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The effects of hip position and posture on scapular kinematics have yet to be explored. The purpose of this study was to measure differences in scapular kinematics with changing hip position. Scapular kinematics were measured during scapular plane humeral elevation. Twenty-four subjects were required to elevate the dominant arm up to 120° in the following randomized conditions: standing, seated, seated ipsilateral hip flexion, and seated contralateral hip flexion. Two-way analyses of variance were used to evaluate effects of shoulder elevation and hip position on scapular upward rotation, posterior tilt (PT), and external rotation. For external rotation, there was no significant interaction (P = .714) and no main effect of elevation (P = .618) or condition (P = .390). For PT, there was no significant interaction (P = .693) but significant main effects of elevation (P < .001) and condition (P < .001), with the greatest PT in standing. For upward rotation, there was no significant interaction (P = .698), a significant main effect of elevation (P < .001), and no significant effect of condition (P = .726). The effect on PT may not be clinically significant. These results may serve as a baseline measurement of healthy scapular kinematics across hip positions.

Every state in the United States mandates concussion education annually or biennially for those involved in organized youth sports to improve awareness, knowledge, and attitudes toward concussions. The purpose of this study was to examine Texas high school and junior high school coaches’ knowledge of and attitudes toward concussions using the Rosenbaum Concussion Knowledge and Attitudes Survey—Coaches Version. Among all analyzed participants, the mean overall concussion knowledge index (Concussion Knowledge Index = 0–25) was 21 (SD = 1.79), while the overall concussion attitude index (Concussion Attitude Index  = 15–75) was 63 (SD = 5.69). No significant differences for knowledge or attitude were found between gender, coaching level, sport type, geographical location, or school size (all p > .10). Mandatory concussion education has resulted in high levels of knowledge about and favorable attitudes toward concussions in Texas junior high school and high school coaches, with similar findings to other research in this area.

Fine-wire electromyography (EMG) is a traditional laboratory technique to estimate muscle activity of the small foot muscles, however, recordings have not been reported from extensor hallucis brevis (EHB). As an extensor of the great toe, EHB is an important muscle when studying physiological changes associated with foot pathologies such as hallux valgus. The purpose of this study was to develop an ultrasound-guided fine-wire EMG protocol to record EHB muscle activity and report normative EMG profiles of healthy young adults during locomotion. Sixteen asymptomatic young adults completed 20 walking trials at a self-selected velocity. Ensemble averages were calculated from the time normalized linear envelopes and represented from 0% to 100% of the single stance phase of gait. EHB muscle bursts were observed between 0% and 20% of the stance phase of gait in all participants. A second burst of EMG was observed between 80% and 100% of stance in 50% of the participants. This study introduces a novel ultrasound-guided EMG protocol and normative data from EHB recordings suggest a synergistic role to anterior compartment musculature at contact. These results provide preliminary insights into understanding the functional role of EHB and may help elucidate the biomechanical factors exacerbating the progression of hallux pathologies.

Context: Chronic ankle instability (CAI) is associated with motor-behavioral and sensory-perceptual impairments, including reduced balance performance, hip strength, and ankle function, and increased disablement, and injury-related fear. Progressive balance training (BAL) and hip strengthening (HIP) can both improve balance and function, but their comparative effects are unknown. Our objective was to compare the effects of progressive BAL and HIP on balance, hip strength, and patient-reported outcomes in those with CAI. Methods: Forty-five individuals with CAI volunteered for this randomized control study. Participants were randomly allocated to BAL, HIP, and control (CON) groups (n = 15 per group). BAL and HIP each participated in 8-week interventions while CON did not. Participants’ involved limbs underwent testing of patient-reported outcomes (Foot and Ankle Ability Measure [FAAM-ADL, FAAM-S], modified Disablement in the Physically Active Scale [mDPA], Tampa Scale of Kinesiophobia-11 [TSK-11], Fear-Avoidance Beliefs Questionnaire [FABQ], and Self-Efficacy of Balance Scale [SEBS]), Star Excursion Balance Test (SEBT), and isometric hip strength (extension [EXT], abduction [ABD], and external rotation [ER]) before and after the intervention. Multiple imputation was used for missing data. Multivariate repeated-measures analyses of variance analyzed effects of the interventions. Results: A significant group × time interaction existed for psychosocial outcomes (P = .008), but not for balance (P = .159), strength (P = .492), or ankle function and disability (P = .128). Time main effects existed for balance (P = .003), strength (P < .001), function and disability (P < .001), and psychosocial outcomes (P = .006). BAL significantly improved in SEBT, EXT, ABD, and all patient-reported outcomes. HIP significantly improved in EXT, ABD, ER, FAAM-S, mDPA, FABQ, and SEBS. Conclusions: Balance training and hip strengthening can both improve motor-behavioral and sensory-perceptual impairments in individuals with CAI; however, balance training remains the most effective option for clinicians.

Low back pain is a leading cause of disability. Cupping can be effective for improving motion in those with back pain; however, little is known about its efficacy compared with other interventions. This study evaluated differences among cupping, stretching, and cupping with stretching on lumbar flexion, extension, and lateral flexion. Although the interventions increased lumbar spine motion, there was no significant difference between groups. Cupping with stretching appears to result in greater motion changes; however, the overall increases were small. Cupping does not appear to increase lumbar spine motion more than stretching or cupping combined with stretching. While cupping may improve low back pain through other means, it does not appear to significantly impact lumbar spine motion in asymptomatic individuals.

Non-time-loss ankle sprains often receive less care than time-loss (TL) ankle sprains, but the effect of TL on persistent impairments needs to be explored. Our purpose was to compare patient-reported outcomes between athletes with non-time-loss and TL ankle sprains at return to activity and 6-month postinjury. Participants with a non-time-loss ankle sprain had worse patient-reported outcome scores at return to activity and 6 months compared with TL ankle sprains despite having less severe injuries. Greater than 24 hr of activity restriction following an acute ankle sprain is likely beneficial to the recovery of perceived function and stability.

Context: Social support is an important consideration during athletes’ rehabilitation following a concussion. Yet, its influence during the return-to-sport (RTS) strategy has been underexplored. Design: Concussed athletes’ experiences with social support during RTS were explored prospectively using an explanatory sequential mixed methods design. Methods: University rugby, basketball, and track and field athletes (N = 8) from a single Canadian institution, 19–23 years of age (mean = 20.63, SD = 1.51), completed concentric circles maps, the Perceived Available Support in Sport Questionnaire, and 2 semistructured interviews during their RTS. We analyzed concentric circles maps and questionnaire data descriptively and interview data using codebook thematic analysis. Results: Athletes identified 16 different social support agents. The 5 most important agents during RTS were athletic therapists, student therapists, head coaches, significant others, and teammates/friends. Significant others provided the most emotional (mean = 2.82, SD = 1.85) and esteem (mean = 2.63, SD = 1.85) support, and the athletic therapist (mean = 1.82, SD = 1.35) and head coaches (mean = 0.93, SD = 1.19) provided the most informational and tangible support. We generated 4 themes from athletes’ interviews: social support behaviors, contextual factors, concussion and RTS factors, and psychological readiness factors. Conclusions: The number of social support agents present, frequency of support types, and demonstration of support behaviors decreased across the concussion RTS strategy. Contextual (ie, toughness), concussion (ie, visibility), and RTS (ie, prognosis uncertainty) factors influenced athletes’ perceptions of social support agents’ support behaviors. Results add to our limited understanding of athletes’ social support during RTS following a concussion and suggest exploring the integration of behavior-specific (eg, checking in, providing reassurance, and demonstrating compassion) social support strategies to promote concussion rehabilitation and readiness to RTS.

A 19-year-old collegiate female acrobatics and tumbling athlete presented with deep shooting pain in her right thigh during impact activities. Diagnostic imaging revealed a 12-mm enchondroma in her right proximal femoral metadiaphysis. After 10 days of rest, the patient began gradually increasing the intensity of impact skills and completed the remainder of the acrobatics and tumbling season. This is the first reported case of an enchondroma in the proximal femoral metadiaphysis in a young athlete. Athletic trainers must use clinical reasoning skills and interprofessional collaboration when managing atypical presentations to improve patient care and promote a positive recovery after injury.

Context: Social determinants of health including insurance type, income, race, and ethnicity have been shown to influence the utilization of physical therapy and recovery after an orthopedic injury. The influence of social determinants of health on the utilization of physical therapy and recovery from concussion is not well understood. Design: Prospective observational registry study in a specialty concussion program. Methods: Patients diagnosed with a concussion using the Postconcussion Symptom Inventory and the visio-vestibular examination (VVE) who were also referred to physical therapy were included. The main outcomes of interest were the number of days from referral to initial physical therapy evaluation and the number of physical therapy visits completed. Information related to patients’ age, race, ethnicity, sex, insurance type, and Child Opportunity Index was extracted from the registry. Multivariate and univariate regressions were used to assess the associations of each sociodemographic characteristic with the outcomes. Results: A total of 341 patients diagnosed with concussion between January 2017 and December 2023 met inclusion criteria. The average age was 14.77, and 64% were female. Patients’ age, race, ethnicity, insurance type, and Child Opportunity Index were not associated with days to evaluation or length of care in physical therapy. Higher PCSI scores in children under 12 years (coefficient: 0.17, 95% CI, 0.06–0.29) and female sex (coefficient: 1.2, 95% CI, 0.26–2.1) were associated with a longer course of care in physical therapy. Patients with an abnormal VVE score had on average 2.1 more physical therapy visits than those with a normal VVE score (coefficient: 2.1, 95% CI, 0.73–3.5). Conclusions: Higher PCSI scores in children, female sex, and higher VVE scores in general predicted a longer course of care in physical therapy. Implementation of a clinical care pathway for concussion care using the PCSI and the VVE may be one strategy to help mitigate systemic factors that might otherwise negatively influence access to physical therapy.

An overhead throwing motion is a common gross motor skill often taught in early childhood to improve physical activity participation. Yet, research investigating motor efficiency in overhead throws often focuses on improving performance in trained individuals. This project compares kinematic sequencing between trained and untrained youth. After a brief warm-up, untrained high school students (N = 9) and trained high school and college students (N = 10) threw a weighted tennis ball for accuracy (N = 10 throws). Upper extremity angular velocities were collected using 3-dimensional inertial sensor motion capture. Kinematic sequencing of joints and segments (pelvis, trunk, shoulder, elbow, and wrist) was assessed using Kruskal–Wallis test; Friedman and Wilcoxon tests identified group differences between sequences. Seven independent kinematic sequences were identified (N = 2 unique trained; N = 3 unique untrained; N = 2 shared). The rankings for the trained group maintained a mostly consistent pattern with only elbow and wrist joints producing similar rankings. The untrained group lacked that consistency with similar rankings of elbow versus wrist and shoulder versus elbow. Trained individuals threw with a more efficient proximal-to-distal sequencing pattern than the untrained participants, specifically at the trunk and shoulder. Continuous training of gross motor skills beyond initial skill development is necessary to maintain motor proficiency.