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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.

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.

Context: After completing rehabilitation, patients face a high risk of subsequent injury following anterior cruciate ligament reconstruction. It is important to identify potential barriers to patient success including clinician knowledge. The purpose of this study was to assess clinician knowledge of research related to anterior cruciate ligament reconstruction rehabilitation. Design: This was a survey study using snowball sampling. Methods: Survey development began with the creation of a construct map and contained varying levels of advanced concepts, level I indicating the most basic and level V the most complex. The survey was distributed to advertise to target population. A total of 60 participants (24 athletic trainers, 33 physical therapists, and 3 dual credentialed) completed the study. Results: Overall, participants displayed moderate to high levels of knowledge (79.7%–93.5% correct), apart from the implementation of motor learning principles. Conclusions: Clinician knowledge may not be the primary barrier to patient success, but the implementation of this knowledge should be explored in relation to patient outcomes. Future research should examine a larger cohort to examine differences between clinician types.

Context: In line with emerging research, an interprofessional specialty concussion clinic instituted a policy change permitting earlier physiotherapy-based treatment entry. Our objective was to determine the effect of this policy change on concussion recovery outcomes. Design: Secondary analysis of prospectively collected clinical data. Methods: 600 youth with concussion were included. Active rehabilitation was initiated ≥4 weeks (prepolicy) or ≥2 weeks (postpolicy) postconcussion based on institutional policy. Cox proportional hazard models, linear mixed models, and chi-square analyses were conducted. Results: The postpolicy group (median = 22 d [interquartile range: 17–27]) started treatment earlier than the prepolicy group (median = 26 d [interquartile range: 24–30], P < .001). Length of episode of care (χ ²(1) = 11.55, P < .001, odds ratios = 1.49; 95% confidence interval, 1.19–1.88); rehabilitation (χ ²(1) = 9.47, P = .002, odds ratios = 1.73, 95% confidence interval, 1.22–2.45]); and total recovery (χ ²(1) = 11.53, P < .001, odds ratios = 1.49; 95% confidence interval, 1.18–1.88) were reduced in patients postpolicy change. A significant interaction effect was found for total postinjury symptom (F _2,320 = 3.59, P = .03) and symptom change scores (F _2,315 = 5.17, P = .006), with the postpolicy group having faster symptom resolution over time. No group differences were observed for persisting symptoms. Conclusions: Earlier rehabilitation initiation occurred as intended following an institutional policy change, which had small, but significant, effects on recovery outcomes in youth with concussion. Health care providers should adopt policies to encourage early active rehabilitation services after concussion.

Context: Limited information exists regarding the immediate and short-term effects of scapula retraction exercises (SREs) on acromiohumeral distance (AHD) in subacromial pain syndrome (SPS). This study’s 2 main objectives were to investigate (1) the immediate effect of the SRE on AHD at varying shoulder abduction angles in patients with SPS and healthy controls and (2) the effect of the 8-week SRE program on AHD in patients with SPS. Design: Cross-sectional and pre–post intervention designs were utilized on this study. Methods: Twenty-one patients with SPS and age-matched healthy controls were included. First, AHD at 0°, 30°, 45°, 60°, and 90° of active shoulder abductions were recorded during (1) resting upper quadrant posture and (2) while participants were performing SREs. Patients then underwent an 8-week progressive SRE program. AHD measures, pain intensity (visual analog scale), and disability (Shoulder Pain and Disability Index) were recorded at baseline and 8 weeks. AHD were analyzed using mixed-model analyses of variance. Pain and disability were analyzed using paired samples t test. Results: The immediate effect of the SREs revealed a significant angle-by-exercise-by-group interaction for the AHD values (F _3,155 = 3.956, P = .009, ${\eta }_{\mathrm{p}}^2=.175$ ). Pairwise comparisons yielded that the SRE increased AHD values in patients with SPS (P < .05), yet it did not affect healthy controls (P > .05). Besides, the SRE program revealed a significant angle-by-time interaction for the AHD values (F _3,054 = 9.476, P < .001, ${\eta }_{\mathrm{p}}^2=.195$ ). AHD increased at all elevation angles, and pain and disability improved over time (P < .05). Conclusion: SREs immediately affect AHD in patients with SPS but not in healthy populations. Moreover, SREs applied in progressive abduction angles improve pain, functionality, and AHD values in patients with SPS.

Context: To further improve rehabilitation programs while preventing overstretching the anterior cruciate ligament (ACL), a thorough understanding of the knee kinematics and ACL length change during closed kinetic chain and open kinetic chain (OKC) exercises is essential. The measurement of ACL graft length relates to the changes in strain experienced by the ACL graft during different types of exercises rather than simple physical length. Objective: This study aimed to determine the effects of closed kinetic chain and OKC exercises on tibiofemoral kinematics and ACL graft length changes following double-bundle ACL reconstruction. Design: Cohort study (diagnosis); level of evidence, 3. Setting: Laboratory. Patients: Fifteen patients who underwent double-bundle ACL reconstruction were asked to perform 10-kg loaded seated knee extension (OKC-10) and single-leg lunge. During the seated knee extension, patients were instructed to extend and flex the knee within a range of 0° to 90° of flexion, with a 10-kg load applied to the ankle. For the lunge, patients began in a natural standing position and were instructed to flex the ACL-reconstructed knee to approximately 90°. Interventions: The 3-dimensional tibiofemoral kinematics under different weight-bearing conditions were determined using a dual-fluoroscopic imaging system. Main Outcome Measures: The tibiofemoral kinematics in 6 degrees-of-freedom were measured. And 3-dimensional ligament simulation technique was used to quantify length changes of the anteromedial bundle and posterolateral bundle. Results: The tibia exhibited significantly more external rotation during the OKC-10 motion than during the single-leg lunge from 35° to 70° of knee flexion (P ≤ .028). Beyond 30° of knee flexion, the tibia exhibited significantly more varus during the OKC-10 motion than during the single-leg lunge (P ≤ .028). And a significantly more anterior tibial translation was observed during the OKC-10 motion than during the lunge from 0° to 15° of flexion (P ≤ .018). The anteromedial bundle length was significantly longer during the OKC-10 motion than during the lunge between 0° and 25° of knee flexion (P ≤ .028). Conclusions: The effects of OKC exercises with loads on knee rotational stability should be considered in making rehabilitation programs for patients after ACL reconstruction. Since some degree of anterior tibial translation is physiological, it is important to note that increased translation alone does not necessarily indicate danger or instability.

Context: Athletes with a history of concussion (CON) have been demonstrated to have heightened levels of anxiety and depression that may continue well beyond the resolution of concussion symptoms. The global events of 2020 resulted in elevated levels of anxiety and depression in the general population, which may have unequally presented in collegiate athletes with (CON) than those without a history of concussion (NoCON). Using a deception design, our survey-based study compared levels of anxiety and depression in CON and NoCON collegiate athletes in response to the pandemic and social injustices. We hypothesized that the CON group would have significantly elevated anxiety and depression as compared to the NoCON group in response to events of 2020. Design and Methods: Collegiate athletes (N = 106) during the academic 2020–2021 academic year were divided into CON and NoCON groups based on their preinjury (baseline) concussion assessment. Participants completed the Social Readjustment Rating Scale (SSRS), Center for Epidemiologic Studies Depression Scale (CES-D), and Generalized Anxiety Disorder Scale-7 (GAD-7) via an electronic survey pertaining to the events of 2020. The term “concussion” was not used in any study materials which was the basis for our deception-based design. An analysis of covariance was used to compare group CES-D and GAD-7 outcome scores while controlling for the SSRS outcome score. Results: Our survey response rate was 14.2% (48/337 [77.1% female]) and 10.1% (58/580 [67.2% female]), for the NoCON and CON groups, respectively. The NoCON group had significantly (F ₁ = 5.82, P = .018, ${\eta }_{\mathrm{p}}^2=.06$ ) higher anxiety (8.3 [5.89]) as compared to the CON group (5.5 [2.85]). The NoCON group also had significantly (F ₁ = 13.7, P < .001, ${\eta }_{\mathrm{p}}^2=.12$ ) higher levels of depression (21.0 [12.52]) as compared to the CON group (16.07 [9.10]). Discussion: Our deception-based study revealed NoCON participants had elevated and clinically relevant mood states as compared to CON participants in response to the events of 2020.