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Context: Triathlons are a popular endurance sport with an elevated injury risk. Prevalence for injuries in triathletes varies greatly and is thought to be related to racing distance. The most common injuries in triathletes occur in the lower-extremities and are considered overuse in nature. The primary purpose of this study was to examine injury patterns and prevalence among triathletes during the 2022 season. Design: This study adopts an epidemiological approach using a retrospective survey to better understand the prevalence, nature, and patterns of injuries among triathletes. Methods: A live online questionnaire was developed that collected information about demographics, triathlon racing, and injury epidemiology. The survey was posted to social media and emailed to large triathlon clubs and international federations at the beginning of 2023 and was left open for 75 days. Results: Two hundred nineteen triathletes reported at least 1 injury, with 58.5% classified as overuse. Eighty-one percent were reported as triathlon related. The most frequent area of injury was to the lower-extremity (73.8%). Triathletes sought advice from a health care provider 64.6% of the time. Eighty-seven percent of triathletes had to miss or modify training because of their injury. Those triathletes not reporting injury indicated that strength training (72.2%) and stretching/foam rolling (64.9%) were believed to help prevent injury. Conclusion: The risk of injury while training for a triathlon is significant and can be severe enough to require modifications to the training program. The most vulnerable area for injury is the lower-extremities, and such injuries are usually caused by overuse. To reduce the risk of injury, there is a need to examine preventive strategies further and determine their effectiveness.

Clinical Scenario: Anterior cruciate ligament (ACL) injury risk may increase when certain movements are noted during landings. Initial ACL injury produces poor long-term outcomes for patients. Movement assessments may help predict risk of initial ACL injuries. Clinical Question: Are movement assessments predictive of initial ACL injuries in college/high school athletes? Summary of Key Findings: Six articles met the inclusion criteria. Some movement assessments did not predict ACL injury. However, the functional movement screen composite score of 14 or less and landing error scoring system scores of 5 or greater were found to be associated with an increased risk of an ACL injury. Knee valgus angles of ≥6.5 cm were associated with future knee injury but only had fair predictive validity. Clinical Bottom Line: There are conflicting results on whether movement assessments can accurately predict primary ACL injuries. However, clinicians can consider the use of the functional movement screen composite score (14 or less) and the landing error scoring system score (5 or greater) as both may predict a future ACL injury. More research is needed to uncover movement assessments that better predict ACL injury. Strength of Recommendation: A grade B recommendation can be given that movement assessments may be used for screening for initial ACL injury.

Background: Compression socks are a popular feature for runners and are widely advertised by the industry. Limited high-quality evidence has summarized the effects of compression socks during running. We aimed to investigate the effects of wearing compression socks compared with placebo or regular socks during running on physiological parameters, running performance, and perceptual outcomes. Methods: The protocol was registered at PROSPERO (CRD42022330437). Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched. Clinical trials exploring the effect of compression socks during running on physiological parameters, performance, and perceptual outcomes were included. The Cochrane risk of bias 2 tool was used to assess the risk of bias. Results: We included 28 trials (600 runners), with 16 trials (284 runners) contributing to meta-analysis. For physiological outcomes (eg, heart rate mean difference [95% CI = 0.82 [−0.39 to 2.03] and blood lactate concentration mean difference [95% CI] = 0.30 [−0.39 to 0.98]), pooled analysis indicated low to moderate-certainty evidence that compression socks do not differ from regular socks. For running performance (eg, running speed mean difference [95% CI] = −0.24 [−0.79 to 0.31] and time to exhaustion standardized mean difference [95% CI] = −0.26 [−0.65 to 0.13]), pooled analysis indicated very low to low-certainty evidence that compression socks do not differ from regular socks. For perceptual outcomes (eg, perceived exertion standardized mean difference [95% CI] = 0.06 [−0.17 to 0.29] and lower limb muscle soreness standardized mean difference [95% CI] = 0.08 [−0.35 to 0.51]), pooled analysis indicated very low to moderate-certainty evidence that compression socks do not differ from regular socks. Conclusion: There is very low to moderate-certainty evidence that wearing compression socks during running does not benefit physiological, running performance, or perceptual outcomes compared with regular socks.

Context: Chronic ankle instability (CAI) is a common consequence of a lateral ankle sprain. Sex differences in functional outcomes exist, but there is a lack of female-specific intervention studies. Hop stabilization training is effective in male athletes with CAI but has not been investigated in female athletes. Therefore, the purpose of this investigation was to describe the effect of hop stabilization exercises on functional movement patterns and patient-reported outcomes in female athletes with CAI. We also compared the current effect sizes with those observed in an all-male cohort following an identical intervention. Design: Randomized controlled trial. Methods: Fourteen female CAI participants completed hop stabilization training (age = 25.29 [5.86] y), and 14 female CAI participants were in the control group (age = 24.73 [6.97] y). Inclusion criteria were consistent with the International Ankle Consortium recommendations. The hop stabilization program consisted of three 20-minute sessions per week for 6 weeks. Sessions consisted of increasing foot-to-ground contacts each week until a taper in the final week. Exercise difficulty was also modified throughout the program. Functional movement patterns via the Functional Movement Screen and Fusionetics Scores, dorsiflexion range of motion, and select region-specific patient-reported outcomes were captured. Results: The hop training group (pre: 12.68 [1.32] cm, post: 13.42 [1.35] cm) had a significant improvement (P< .001) in dorsiflexion range of motion relative to the control group (pre: 13.62 [1.22] cm, post: 13.68 [1.16] cm). Hop training also significantly improved (P,<0.01) functional movement patterns and all patient-reported outcomes. Relative to an all-male cohort who previously underwent the same hop stabilization program, the current female cohort demonstrated larger effect sizes, but all 95% CIs overlapped. Conclusions: A 6-week hop training program significantly improves patient-reported outcomes, dorsiflexion range of motion, and functional movement patterns in female athletes with CAI .

Context: Those with chronic ankle instability (CAI) rely more on visual information to maintain postural control. Plantar massage and ankle joint mobilization are moderately successful at improving CAI-associated postural control impairments. Manual therapies may have a larger influence on the underlying sensory strategy used to maintain postural control, but their effect on these strategies remains unknown. Objective: To evaluate the effects of separate 2-week plantar massage and ankle joint mobilization interventions on estimates of visual reliance during single-limb stance in those with CAI and determine whether changes in visual reliance estimates were driven by concurrent changes in peripheral- or spinal-level sensorimotor function. Design: Randomized controlled clinical trial. Setting: Research laboratory. Patients: Sixty participants with CAI. Interventions: Participants were equally randomized into plantar massage, ankle joint mobilization, and control (no intervention) groups. The manual therapy groups received six 5-minute treatments of their respective interventions over a 2-week period. Main Outcome Measure: A percentage modulation outcome quantified an individual’s reliance on visual information by estimating the weight given to visual information during eyes-open stance based on the magnitude of postural instability that occurs with vision removed. Secondary measures included joint position sense, plantar light-touch thresholds, and the H-reflex. Outcomes were captured before (baseline), immediately after (post), and 1-month (follow-up) after the 2-week intervention. Results: Plantar massage resulted in significant percentage modulation changes in sagittal (P ≤ .046) but not frontal plane outcomes (P ≥ .069) relative to the control group. Joint mobilization did not alter percentage modulation changes (P ≥ .413). Significant correlations between percentage modulation changes and peripheral sensorimotor function were noted primarily at the 1-month follow-up. Conclusions: A 2-week plantar massage but not an ankle joint mobilization intervention alters sagittal plane percentage modulation values during single-limb stance in those with CAI. These changes may be driven by changes in peripheral sensorimotor function.

Background: To investigate how physiotherapists approach lateral ankle sprain (LAS) rehabilitation and their rationale for exercise progression. We also sought to determine typical exercise dosage prescribed and the extent to which they rely on objective outcomes for guiding rehabilitation progression and return-to-sports decisions. Methods: We distributed an online survey using Qualtrics. The survey comprised a combination of 23 open and 8 closed questions to capture data on: participant demographics and clinical experience, typical caseload, LAS rehabilitation dosage, with clinical vignettes used to determine the time taken to reach key rehabilitation milestones, use of objective markers to inform rehabilitation progress, and progression to each milestone. Data were analyzed descriptively; open questions were inventoried and categorized. Proportions were then calculated per category. Results: Ninety-six physiotherapists from Belgium, the Netherlands, and the United Kingdom responded to the survey, of which 23 completed all sections. On average, less than half (46%) of the responding therapists use objective measurements to guide rehabilitation progress. The estimated time to reach key clinical milestones is equivocal among participating physiotherapists. Most physiotherapists use pain and ankle impairments (eg, range of motion and muscle strength) to guide rehabilitation progress. Conclusion: This study indicates that progress in LAS rehabilitation is determined subjectively and that not the entire spectrum of impairments is assessed. Physiotherapists should implement more objective measures throughout LAS rehabilitation.

Context: Musculoskeletal ultrasound imaging is a valid and reliable tool to measure muscle morphology, but minimal research explores its utility in assessing acute morphology changes after exercise in active populations. The purpose of this study was to assess changes in ultrasound-based measures of muscle thickness (MT) and quality (MQ) in response to a single bout of short-duration, high-intensity bodyweight exercise in the acute and postacute recovery timeframe. Design: Interventional study. Methods: Nineteen healthy, recreationally active young men and women (27.1 [8.3] y) completed a dynamic bodyweight exercise circuit primarily focused on the lower body. B-mode ultrasound images were obtained of the rectus femoris in resting and contracted conditions preexercise, ∼15 minutes, and 24 hours postexercise. Knee-extensor strength and MQ (muscle strength [in newtons]/resting MT [in centimeters]) were also assessed at the same timepoints. Results: Resting and contracted MT increased (13.0%; 6.9%) from pre- to 15 minute postexercise, returning to baseline at 24 hours postexercise. Δ MT decreased (−24.5%) from pre- to 15 minutes postexercise and was not different from either 15 minutes postexercise or baseline by the 24-hour timepoint. Knee extension strength and MQ decreased (−15.6%; 24.2%) from pre- to 15 minutes postexercise and remained below baseline at 24 hours postexercise. Conclusion: MT measures alone suggested faster recovery from an exercise circuit than knee-extensor strength or MQ, though the combined metric of MQ may be useful for longitudinal monitoring of muscle recovery timelines in rehabilitation programs.

Context: To cross-cultural translate the Cumberland Ankle Instability Tool (CAIT) to Turkish version (CAIT-T) and to evaluate the validity, reliability, and cutoff score of CAIT-T for Turkish athletic population. Design: The English version of CAIT was translated to CAIT-T based on a guideline of cross-cultural adaptation. Fifty-two athletes with chronic ankle instability and 63 athletes without chronic ankle instability were included in the study. Construct validity was evaluated with correlations between the CAIT-T, Turkish version of Foot Ankle Ability Measure (FAAM-T), and Numeric Rating Scale. CAIT-T was completed twice by each participant at 7 to 10 days intervals to assess test–retest reliability based on the intraclass correlation coefficient, whereas Cronbach alpha evaluated internal consistency. Discriminative validity and content validity of the CAIT-T also evaluated. Results: In construct validity, strong positive correlation was found between CAIT-T and Numeric Rating Scale perceived ankle instability (rho = −.771, P < .001), as well as moderate negative correlations with FAAM-T-activities of daily living and FAAM-T-sports (rho = −.448, P < .001 and rho = −0.541, P < .001, respectively). The CAIT-T demonstrated strong test–retest reliability (intraclass correlation coefficient score of .98) with a good internal consistency (Cronbach α: .85). Receiver operating characteristic curve showed a cutoff score of 26.5 (Youden index: 0.78, sensitivity: 0.57, specificity: 0.90.5). No ceiling or floor effects were observed. Conclusions: CAIT-T is a valid and reliable questionnaire for the assessment of chronic ankle instability in the Turkish athletic population.

Clinical Scenario: Sacroiliac joint dysfunction (SIJD) is pain in the sacroiliac region that can be debilitating and difficult to treat. Many interventions can be used to treat SIJD, including exercise and manual manipulation. The effectiveness of these treatments by themselves, or in conjunction, is not well understood. Clinical Question: In active individuals with SIJD, is an exercise intervention, manual manipulation, or a combination of the 2 effective in reducing pain and improving function? Summary of Key Findings: Three studies were included in this critically appraised topic. One study found that both exercise therapy and manipulation therapy decreased pain and improved function, but found no between-group differences. The other 2 studies found that exercise therapy, manipulation therapy, and the combination of the 2 were effective in decreasing pain and improving function in the participants. Clinical Bottom Line: The results of the studies suggested that exercise therapy, manual therapy, and a combination of the 2 therapies can be effective in reducing pain and dysfunction in patients with SIJD. While manual therapy techniques alone may be effective in reducing SIJD pain short term, exercise therapy or a combination of the 2 may be more effective in reducing pain long term. Strength of Recommendation: There appears to be level B evidence supporting the use of exercise therapy, manual therapy, or a combination of the 2 for the treatment of SIJD. This recommendation is based on the inconsistent or limited quality patient-oriented evidence presented in the 3 included studies, as defined by the Strength of Recommendation Taxonomy.

Context: The Balance Error Scoring System (BESS) is the most commonly used balance test during concussion assessment; however, the test has known limitations related to fatigue. Jumping and landing along with running are common athletic activities that adversely affect postural control. However, the effect of neither subexertional running nor jumping and landing tasks on the BESS is known. Therefore, the purpose of this study was to investigate the effects of a brief exercise bout of running or jumping on BESS performance. Design: We recruited 52 recreationally active participants who were divided into 3 groups: (1) Drop Jump (Landing), Treadmill Running (Run), and Control. Methods: All participants performed a preintervention BESS test and were then randomly assigned to a group. The jumping group performed 10 drop jumps from a 50 cm box, 30 seconds between trials, the running group performed a 3-minute treadmill run, and the control group sat quietly for 5 minutes. All participants then completed a second BESS test. The primary analysis was a 2 (time) by 3 (group) repeated-measure analysis of variance with sex as a covariate. Results: There was a significant interaction (F = 7.396, P = .002). On post hoc, there was a significant improvement (lower) score in the Control group (PRE: 13.9 [4.5]; POST: 10.5 [2.9]; P = .019, d = 0.89) but no significant differences in either the running (P = .579) or landing (P = .849) groups. Conclusions: A relatively brief exercise intervention resulted in participants failing to improve a subsequent BESS assessment, whereas control participants who rested for 5 minutes committed fewer (3.4) errors. These results suggest that sports health care providers should recognize that even low- to moderate-intensity brief exercise can result in a failure to improve with repeat BESS administration.