation experiences and RTS rates after ACLR.

Context: Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport. Objectives: To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data. Methods: Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total n_c = 25) and 10 youth sport participants (ages 10–25 y) with a history of concussion in the previous year (total n_y = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity. Discussion: This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.

Objective: The aim of this study is to compare kinematic data of the frontal trunk, pelvis, knee, and summated angles (trunk plus knee) among categorized grades using the single-leg squat (SLS) test, to classify the SLS grade, and to investigate the association between the SLS grade and the frontal angles using smartphone-based markerless motion capture. Methods: Ninety-one participants were categorized into 3 grades (good, reduced, and poor) based on the quality of the SLS test. An automated pose estimation algorithm was employed to assess the frontal joint angles during SLS, which were captured by a single smartphone camera. Analysis of variance and a decision tree model using classification and regression tree analysis were utilized to investigate intergroup differences, classify the SLS grades, and identify associations between the SLS grade and frontal angles, respectively. Results: In the poor group, each frontal trunk, knee, and summated angle was significantly larger than in the good group. Classification and regression tree analysis showed that frontal knee and summated angles could classify the SLS grades with a 76.9% accuracy. Additionally, the classification and regression tree analysis established cutoff points for each frontal knee (11.34°) and summated angles (28.4°), which could be used in clinical practice to identify individuals who have a reduced or poor grade in the SLS test. Conclusions: The quality of SLS was found to be associated with interactions among frontal knee and summated angles. With an automated pose estimation algorithm, a single smartphone computer vision method can be utilized to compare and distinguish the quality of SLS movement for remote clinical and sports assessments.