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Context: The evaluation of quadriceps muscle inhibition with the interpolated twitch technique is usually performed by stimulating the femoral nerve (FN). However, there are some problems related to the use of this stimulation site, which may be partially overcome by delivering the stimulation over the motor point (MP). This study sought to compare MP to FN stimulation at different joint angles for the evaluation of quadriceps muscle inhibition, resting peak torque, and discomfort in healthy women. Design: Cross-sectional study. Methods: Sixteen healthy women (age: 28 [4] y; body mass: 60 [5] kg; height: 162 [5] cm) participated in this study. Supramaximal paired stimuli were delivered to the FN and to the rectus femoris MP before and during maximal voluntary contractions at different knee angles (15°, 30°, 45°, 60°, and 90° of knee flexion) to assess muscle inhibition and resting peak torque. Discomfort was also recorded for each stimulation site and knee angle. Results: Muscle inhibition was similar between the 2 stimulation sites (P > .05) and was higher at 45° than at 90° (P = .03). MP stimulation evoked lower resting peak torque at 30° (P = .004), 60° (P = .006), and 90° (P = .006) and higher discomfort at 30° (P = .008) and 90° (P = .027) compared to FN stimulation. Conclusions: Despite lower resting peak torque and higher discomfort at some angles, MP stimulation provided similar muscle inhibition to FN stimulation at all knee angles and is therefore a valid method to evaluate quadriceps muscle inhibition in healthy women. MP stimulation can be used as an alternative to FN stimulation for the evaluation of quadriceps muscle inhibition with no added discomfort at the angles where muscle inhibition is the highest.

Balance training paradigms have been shown to effectively reduce fall risk. Visual feedback is an important sensory mechanism for regulating postural control, promoting visual perturbations for balance training paradigms. Stroboscopic goggles, which oscillate from transparent to opaque, are a form of visual perturbation, but their effect on standing balance has not been assessed. In this study, 29 participants stood in bilateral and tandem stances as the center of pressure was recorded for 6 consecutive minutes wherein there were no stroboscopic perturbations in the first and last minutes. Spatial–temporal, frequency domain, and nonlinear standing balance parameters were calculated for each period. More differences in spatial–temporal parameters due to the strobe were found in the medial–lateral direction than the anterior–posterior direction. More differences in frequency domain parameters were observed in the anterior–posterior direction than the medial–lateral direction, but this did not occur for each variable. The nonlinear parameters were strongly affected by the strobe. Stroboscopic perturbations did not affect the bilateral and tandem stances equally. Spatial–temporal parameters for the tandem stance were greater in magnitude during the strobe period than the no strobe periods. This effect was not seen with the bilateral stance. This indicates that the efficacy of stroboscopic perturbations for challenging standing balance depends on task difficulty. Balance training paradigms that utilize stroboscopic perturbations will need to harmonize these perturbations with task difficulty.

Context: Athletes who do not follow proper concussion recovery protocols are likely to experience their symptoms for longer while putting themselves at risk of further health issues. It is, therefore, critical to identify the types of athletes who may be more or less likely to follow the guidance of medical professionals following concussions. In this research, we tested the hypothesis that athletes with higher levels of self-compassion would be more willing to follow concussion recovery protocols. Design: Cross-sectional study. Methods: We collected data from 2 samples of combat sport athletes (sample 1, N = 173 and sample 2, N = 172). All participants completed online surveys assessing self-compassion, the likelihood that they would follow 10 recovery recommendations if they were to experience a concussion in their sport, and scales assessing 3 covariates: self-esteem, conscientiousness, and sport competitiveness. Results: After controlling for self-esteem, conscientiousness, and sport competitiveness, the results of multiple regression analyses in both samples showed that self-compassion was positively associated with willingness to follow concussion recovery recommendations (sample 1: β = 0.19, 1-tailed P = .039; sample 2: β = 0.20, 1-tailed P = .025). The results of a mini meta-analysis of these effects supported this positive association, Mean r = .144, Z = 2.666, 1-tailed P = .004. Conclusions: Athletes who are highly self-compassionate reported a greater willingness to follow the advice of medical professionals and adhere to return-to-play protocol. This finding has implications for the rehabilitation of sport concussions; it may be advantageous to encourage athletes to be kind and compassionate toward themselves throughout the concussion recovery process.

The stiffness of the supporting leg may alter the energy transfer to the trunk and lower extremities of the kicking leg, which may affect kick performance. This study aimed to clarify whether the stiffness of the supporting leg affects the trunk kinematics during kicking and kicking performance in soccer players. Twenty-two male collegiate soccer players participated in the study. The data for the stiffness properties of the supporting leg and trunk kinematics were obtained and calculated using a 3-dimensional motion analysis system. The results showed that a greater leg stiffness of the supporting leg was associated with a lower trunk rotation angle during kicking. There were no significant correlations between the maximum swing speed and the stiffness of the supporting leg (P < .05). These results suggest that stiffness of the supporting leg may restrain trunk rotation during the kicking motion. However, the lack of a relationship with swing speed indicates the need for further investigation into its effects on kicking performance.

Context: Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. Case Presentation: A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. Management and Outcome: After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the first surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. Conclusion: Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research.

Objective: To culturally adapt and validate the Italian version of the Shoulder Instability—Return to Sport after Injury (SI-RSI-I) scale. Methods: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament—Return to Sport Index—Italian version and replacing the term “knee” with “shoulder.” Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test–retest reliability, measurement error, and construct validity. Results: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α = .935), and excellent test–retest reliability (ICC = .926; 95% CI, .853–.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. Conclusion: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI.

This study investigated the effects of two physical exercise programs for adults with intellectual and developmental disabilities. Twenty-one participants were assigned to an indoor group (IG, n = 7; 24-week gym intervention with machine), an outdoor group (OG, n = 7; 24-week outdoor intervention with low-cost materials) or a control group. The outcomes assessed included quality of life, dementia, and functional capacity. The IG significantly improved physical well-being compared with the control group (p = .017). There were no significant differences in dementia score between groups and moments. Postintervention, the IG showed improvements compared with the control group for the 30-s sit-to-stand test (p = .03), timed up-and-go (p = .00), and 6-min-walk test (p = .033) and between moments in the IG for 30-s sit-to-stand test (pre ≠ post; p = .007) and 6-min-walk test (pre ≠ post; p = .007). Outdoor interventions appeared effective for physical well-being, while indoor interventions using weight-training machines benefited functional capacity. No significant effects were observed for dementia/cognitive decline.

Context: Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. Design: Scoping review. Methods: A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. Results: Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. Conclusion: This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.

Context: Proprioceptive neuromuscular facilitation stretching (PNFS) is suggested to improve the range of motion and flexibility as an active warm-up. Recently, the foam rolling (FR) methods have also emerged as a passive warm-up. However, the combined effects of PNFS and FR are still unclear, and no reports have compared their effects using thermal imaging. This study investigated the acute effects of combining nonvibration FR (NVFR) and vibration FR (VFR) prior to PNFS, in comparison with PNFS alone, on hamstring flexibility and thigh skin temperature. Design: Randomized controlled trial. Methods: Participants (n = 60) were randomly assigned to PNFS, NVFR + PNFS, VFR + PNFS, and control group (CG). Active knee-extension (AKE), sit and reach (SR) test, and thermal imaging were evaluated before (pre-int), immediately after (post-int), and 30-minutes after (post₃₀-int) intervention. Results: All intervention groups had a significant increase at all time periods (P < .001) except the CG in terms of AKE and sit and reach test (P > .05). Combined (NVFR + PNFS/VFR + PNFS) groups had also a significant increase in the post₃₀-int compared with pre-int and post-int values of thigh skin temperature (P < .001). Combined groups, over time, had the best post₃₀-int effect on increasing skin temperature. The study found a significant interaction effect between interventions and time across several measurements (P < .05). Combined groups showed more significant improvements in AKE compared to CG at post-int (P < .05). There is a similar change in AKE, SR test, and skin temperatures between combined groups and PNFS alone at both post-int and post₃₀-int (P < .05). Conclusions: These findings indicate that using FR, with or without vibration, before PNFS does not provide an additional benefit in improving hamstring flexibility and thigh skin temperatures compared with PNFS alone.

Context: General screening methods for athletes are limited. This study aims to analyze the reliability and validity of the Japanese version of the athlete sleep screening questionnaire. Methods: In total, 111 female collegiate athletes completed the initial test and retest. The independent variables included the kind of sports of the participants and their athletic level, grade (freshman, sophomore, junior, and senior), and age. The reliability of the questionnaire was assessed using Cronbach’s alpha and intraclass correlation coefficients. Athletes competing in team sports and individual sports were compared to evaluate for differences. Results: A total of 38.7% of athletes had moderate to severe sleep difficulty score. Their Cronbach’s alpha for test and retest were .34 and .44, respectively. The intraclass correlation coefficient indicated sufficient internal consistency and test–retest validity. The mean sleep difficulty scores were 7.0 (2.3) and 6.5 (2.1) for test and retest, but no significant difference was observed between the individual and team sport athletes. Results of multivariable regression analysis revealed that having sleep and performance issues during travel was related to sleep difficulty scores (Coef 1.44, P < .01). Conclusions: Athletes of all levels have sleep disorders. The Japanese version of athlete sleep screening questionnaire has been validated with sufficient test–retest validity but has poor internal consistency. Thus, although Japanese version of the athlete sleep screening questionnaire is an appropriate questionnaire for assessing sleep disorders in athletes whose primary language is Japanese, future research is needed to optimize the questionnaire accounting for cultural variation.