Adolescent athletes participating in sports involving sudden directional changes, pivoting, and jumping frequently sustain anterior cruciate ligament (ACL) ruptures. ACL reconstruction (ACLR) surgery is often required, followed by a lengthy rehabilitation period. This study aims to evaluate the effectiveness of combining BOth Sides Up (BOSU) ball exercises with conventional resistance training in the recovery of joint stability and function after ACLR in adolescent athletes. Thirty adolescent athletes (ages 14–18) who underwent ACLR were randomly allocated to either the control group receiving traditional postoperative rehabilitation (n = 15) or the intervention group combining BOSU ball training with resistance exercises (n = 15). Joint stability, proprioception, strength, and functional outcomes were assessed before the procedure, as well as 3, 6, and 12 months after the operation using the KT-1000 arthrometer, Y-balance test, isokinetic dynamometry, and the ACL-Return to Sport after Injury ACL-Return to Sport after Injury (ACL-RSI) scale. The intervention group demonstrated notably better anterior-posterior knee joint stability (P < .05) than the control group at the 6-month and 12-month follow-ups after the surgery, greater reach distances in the Star Excursion Balance Test (P < .05), higher quadriceps and hamstring strength ratios (P < .05), and superior ACL-RSI scores (P < .01). Incorporating BOSU ball training with resistance exercises appears to be more effective than traditional rehabilitation alone in enhancing joint stability and neuromuscular control after ACLR in adolescent athletes. These results provide evidence supporting the incorporation of unstable surfaces into a comprehensive rehabilitation program to optimize recovery and safe return to sports.
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Evaluation of the Application of BOth Sides Up Ball Training Combined With Resistance Training in Joint Stability Improvement Following Anterior Cruciate Ligament Reconstruction Surgery in Teenage Athletes
Xiaodong Cao, Junlian Liu, Jinwei Zhao, Shuolei Feng, and Zijian Zhao
A Tai Chi Program Improves Physical Performance Measures in Adolescents With Down Syndrome and Enhances Their Parents’ Psychological Well-Being: A Randomized Controlled Trial
Ala Cherni, Nejmeddine Ouerghi, Nidhal Jebabli, Hatem Ghouili, Houda Bougrine, Nicola Luigi Bragazzi, and Anissa Bouassida
To investigate the effect of a 6-week tai chi (TC) training program on physical performance in adolescents with Down syndrome and its influence on the psychological well-being of their parents, in a randomized controlled design, 25 male adolescents with Down syndrome (age 14.4 ± 1.30 years) were randomly assigned to a control group (n = 10) or a training group (n = 15). Before and after the training period, lower limb explosive strength, upper limb strength, flexibility, and balance were assessed in all participants, as well as their parents’ psychological well-being. Using 2 × 2 repeated-measures analysis of variance, significant Group × Time interactions (p < .05;
Balancing the Load: Perceived Stress, Burnout, and Coping in Irish Athletic Therapy Students
Siobhán O’Connor, Maftei Ionut Tarmure, and Sinéad O’Keeffe
Prolonged stress, poor coping skills, and a lack of engagement in self-care activities can contribute to burnout. We investigated perceived stress, burnout, and coping in Irish athletic therapy students. Moderate stress (20.5 ± 6.7), personal (57.5 ± 20.4), and work-related burnout (52.7 ± 18.1), along with low resilient coping (13.7 ± 2.4), overall (46.0 ± 15.6) and client-related (26.7 ± 17.2) burnout were noted. Women athletic therapy students presented with higher overall (r = .17, p = .04), personal (r = .20, p = .02), and work-related (r = .17, p = .03) burnout and lower resilient coping (r = .20, p = .02). Students working longer hours in employment had higher work- (r = .19, p = .04) and client-related (r = .19, p = .04) burnout scores. Thus, interventions to alleviate stress and burnout and enhance coping skills in students embarking on their career are urgently needed. Targeted strategies for women and those working a high number of hours in external employment are particularly required.
Minimizing Running Load via Gentle Heel Strike Techniques: A Gait Modification Study
Wei Shen, Zongchen Hou, Patrick C. Wheeler, and Daniel T.P. Fong
Introduction: Running overuse injuries are among the most common running-related musculoskeletal injuries. Modifying gait has been recognized as an effective strategy for preventing running overuse injuries. This study investigates whether gentle heel strike (GHS) running decreases the impact loading rate during 30-minute runs in healthy participants. Methods: In this prospective cohort interventional study, 20 male participants underwent gait modification in a controlled laboratory setting, with the goal of reducing heel impact through real-time visual feedback. Comprehensive measurements, including plantar contact, force, pressure, and detailed kinetic and kinematic analyses, were employed to assess changes in gait dynamics. Results: GHS significantly shifted plantar pressure, reducing heel forces and increasing forefoot load. Mean heel force decreased by 0.32 (0.1) body weight (BW) and heel pressure reduced by 0.1 kPa/BW. Although peak vertical ground reaction force and anterior–posterior ground reaction force did not change significantly across the entire stance phase, early stance vertical ground reaction force (7%–12% of the gait cycle) was reduced, leading to the disappearance of the vertical impact peak. Vertical impact peak dropped from 1.45 (0.23) to 1.27 (0.25) BW. Significant reductions were also seen in the vertical instantaneous loading rate, which decreased from 68.32 (14.20) to 46.77 (13.95) BW/s, and the vertical average loading rate, which fell from 54.96 (14.38) to 38.84 (12.62) BW/s (P < .001). Discussion: GHS has the potential to modify running mechanics by redistributing plantar pressure and diminishing heel impact force. This reduction in heel impact force could lead to a change in landing pattern anteriorly and a decrease in loading rates, potentially reducing the risk of running overuse injuries. Conclusion: Visual biofeedback-guided GHS is feasible in healthy participants, and it effectively reduces the loading rate during running for 30 minutes.
Treatment Order and Retention of Self-Myofascial Release and Static Stretching on Passive Hip Flexion Range of Motion
Blaine C. Long
Context: Many healthcare professions incorporate foam rolling (FR) and static stretching (SS) to improve tissue extensibility. Currently, it is unknown if the order an individual performs FR and SS influences flexibility or whether flexibility is retained. This study aimed to determine if FR before, or, following SS influences passive hip flexion range of motion (ROM), and if changes are retained. Design: Between-group experimental design. Methods: Thirty-five participants with less than 90° of passive hip flexion ROM volunteered. Over 8 days, 6 days separated by 24 hours, and then 1 week (day 7) and 2 weeks (day 8) following the last treatment, ROM was measured before and following 1 of 5 treatments; FR/SS, SS/FR, SS, FR, or nothing (control). Participants laid supine on a table where a bubble inclinometer was placed on the tibia of the dominant leg with the hip passively flexed to establish pretreatment ROM. Participants then received the treatments. Passive hip flexion ROM was assessed from pretreatment on day 1 to posttreatment on day 6, day 7 (1 wk), and day 8 (2 wk). Results: Passive hip flexion ROM increased for those receiving FR/SS, SS/FR, FR, and SS. ROM with FR and SS/FR was retained at day 7 but not day 8. Hip flexion ROM for FR/SS and SS were not retained at day 7 nor 8. SS/FR resulted in greater ROM than FR on day 6. SS/FR, FR/SS, SS, and FR were greater than the control at day 6. SS/FR was also greater than the control on days 7 and 8. Conclusion: This study revealed that FR the hamstring muscles after SS produces the greatest gains in passive hip flexion and would be appropriate in noninjured patients with less than 90°.
Psychological Responses Among Individuals Undergoing Anterior Cruciate Ligament Reconstruction Surgery
Airi Naoi, Yasukazu Yonetani, Yoshinari Tanaka, and Shuji Horibe
This study elucidated how previous surgery experience, coping, and optimism influenced the mood of patients who underwent anterior cruciate ligament (ACL) reconstruction surgery. Additionally, it examined the relationships among age, preoperative mood, and postoperative mood. Sixty-four patients (n = 42 men, n = 22 women; age range = 18–51 y) who underwent ACL reconstruction surgery at one hospital in western Japan completed questionnaires before and after surgery. Results revealed that patients who underwent previous ACL reconstruction surgery reported higher tension-anxiety (P < .01) and total mood disturbance (TMD) (P < .05) than did patients who underwent primary surgery. Additionally, tension-anxiety, anger-hostility, TMD (P < .001), depression-dejection, fatigue, and confusion (P < .01) assessed before surgery were significantly reduced after surgery, and preoperative mood was positively related to postoperative mood. Furthermore, positive interpretation was negatively related to TMD before surgery (P < .05), and evading one’s responsibility was positively related to TMD after surgery (P < .05). Therefore, psychological support might be necessary for patients who underwent previous ACL reconstruction surgery and patients who evade responsibility. The results of this study will help sport medicine professionals identify several individual factors that are related to psychological responses of patients who underwent ACL reconstruction surgery.
NATA News & Notes
Volume 41 (2025): Issue 1 (Feb 2025)
Volume 34 (2025): Issue 2 (Feb 2025)
Anterior Cruciate Ligament Injury Does Not Increase the Risk for a Future Concussion: A Unidirectional Phenomenon
April L. McPherson, Dirk R. Larson, Matthew B. Shirley, Malik E. Dancy, Nathaniel A. Bates, and Nathan D. Schilaty
Context: Epidemiological studies have shown an increased risk of musculoskeletal injury after concussion. The purpose of this study was to determine whether the reverse relationship exists, specifically whether there is an increased risk of concussion after an anterior cruciate ligament (ACL) injury in a population-based cohort. Design: Retrospective cohort. Methods: The Rochester Epidemiology Project was searched between 2000 and 2017 for International Classification of Diseases, 9th and 10th Revision codes relevant to the diagnosis and treatment of concussion and ACL tear. A total of 1294 unique patients with acute, isolated ACL tears and no previous history of concussion were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion after the ACL injury. Cases were matched by age, sex, and Rochester Epidemiology Project availability to patients without an ACL tear (1:3 match), resulting in 3882 controls. Medical records of matched control patients were reviewed to rule out history of ACL injury. The hazard ratio of concussion injury following an ACL injury was determined. Results: Nine patients with an ACL injury suffered concussion up to 3 years after the ACL injury. The rate of concussion was no different between ACL-injured cases (0.7%) compared with matched controls with no ACL injury (1.2%), which corresponded to a hazard ratio of 0.55 (95% confidence interval, 0.3–1.1; P = .10). Conclusions: Based on the current evidence, there does not appear to be a significant association between ACL injury and subsequent concussion, which suggests that a concussion uniquely affects the risk of future subsequent musculoskeletal injury.