Context: Intermittent floor trunk extensions are popular exercises in group fitness programs. The aim of this study was to investigate whether fewer repetitions of longer isometric trunk extension efforts compared with more repetitions of shorter isometric contractions have different acute effects on muscle thickness and activation as well as perceived exertion. Design: This study followed a cross-sectional design. Methods: Twenty healthy young males performed floor prone trunk extension exercises using 3 different exercise protocols of repetition and duration: 10 × 5 seconds (D10 × 5), 2 × 25 seconds (D2 × 25), and 5 × 10 seconds (D5 × 10). Ultrasound multifidus thickness and rate of perceived exertion on a 10-point scale were measured immediately after each protocol. Electromyographic activation from the erector spinae, multifidus, and gluteus maximum during each protocol was measured using bipolar surface electrodes. Results: The longer duration (D2 × 25) protocol showed a significant greater rate of perceived exertion (6.22 [0.73]) and rest multifidus thickness change (median: 8.04%) compared with the other protocols (P < .05). Within each protocol, root mean square of all muscles increased from trial to trial in the D2 × 25 and D5 × 10 (P < .05), but not during the D10 × 5 protocol (P > .05). The maximum root mean square was achieved in the shorter duration (D10 × 5) protocol compared with the other ones (P < .05). Conclusion: If trunk extension exercises on the floor are used in a training setting, then using exercises with long duration and fewer repetitions may elicit a greater metabolic response.
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The Effects of Floor Isometric Trunk Extension Exercise on Muscle Thickness and Activation Vary Between Different Combinations of Duration and Repetition Number
Eleftherios Kellis, Athanasios Konstantopoulos, and Athanasios Ellinoudis
Gaze Stability Test Asymmetry Before and After Individualized Rehabilitation in Youth Athletes With Concussion
Amy Alexander, Rachel Sweenie, Bradley Meacham, and Jamie Pardini
Context: Concussion causes physiological disruptions, including disruptions to the vestibular and visual systems, which can cause dizziness, imbalance, and blurry vision. The vestibular ocular reflex functions to maintain a stable visual field, which can be measured using the gaze stability test (GST). Design: This preliminary study used retrospective chart review to examine changes in GST performance and asymmetry in a sample of 117 youth athletes with concussion (mean age = 14.51, SD = 2.08) before (T1) and after (T2) they completed a vestibular therapy program that included in-office treatment by a vestibular physical therapist and a customized home exercise program. Examples of exercises that may be assigned in the home exercise program during vestibular therapy are provided. Methods: After examining descriptive information, changes in GST scores and asymmetry percentage between time points were compared via Wilcoxon signed-rank tests. Results were also compared descriptively with previously published findings. Results: Results revealed significant improvements in median GST in leftward and rightward direction head movements from T1 to T2 and a significant reduction in GST asymmetry (P < .001). Both GST in leftward and rightward direction head movements improved from 145.00 to 210.00°/s, which is above the 50th percentile in previously published literature with uninjured athletes. Asymmetry decreased from an average of 10.07% (SD = 7.89) to 4.11% (SD = 3.88), which is lower than in previously published literature. Conclusions: Concussion produces symptoms that vary among individuals and between injuries. GST velocity and asymmetry values provide objective data about an athlete’s impairment and progress in recovery within the vestibular domain. This can aid in making clinical decisions on return to play progression and promote a successful and safe return to sport.
Performance on the Concussion Balance Test Is Indicative of Time to Recovery in Athletes Following Sports-Related Concussion: An Exploratory Analysis
Carolina P. Quintana, Shelly Massingale, Nicholas R. Heebner, Jamie Pardini, Tamara C. Valovich-McLeod, Anne D. Olson, Arnold Stromberg, and Matthew C. Hoch
Objective: Sports-related concussions (SRCs) are commonly occurring injuries among athletic and recreationally active populations. SRCs can result in vestibular dysfunction that should resolve before returning to activity. It has been suggested that vestibular impairment is a factor that may influence recovery time. The objective of this study was to evaluate the effect of vestibular function on recovery following SRC. Design: Retrospective chart review. Setting: Multidisciplinary Concussion Clinic. Intervention: A total of 32 patient charts (21 males, 15.34 [1.47] y, 171.29 [8.44] cm, 68.37 [15.47] kg) from patients diagnosed with SRC presenting to a concussion clinic between August of 2016 and July 2017 with clinician-identified vestibular involvement were included. Main Outcome Measures: Scores on the Post-Concussion Symptom Scale, Dynamic Visual Acuity Test, Gaze Stabilization Test, Concussion Balance Test (COBALT), and other clinical data were used for analysis. Descriptive statistics were calculated for all variables. Pearson correlations were used to identify variables related to time to recovery. Variables were entered into a forward linear regression model. Results: Moderate to good relationships were identified between days to recovery and Dynamic Visual Acuity Test lines lost in the leftward direction (1.17 [0.52]; r = .39, P = .04), COBALT-condition 8 sway velocity (1.20 [0.18]; r = .44, P = .01), and days to successful completion of the COBALT (14.72 [8.35]; r = .63, P < .001). Patients’ predicted time to recover was equal to 14.61 (0.86) (days to successful COBALT). The model was significant (P < .001, R 2 = .30). Conclusion: The single predictor of time to recover was the number of days to successful completion of the COBALT. Thus, the ability to complete the task may be more informative than the performance on the task in predicting recovery time.
A Qualitative Longitudinal Exploration of Interactions Between Female Athletes and Sport Medicine Staff During Injury Rehabilitation
Kirsten Hutt and Katherine A. Tamminen
Context: Sport injury is a prevalent setback experienced by athletes, wherein they are required to spend time in rehabilitation and interact with sport medicine staff. Sport medicine staff are a frequent line of contact line of contact for athletes at this time and represent an important part of their support network. There is little exploration surrounding the interactions that female athletes have with sport medicine staff during injury rehabilitation and how these interactions may impact the rehabilitation process. The purpose of this research is to explore the experiences of injured female athletes and their interactions with sport medicine staff during injury rehabilitation. Design: Qualitative study using semistructured qualitative interviews and audio diaries. Interpretive descriptive methodology. Methods: A total of 11 injured female varsity athletes who had sustained a musculoskeletal injury within 2 to 4 weeks of being recruited participated. A total of 6 upper body injuries and 5 lower body injuries are represented. Athletes completed 2 semistructured interviews and weekly audio diary entries across 6 weeks. Data were analyzed using reflexive thematic analysis. Results: Results demonstrated that female athletes felt supported by sport medicine staff when provided with clear information about rehabilitation, when they perceived sport medicine staff as competent, and when sport medicine staff made a personal connection. An overarching theme of mattering was identified as underpinning the athletes’ experiences of feeling supported by sport medicine staff during rehabilitation. Conclusions: When sport medicine staff made female athletes feel that they mattered, they were perceived as more supportive during rehabilitation. Sport medicine staff can help athletes to feel that they matter by engaging in supportive behaviors during the rehabilitation process.
Resting Metabolic Rate and Recovery From Sport-Related Concussion: A Critically Appraised Topic
J. Matthew Nerrie and Tamara C. Valovich McLeod
Clinical Scenario: Critical appraisal of whole-body metabolism as a measure of concussion recovery is lacking in the available evidence. There has been extensive exploration of options for a gold standard assessment for concussion, including blood biomarkers, electroencephalogram, and neuroimaging, but none have yet to demonstrate good empirical evidence of efficacy. Clinical Question: In patients with sport-related concussion (SRC), can resting metabolic rate (RMR), as measured through indirect calorimetry, be used as a physiologic assessment of recovery? Summary of Key Findings: Three studies demonstrated relevance to the clinical question. Of the selected studies, 2 studies were case–control, and 1 was a case series. All studies observed reduced total energy expenditure and increased energy balance when initially assessed between 24 and 72 hours after injury. Clinical Bottom Line: Evidence exists to suggest that RMR as measured with indirect calorimetry is a poor indicator of SRC recovery. All 3 articles found that RMR was not affected by SRC, even when compared with healthy controls. One article did observe a between sex difference in RMR, but a very small sample size was included in the case series. Strength of Recommendation: The findings of this critically appraised topic suggest a strength of recommendation of grade B, demonstrating that RMR is a poor indicator of recovery from SRC.
Test–Retest Reliability and Reliable Change Estimates for Sensorimotor Concussion Assessments in Healthy Young Adults
Gregory C. Edwards, Alex E. Bruggeman, Nick Fogt, James A. Onate, Rebecca A. Bliss, Catherine C. Quatman-Yates, and Jaclyn B. Caccese
Context: Sensorimotor impairments are common sequela following concussion, but recovery following a concussion is often determined through examiner scored clinical testing. There are emerging technologies that provide objective methods to determine physiological impairment after concussion, but the psychometrics of these tools are lacking and must be established for use in clinical practice. Objective: The purpose of this study was to examine the test–retest reliability and provide reliable change estimates in healthy young adults for outcomes from 3 emerging technologies providing objective assessments of sensorimotor function in healthy young adults. Design: Test–retest reliability design in a laboratory setting. Methods: Healthy, young adults completed testing at 2 time points 4 weeks apart on the Bertec Vision Trainer, the Concussion Balance Test (COBALT), and the Neurolign Dx-100 eye-tracking system. We determined test–retest reliability using intraclass correlation coefficients with a 2-way mixed-effects model absolute agreement. Reliable change estimates were calculated for 70%, 80%, 90%, and 95% CIs. Results: Participants included 30 healthy young adults (age = 25 [5] y, interquartile range = 20–29; range = 18–38; 17% [57%] women). Test–retest reliability for the Bertec Vision Trainer outcomes ranged from 0.56 to 0.88, with 45% of the outcomes being classified as clinically acceptable (>.70 intraclass correlation coefficients ); for COBALT conditions, sway velocity ranged from 0.50 to 0.95, 95% ellipse area ranged from −0.22 to 0.88, and Sway Score ranged from 0.07 to 0.85, with 50% of COBALT metrics being clinically acceptable; and for the Dx-100, outcomes ranged from −0.20 to 0.89, with 52% being clinically acceptable. Conclusions: Overall, test–retest reliability was moderate-to-good for the Bertec Vision Trainer assessment outcomes but were highly variable for outcomes of postural control using the COBALT and eye-tracking metrics using the Dx-100. This study adds clinically relevant test–retest reliability and reliable change estimates in healthy adults for 3 commercially available sensorimotor assessments.
Validity of Lower-Extremity Strength Between Push- and Pull-Based Handheld Dynamometers: A Technical Report
Neal R. Glaviano, Emma F. Zuk, Lauren Sheldon, Michael DiStefano, and Laurie Devaney
Context: Handheld dynamometers provide clinicians an objective measure of lower-extremity force production at the hip and knee. While push-based dynamometers are common in clinical practice, they can be associated with patient discomfort, and standardization of methods is challenging when patient forces can exceed the ability of the rater. Development of novel, pull-based dynamometers allow for better patient comfort, but validity between dynamometers must be established before integration into clinical practice. Therefore, the purpose of this study was to compare measurement of lower-extremity force between push- and pull-based handheld dynamometers. Design: Descriptive laboratory study. Methods: Twenty-one healthy triathletes performed isometric hip abduction, hip external rotation, and knee extension testing against 2 separate handheld dynamometers. Pearson product correlations were calculated for the relationship between devices, while Bland–Altman plots were used to measure agreement with limit of agreement to assess systematic bias. Results: Correlations between devices were strong for hip abduction and knee extension (r = .743–.767, P < .001) and moderate for hip external rotation (r = .429, P = .052). Additionally, there was good agreement between the 2 devices, with acceptable limits of agreement across the 3 force tasks. The pull-based dynamometer resulted in greater torque values for knee-extension and hip external rotation, with a mean difference of −0.37 and −0.19 N·m/kg, but there was no difference in hip abduction with a mean difference of 0.03 N·m/kg. Conclusion: The results demonstrate that pull-based dynamometers are an acceptable alternative to push-based dynamometers for hip abduction and knee extension, but some caution may exist for hip external rotation. Clinicians should be aware of differences in lower-extremity force across multiple handheld dynamometers when assessing muscle function in practice.
A Dynamic Warm-Up Improves Titleist Performance Institute Screen Scores in Adult Golfers
Andrew Skibski, Pradeep Vanguri, Jeffrey R. Stout, Christopher D. Ingersoll, and L. Colby Mangum
Context: Guidelines for various movement assessments often instruct clinicians to conduct testing without a warm-up. Warm-ups are commonly performed to increase heart rate, decrease stiffness, and prepare for sport-specific demands. Since athletes typically complete a warm-up prior to sport participation, evaluating biomechanics in this condition may provide a better indication of their bodies’ physical capabilities. The primary purpose of this study was to compare scores on the Titleist Performance Institute (TPI) screen before and after a dynamic warm-up in adult golfers. Design: Twenty-four adult golfers (19 male/5 female, age 44.0 [15.4] y, height 171.3 [8.6] cm, weight 82.5 [16.3] kg, average 18-hole score 90.7 [10.3] strokes) completed a single-session crossover laboratory study. Methods: Participants completed the TPI screen, which included 15 simple tests scored based on their ability to properly complete the movement. Following a rest and washout period, participants performed a brief dynamic warm-up including exercises for the extremities and trunk, followed by 30 seconds of practice golf swings. Participants immediately retested the TPI screen, following the same procedures. Composite and individual test scores were compared before and after the warm-up with Wilcoxon signed-rank tests and r effect sizes at a significance of P ≤ .05. Results: TPI composite scores were significantly higher following the warm-up (median: 36, interquartile range 31/40) than before the warm-up (median: 33, interquartile range 28/36) (P < .001), with a large effect size (r = .81). Conclusions: Our findings suggest a warm-up leads to higher scores on the TPI screen, and that an athlete’s warm-up condition should be considered when interpreting their performance.
Early Surgical Treatment of Posttraumatic Myositis Ossificans of the Vastus Intermedius Muscle
Pave Kalebić, Silvije Šegulja, Bojan Miletić, Hrvoje Vlahović, and Gordana Starčević-Klasan
Context: This case study demonstrates the effectiveness of early surgical excision of the traumatic myositis ossificans of the vastus intermedius muscle in an elite football player and return to sports activity within 3 months from the initial injury. Case presentation: A 27-year-old male professional football player presented with progressive pain and loss of range of motion after sustaining a severe, right quadriceps contusion 4 weeks earlier. After unsuccessful conservative therapy, the differential diagnosis of myositis ossificans was suspected and confirmed on radiographic examination. MRI revealed significant edema encompassing a substantial portion of the vastus intermedius muscle. Management and outcomes: Surgical treatment was considered for the right thigh mass, being symptomatic 1 month after the onset and refractory to conservative treatment and rehabilitation program. At 2 months postsurgery, the patient was asymptomatic and had completed a rehabilitation program. Conclusion: Early surgical treatment followed-up with a rehabilitation program results with a complete recovery of muscle strength and range of motion. At 3 months postinitial injury, the patient was considered fully recovered and had returned to the match without reporting pain or other symptoms.
Return to Sport After Partum in Patients With Diastasis of the Rectus Abdominis Muscles: Ultrasound Evaluation and Rehabilitation Protocol
Fabio Vita, Danilo Donati, Vincenza Amouso, Salvatore Massimo Stella, Marta Fantini, Roberto Tedeschi, Marco Miceli, Stefano Galletti, and Cesare Faldini
Background: Diastasis rectus abdominis is a condition in which the rectus abdominis muscles separate and move laterally, causing stretching of the linea alba tissue with weakness of the abdominal wall. Although it can lead to hernia of the abdominal viscera, diastasis rectus abdominis is not a hernia in itself. This condition is common among women during pregnancy and the postpartum period and can significantly affect their quality of life and their return to sports activity. Unfortunately, information on the incidence, risk factors, prevention, and treatment of diastasis rectus abdominis are limited. Methods: We conducted a pilot prospective observational study on 37 patients who practiced sports at high levels (at least 3 times a week with amateur/competitive competitions) who underwent ultrasound measurements of the distance between the rectus abdominis muscles at the level of the xiphoid process, supraumbilical, umbilical, and subumbilical at time (T0), after 2 months from the rehabilitation protocol (T1), and then after 4 months of rehabilitation protocol (T2) from approximately 3 months after giving birth, and we saw an early return to sport. Results: Our data analysis reveals that there is an initial decrease in diastasis during the first 2 months with 3 weekly physiotherapy activity sessions in all 4 measurements. One session takes place on site with physiotherapists, while the other 2 are carried out at home using the rehabilitation protocol provided by the medical staff. At the 4-month follow-up, the improvement was similar to the previous follow-up. Conclusion: Of the 37 women analyzed, 6 were referred to the surgeon; 2 for hernias and 4 for diastases greater than 4 cm. The remaining women benefited from a conservative approach. Patients undergoing the rehabilitation protocol showed improvements in all 4 measures, as well as their early return to sport.