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Context: A common component within rehabilitation recommendations for baseball pitchers is employment of an interval throwing program. However, there is a lack of a consistent set of advocated guidelines for program content and implementation for athletes at the professional and collegiate levels. Design: Cross-sectional study. Methods: A survey was developed to obtain clinician views regarding the composition and implementation of interval throwing programs for baseball pitchers. The survey was divided into demographic information and sections on criteria to begin throwing programs, frequency of throwing, soreness management, warm-up components, program components and regulation of a program, and criteria to achieve permitting live throwing. Clinicians including physicians, physical therapists, and certified athletic trainers who evaluate and treat musculoskeletal injuries among baseball pitchers at the professional-level and/or collegiate-level clinician received the survey. Responses were tabulated and compared between the professional-level clinician and collegiate-level clinician groups using chi-square analyses with statistical significance set at P ≤ .05. Results: The survey was completed by 166 clinicians (collegiate level = 81, professional-level clinician = 85). There were no statistical differences between groups for allowing warm-up throws, program regulation, maximum distance allowed, managing soreness, or criteria to achieve before permitting live throwing. Between-group differences included criteria to begin a program (≤.03), warm-up distance (P ≤ .02), nonthrowing warm-up methods (P ≤ .04), non-warm-up distance (P ≤ .01), using ratings of perceived exertion (P < .01), throwing frequency (P < .01), and program components (P ≤ .04). Conclusions: Responses appear to mirror interval throwing program designs previously reported in the literature but there are modifications and additions utilized by clinicians at different playing levels.

Context: The Buffalo Concussion Treadmill Test (BCTT) for exercise intolerance following concussion may highlight underlying autonomic dysfunction. Autonomic function at rest and with exertion may be predictive of neurocognitive performance for individuals with sports-related concussion. The purpose of this study is to explore the feasibility and utility of combining multimodal assessments with heart rate variability (HRV) measures during the BCTT for individuals with a remote history of concussion. Design: Prospective cohort study design, pretest/posttest. Methods: Participants included 5 males and 5 females (N = 10, age: 25.2 [3.3] y old, height: 173.2 [11.2] cm, mass: 73.4 [13.7] kg, body mass index: 24.5 [3.9], time since last concussion of 6.3 [4.5] y). All participants completed the multimodal assessment battery including: Concentration Reverse Digits (6 digits), Stroop Incongruent, and King–Devick Test under single- (seated) and dual-task conditions (walking on treadmill at 2.0 mph, 0% incline). Heart rate and HRV was collected at rest, during the BCTT, and during postexercise recovery. HRV data were processed and analyzed based on established protocols. Paired t tests were performed for pre- and postmeasurements separately for single- and dual-task tests of the multimodal assessment battery and HRV indices. Results: During the BCTT, HRV indices reflective of peripheral nervous system activity demonstrated a significant reduction with concomitant increase in HRV indices of sympathetic nervous system activity (P < .05). Recovery in these HRV indices toward baseline was observed during postexercise recovery. Neurocognitive performance on the Stroop task significantly improved with exercise (P < .05). Conclusion: Implementation of multimodal assessments to evaluate physiological and neurocognitive responses to exercise in individuals with history of sports-related concussion is feasible. Addition of these objective measures may decrease reliance on self-reporting of exercise-induced symptom exacerbation, enabling clinicians to identify individuals whose neurocognitive performance or physiologic response to exercise on the BCTT deviates from the expected.

Context: The single-leg hop is based solely on performance with no measure of movement quality. The purpose of this study was to (1) develop a real-time screening tool to capture single-leg functional performance and movement quality and (2) to provide preliminary validation (criterion validity) of a trained clinician’s real-time movement quality assessment with 3D kinematics. Study Design: Cross-sectional. Methods: Fifty-nine adolescent athletes volunteered (15.2 [1.1] y, 165.8 [9.2] cm, and 61.5 [13.9] kg, 51 females and 8 males). Each participant performed 3 trials of the single-leg hop on their dominant leg. A 3-dimensional inertial measurement system was used to capture knee joint kinematics. A movement quality checklist for use during a single-leg hop (movement quality single-leg hop) was developed to score biomechanical errors based on lower-extremity injury risk factors. Four criteria were developed for the checklist: (1) knee valgus, (2) foot rotation, (3) lateral trunk flexion, and (4) erect posture. An independent t test was conducted for each dependent variable (knee flexion displacement and knee abduction displacement) by each independent variable (movement category presence of (1) lateral trunk flexion, (2) knee valgus, (3) foot rotation, and (4) erect posture/sound during landing [yes or no]). The alpha level was set at α < .05 for all analyses. Results: Knee flexion displacement was significantly decreased (P < .001, mean difference 9.40 [1.88]) and knee abduction displacement was significantly increased (P < .001, mean difference 9.41 [0.47]) for those who had knee valgus documented by the clinician. In additional, for those with visually documented erect posture/sound of landing, there was a significant decrease in knee flexion displacement (P < .001, mean difference 10.13 [2.34]). Conclusion: The movement quality single-leg hop checklist has shown promising preliminary validation (criterion validity) for clinicians to assess movement quality. Increased knee abduction and decreased knee flexion are common risk factors associated with knee injuries and this clinician friendly real-time checklist may highlight individuals who are at risk of sustaining a knee injury.

Clinical Scenario: The Functional Movement Screen (FMS) is used to assess movement patterns and the risk of injury of active individuals. Current studies have found positive relationships with core training and injury prevention as well as lower limb stability, which can help improve FMS scores. Clinical Question: Does the implementation of a core training program have an impact on FMS scores in healthy active adults who participate in sport? Summary of Key Findings: Literature was searched for articles that included core-focused exercises and implementation of the FMS. This resulted in 25 studies being returned, only 23 of which were published in the last 10 years. Only 7 focused on the change in FMS scores after implementation of core training. Three of these studies were included in the analysis due to the specialized athlete population. All 3 studies found that using a core training program led to significantly higher FMS scores postintervention. Clinical Bottom Line: There is clear evidence that core training increases FMS scores in athletes. It is important for health care providers treating athletes to consider core training to improve functional movement patterns or FMS scores in sport-specific populations. Strength of Recommendation: Overall, there are moderate to high levels of evidence that support a grade B recommendation for core training improvements on FMS scores in athletes.

Context: Advancements in portable load-cell technology have enabled high-quality assessment of shoulder internal (IR) and external rotation (ER) peak force (F_max) and rate of force development (RFD). This study’s purpose was to explore the reliability and differences between IR and ER F_max and RFD in different testing positions using a novel load-cell device. Design: A within-subjects repeated-measures design was employed to compare the intersession values and reliability of F_max and RFD for both shoulder IR and ER across 3 positions: seated-0°, supine-0° and supine-90°. Methods: National-level swimmers (n = 19; age = 16.8 [1.0] y) completed 3 testing occasions of each condition (combination of arm, rotation, and test position) separated by 7 to 14 days. Results: IR superseded ER in all testing positions. The association between these positions across IR and ER was typically strong for both F_max and RFD (r > .85, P < .001) except for IR RFD (r = .56–.73, P < .05). For sessions 2 to 3, F_max intraclass correlation coefficient and CV (intraclass correlation coefficient = .89–.96, CV = 5.2%–8.8%) were typically within acceptable ranges, whereas RFD (intraclass correlation coefficient = .74–.90, CV = 11.5%–18.1%) often exhibited inflated error. Conclusion: The supine (90°) position was the most consistent position across both measures. Load-cell technology can be confidently used to assess shoulder rotation F_max in 3 different positions, whereas RFD should be used with caution without protocol refinement.

Context: Interest in the effects of concurrently using neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) to improve muscle strength has risen, but limited studies and inconsistent findings have led to more questions. The 2 current projects aimed to systematically investigate how NMES waveform shape and BFR occlusion pressure acutely influence electrically elicited force (EEF) and tissue oxygen saturation (StO₂) of the knee extensors. Design: A single-session repeated-measures design was followed. Methods: EEF and StO₂ were measured in 2 different groups of 15 participants during 3 sets of NMES contractions. Ten NMES contractions per set were performed with 5 minutes of passive interset recovery. In the first project, different NMES waveforms (RUS, Russian burst-modulated alternating current; VMS, biphasic pulsed current; and VMS-Burst, burst-modulated biphasic pulsed current) were administered for each set, while BFR was applied at 60% limb occlusion pressure (LOP). During the second projet, VMS was administered, while a different BFR occlusion pressure (0% LOP, 40% LOP, and 80% LOP) was used during each set. Two-way repeated-measures analysis of variance examined if repetition and/or NMES waveform (first project) or BFR occlusion pressure (second project) significantly affected (P < .05) EEF or StO₂. Results: VMS (12% [7%] MVIF) and VMS-Burst (13% [10%] MVIF) led to higher EFF compared with RUS (6% [5%] MVIF) with 60% LOP; 80% LOP (20% [14%] MVIF) led to lower EEF compared with 0% LOP (29% [17%] MVIF) with VMS. No significant differences in StO₂ were observed between NMES waveforms or BFR occlusion pressures. Conclusions: If a clinician wanted to concurrently use NMES and BFR, the acute findings of the current projects would suggest the use of VMS or VMS-Burst with lower BFR occlusion pressure (40% LOP). However, further investigation into how these parameters would influence muscle strength subsequent to a training/rehabilitation intervention should be performed.

Clinical Scenario: Ballet dancers exhibit a high risk of musculoskeletal injuries with around 75% of all injuries attributed to overuse injuries. The high prevalence of chronic injuries suggests contributions caused by abnormal biomechanics in combination with repetitive stress common to ballet. Traditional sports settings implement movement screening tools including the Movement Competency Screen (MCS) and functional movement screen (FMS) to identify factors predisposing athletes to injury. However, unique training demands and movement patterns of ballet and contemporary pose challenges for fundamental movement screenings. Identifying relationships between movement screening scores and injury incidence in dancers may allow for early injury risk factors detection and injury prevention programs implementation to reduce overall injury rate. Clinical Question: Does implementation of the MCS improve prediction of injury incidence compared with use of the FMS™ in collegiate, preprofessional, and professional ballet, and contemporary dancers? Summary of Key Findings: Three studies met the inclusion criteria for critical appraisal. One study utilized the MCS while the other 2 implemented the FMS™ to assess ballet and modern dancers. These studies concluded the MCS may predict injury when implemented as a preseason screening in ballet and contemporary. The FMS™ did not demonstrate predictive capability for injuries in ballet and contemporary dancers. Clinical Bottom Line: While the MCS shows injury prediction potential, a dance-specific movement screening more accurately representing dance-related movement patterns may improve validity in this population. Continuation and standardization of dance injury research is imperative to understand movement compensations predisposing individuals to injury and injury prevention measures. Recommendation: Grade B evidence suggests potential predictive ability of the MCS in identifying dance-related injury, while no association exists between the FMS™ and dance injuries. Additional research regarding dance-specific movement application to functional screenings shows potential for accurate and reliable injury prediction methods for ballet and modern dancers.

Context: Active management of modifiable factors during the early rehabilitation stage can help patients who have undergone anterior cruciate ligament (ACL) reconstruction successfully return to sports. This study aimed to determine predictors for performance on the single-leg hop test and Tegner activity score 12-month post-ACL reconstruction, based on knee function assessed 3-month postsurgery. Design: Prospective cohort study. Methods: Ninety-one patients who underwent ACL reconstruction were recruited. Multivariate logistic regression analysis was performed to identify predictors of the one hop test and Tegner activity score 12-month postsurgery, based on a knee examination performed 3 months after ACL reconstruction. Factors evaluated at 3 months included the Biodex balance system anteroposterior and mediolateral indexes; Y balance test anterior, posteromedial, and posterolateral reaches; knee extensors and flexors peak torque per body weight; and knee extensors and flexors average power per body weight. Results: The knee extensor peak torque per body weight (PT/BW) and Biodex balance system-mediolateral index with cutoff values of 132 N·m/kg and 0.45, respectively were identified as predictors for achieving a limb symmetric index within 10% on the hop test. Furthermore, achieving a Tegner activity score over 6 was predicted by Y balance test-posteromedial reach and knee flexors average power per body weight, with cutoff values of 92.5 cm and 122 W/kg, respectively. Conclusion: Three months following ACL reconstruction, knee extensor peak torque, and mediolateral balance predicted performance on the hop test, while dynamic posteromedial balance and knee flexors average power predicted rotational ability, at the 12-month assessment.

Context: Awareness regarding the importance of mental health in athletes has been increasing in recent years. Mental health has been investigated in relation to injury recovery and performance; however, less evidence has examined changes in mental health throughout a competitive season. Objectives: This study aimed to: (1) evaluate the psychological factors of resilience and well-being over a National Collegiate Athletic Association Division I gymnastics season and examine changes over 4 time points: preseason, start of the competitive season, midseason, and postseason and (2) examine the relationships between these psychological measures at these 4 time points. We hypothesized that resilience and well-being would remain stable, and higher resilience would be related to a greater sense of well-being at all time points. Design: This study utilized a retrospective chart review. Setting: This study is conducted in a college setting. Patients or Other Participants: Study participants were 17 Division I female gymnasts. Methods: A retrospective chart review was conducted to evaluate the Brief Resilience Scale and 5-item World Health Organization Well-Being Index, which gymnasts had completed biweekly from preseason to postseason. Descriptive statistics were reported, a 1-way repeated measures analysis of variance was used to examine changes across 4 time points, and Pearson product–moment correlations were used to examine the relationships between Brief Resilience Scale and 5-item World Health Organization Well-Being Index scores. Results: Brief Resilience Scale and 5-item World Health Organization Well-Being Index scores did not change throughout the season (P = .62, .52). No relationship between the variables was identified at the start of preseason or midseason (P > .17). However, at the start of the competitive season and postseason, resilience was positively correlated with well-being (r = .65, P = .006; r = .82, P = .006). Conclusions: Higher resilience and well-being are related in Division I female gymnasts but do not fluctuate throughout the season. Sports medicine staff and coaches should be aware that there is room to improve resilience and well-being, making additional supports warranted, including coping skills and resilience training interventions.