Context: Altered lower-limb biomechanics have been observed during landing task in patients with anterior cruciate ligament reconstruction (ACLR), which increases the risk of secondary anterior cruciate ligament injury. However, the alteration in neuromuscular activity of the lower-extremity during landing task is not clear. Objective: To compare the muscle activity pattern assessed by electromyography between the involved limb of patients with ACLR and the contralateral limb or control limb of matched healthy subjects during landing task. Evidence Acquisition: Database of PubMed, Ovid, Scopus, and Web of Science from the inception of the databases until July 2019, using a combination of keywords and their variations: (anterior cruciate ligament OR ACL) AND (electromyography OR EMG) AND (landing OR land). Studies that assessed lower-extremity muscle activity patterns during landing task in patients with ACLR and compared them either with the contralateral side or healthy controls were included. Evidence Synthesis: Of the 21 studies, 16 studies reported altered muscle activity pattern during landing tasks when compared with either the healthy controls or the contralateral side. For the specific muscle activity patterns, the majority of the studies showed no significant difference in reactive muscle activity, and comparisons across studies revealed a possible trend toward the early onset of quadriceps and hamstring activity and increased cocontraction of the involved limb. There are inconsistent findings regarding the alteration in muscle timing and preparatory muscle activity. Conclusions: Patients with ACLR displayed an altered muscle activity pattern during landing tasks, even though they were considered to be capable for sport return. Nevertheless, a firm conclusion could not be drawn due to great heterogeneity in the subject selection and study methods.
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Altered Neuromuscular Activity of the Lower-Extremities During Landing Tasks in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review of Electromyographic Studies
Xin He, Hio Teng Leong, On Yue Lau, Michael Tim-Yun Ong, and Patrick Shu-Hang Yung
Does the Method of Administration Affect Reliability of the Foot and Ankle Ability Measure?
Christopher J. Burcal, Sunghoon Chung, Madison L. Johnston, and Adam B. Rosen
Background: Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established. Purpose: To determine the agreement between and compare the test–retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM). Study Design: Randomized, nonblinded, crossover observational study. Methods: A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test–retest reliability for the FAAM activities of daily living. Results: The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test–retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91). Conclusions: The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.
A Trial of the Effect of 2-Step Orthosis Treatment for Mallet Finger Fractures
Kazuo Saito and Hitoshi Kihara
Context: Many patients report poor therapeutic outcomes following mallet finger fracture surgery. A more reliable technique is urgently needed. Objective: To present a novel treatment for mallet finger fractures using a 2-step orthosis method. Design: Prospective, observational study. Setting: Hospital. Participants: Patients with mallet finger fractures. Interventions: The finger is fixed with splints for 6 weeks, including 3 weeks for the proximal interphalangeal joint in the flexion position and the distal interphalangeal joint in the hyperextension position (first splint) and 3 weeks for the distal interphalangeal joint in the hyperextension position (second splint). Up to week 8, the second splint was attached at night and during physical exertion. Main Outcome Measures: Crawford criteria, Abouna–Brown criteria, bone fusion, grip strength, Doyle classification, Ishiguro classification. Results: Sufficient bone fusion was achieved 12 weeks after fixation; at which time, the range of motion with the distal interphalangeal joint flexed, and extended in the 3 patients was 50° and 0°, 70° and −3°, and 60° and 0°, respectively. The right and left hand grip strengths in the 3 patients were 58 and 55 kg, 62 and 58 kg, and 31 and 29 kg, respectively; there were no problems with respect to function or work. The first 2 patients could start sports again with partial return after 1 week and complete return after 12 weeks and 8 weeks, respectively. For the third patient, rehabilitation was complete after 16 weeks. Evaluation of the fracture sites based on the Crawford criteria showed the condition to be perfect, and evaluation based on the Abouna–Brown criteria showed success. Conclusions: This method provides satisfactory fixation and can prevent proximal interphalangeal joint contracture. Favorable long-term outcomes were confirmed in all patients, suggesting that this method may be effective for previously untreated mallet finger fractures with little displacement.
Body Image in Athletes and Nonathletes With Low Back Pain: Avoidance–Endurance-Related Subgroups and Sports Status Play a Role
Claudia G. Levenig, Michael Kellmann, Jens Kleinert, Johanna Belz, Tobias Hesselmann, Jahan Heidari, and Monika I. Hasenbring
Context: Low back pain (LBP) is a serious health problem, both in the general population as well as in athletes. Research has shown that psychosocial aspects, such as dysfunctional pain responses, play a significant role in the chronification of LBP. Recent research supports the relevance of the multidisciplinary concept of body image in the interpretation of LBP. Objective: To examine the differences in 2 psychosocial aspects, body image and pain responses, between athletes and nonathletes with LBP. Design: Cross-sectional design. Setting: The questionnaires were distributed in the course of LBP treatment. Participants: Data from 163 athletes (mean age = 28.69 [9.6] y) and 75 nonathletes (mean age = 39.34 [12.63] y) were collected. Interventions: Data were collected by questionnaires assessing body image, pain behavior, training activity, and LBP. Main Outcome Measures: To examine group differences between athletes and nonathletes regarding body image and pain behavior, the authors performed 2-way analyses of variance with Bonferroni post hoc tests. Results: The results showed (1) a significant main effect regarding pain responses and body image, showing that participants with eustress endurance or adaptive pain behavior revealed a more positive body image in both groups compared with participants with distress endurance or fear-avoidance behavior, and (2) a significant main effect for the factor group in the body image dimension of physical efficacy, indicating a more positive body image for athletes. Conclusion: These results suggest that considering multiple risk factors for LBP, such as body image and dysfunctional pain behavior, as well as subgrouping, might be valuable for research and for broadening therapy options.
Different Perceptions of Parents and Children on Factors Influencing Sport Specialization
Mayrena I. Hernandez, Kevin M. Biese, Dan A. Schaefer, Eric G. Post, David R. Bell, and M. Alison Brooks
Context: Sport specialization among youth athletes has been associated with increased risk of overuse injuries. Previous research demonstrates that children perceive specialization to be beneficial in making their high school team and receiving athletic college scholarships. Previous research demonstrates that parents play a significant role in their child’s sport experience. However, it is unknown if parents and children answer questions related to specialization factors in a similar manner. Objective: To evaluate the beliefs of youth athletes and parents on factors related to sport specialization and evaluate the level of agreement between dyads on sports specialization. Design: Cross-sectional. Setting: Online and paper surveys. Patients or Other Participants: Aim 1: 1998 participants (993 children and 1005 parents). Aim 2: 77 paired parent–child dyads. Interventions: Self-administered survey. Main Outcome Measures: The responses were summarized via frequency and proportions (%). Chi-squares were calculated between parent and child responses. Kappa coefficients were calculated for dyads to determine level of agreement. Sport specialization was classified using a common 3-point scale. Results: The parents were more concerned about risk of injury in sports compared with children (P < .001, χ2 = 231.4; parent: extremely: 7.1%; child: extremely: 3.7%). However, children were more likely to believe that specialization was associated with their chances of obtaining an athletic college scholarship compared with parents (P < .001, χ2 = 201.6; parent: very/extremely likely: 13.7%; child: very/extremely likely: 15.8%). Dyad subanalysis indicated a moderate level of agreement for “quitting other sports to focus on one sport” (κ = .50) and a low level of agreement for “identifying a primary sport” (κ = .30) and “training >8 months per year in primary sport” (κ = .32). Conclusions: Parents and youth athletes had differing beliefs on the factors related to sport specialization. Dyad analysis shows that parents and children answer sport specialization classification questions differently. Health care providers should be aware of these differences, and messaging should be individualized to the audience.
The Effectiveness of Frequency-Based Resistance Training Protocols on Muscular Performance and Hypertrophy in Trained Males: A Critically Appraised Topic
Theodore Kent Kessinger, Bridget Melton, Theresa Miyashita, and Greg Ryan
Clinical Scenario: Manipulation of exercise variables in resistance training (RT) is an important component in the development of muscular strength, power, and hypertrophy. Currently, most research centers on untrained or recreationally trained subjects. This critically appraised topic focuses on studies that center on the well-trained subject with regard to frequency of training. Clinical Question: In well-trained male subjects, is there an association between RT frequency and the development of muscular strength and hypertrophy? Summary of Key Findings: Four studies met the inclusion criteria and were included for analysis. All studies showed that lower-frequency training could elicit muscular strength and hypertrophy increases. One study suggested that a higher frequency compared with a lower frequency may provide a slight benefit to hypertrophic development. One study reported a greater level of delayed onset muscle soreness with lower frequency training. The 4 studies demonstrate support for the clinical question. Clinical Bottom Line: Current evidence suggests that lower-frequency RT produces equal to greater improvements on muscular strength and hypertrophy in comparison to higher-frequency RT when volume is equated. The evidence is particularly convincing when lower-frequency RT is associated with a total-body training protocol in well-trained male subjects. Strength of Recommendation: There is moderate-to-strong evidence to suggest that lower-frequency RT, when volume is equated, will produce equal to greater improvements on muscular strength and hypertrophy in comparison to higher-frequency RT.
The Effects of Therapeutic Exercise With and Without Mobilization in Participants With Chronic Ankle Instability: A Randomized Controlled Trial
Cameron Bolton, Sheri Hale, and Todd Telemeco
Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.
A Clinically Relevant Method of Quantifying the Mechanical Properties of RockTape® Kinesiology Tape at Different Elongation Lengths
Scott W. Cheatham and Russell Baker
Context: Kinesiology tape (KT) is a therapeutic intervention used to treat different musculoskeletal conditions and to enhance sports performance. The evidence is inconclusive, with researchers attributing the variable outcomes to different manufactured KT used in the research. Researchers have begun to measure and document the mechanical properties of different brands, using machines versus professionals. This prevents a clear translation to clinical practice, as it may be difficult to reproduce outcomes. There is a need to measure the mechanical properties of KT using more clinically relevant methodology. Objective: The purpose was to document a clinically relevant method of measuring the mechanical properties of 2 different types of precut RockTape® tape at common elongation lengths and to establish the methodology for future validation research on this testing method. Design: Controlled laboratory study. Setting: University laboratory. Participants: One researcher conducted all measurements. Procedures: Each tape was measured at 3 elongation lengths with a force gauge. Main Outcome Measures: Force, stress, and Young modulus. Results: The RockTape® 2 and RockTape® 3 elongation force were 25% = 2.27 (0.21) and 2.12 (0.26) N, 50% = 6.51 (0.27) and 5.93 (0.20) N, and 75% = 30.13 (0.63) and 21.23 (0.41) N. The stress values for the RockTape® 2 and RockTape® 3 were 25% = 0.88 (0.05) and 0.82 (0.03) kPa, 50% = 2.52 (0.03) and 2.29 (0.01) kPa, and 75% = 11.67 (0.04) and 8.23 (0.02) kPa. The Young modulus values for the RockTape® 2 and RockTape® 3 were 25% = 3.51 (0.00) and 3.29 (0.00) kPa, 50% = 5.04 (0.00) and 4.60 (0.00) kPa, and 75% = 15.57 (0.00) and 10.96 (0.00) kPa. Conclusion: This investigation documented a novel method of measuring the mechanical properties of 2 types of RockTape® KT. Future research should attempt to validate these testing methods.
The Effectiveness of Nonoperative Treatment for Anterior Cruciate Ligament Rupture on Patient-Reported Outcomes and Muscular Strength: A Critically Appraised Topic
Emily R. Hunt, Cassandra N. Parise, and Timothy A. Butterfield
Clinical Scenario: Anterior cruciate ligament (ACL) ruptures are one of the most common injuries in young athletic populations. The leading treatment for these injuries is ACL reconstruction (ACL-r); however, nonoperative treatments are also utilized. Following ACL-r, patients experience prolonged muscle weakness and atrophy of the quadriceps muscle group, regardless of rehabilitation. Nonoperative treatment plans following ACL injury exist, but their outcomes are less familiar, in spite of providing insight as a nonsurgical “control” for postsurgical rehabilitation outcomes. Therefore, the purpose of this critically appraised topic was to evaluate quadriceps strength and function following nonoperative ACL rehabilitation using objective and subjective measures including isokinetic dynamometry, the single-leg hop test, and the International Knee Documentation Committee (IKDC) subjective knee form. Focused Clinical Question: What are the effects of nonoperative treatment on peak isokinetic knee-extensor torque, the single-leg hop tests, and the IKDC in patients who have sustained an ACL rupture? Summary of Key Findings: Patients who underwent nonsurgical ACL treatment produced limb symmetry index, with the side-to-side torque difference expressed as a percentage, and values at or above 90% for all 4 single-leg hop tests and strength tests similar to ACL-r patients. All studies showed individuals had higher IKDC scores at baseline collection when compared with patients who underwent ACL-r but showed lower IKDC scores at long-term follow-up compared with ACL-r patients. Clinical Bottom Line: Nonoperative treatments of ACL injuries yield similar long-term results in quadriceps strength as ACL-r. Due to the quality of evidence and the absence of randomized controlled trials on this topic, these outcomes should be considered with caution. Strength of Recommendation: The Oxford Centre for Evidence-Based Medicine taxonomy recommends a grade of B for level 2 evidence with consistent findings.
The Effect of Kinesio Tape on Factors for Neuromuscular Control of the Lower-Extremity: A Critically Appraised Topic
Nickolai Martonick, Kimber Kober, Abigail Watkins, Amanda DiEnno, Carmen Perez, Ashlie Renfro, Songah Chae, and Russell Baker
Clinical Scenario: Joint instability is a common condition that often stems from inadequate muscle activation and results in precarious movement patterns. When clinicians attempt to mechanically treat the unstable joint rather than attending to the underlying cause of the instability, patient outcomes may suffer. The use of kinesiology tape (KT) on an unstable joint has been proposed to aid in improving lower-extremity neuromuscular control. Clinical Question: Does KT improve factors of neuromuscular control in an athletic population when compared with no-tape or nonelastic taping techniques? Summary of Key Findings: The current literature was searched, and 5 randomized controlled studies were selected comparing the effects of KT with no-tape or nonelastic taping techniques on lower-extremity neuromuscular control in an athletic population. Primary findings suggest KT is not more effective than no-tape or nonelastic tape conditions at improving lower-extremity neuromuscular control in a healthy population. Clinical Bottom Line: The current evidence suggests that KT is ineffective for improving neuromuscular control at the ankle compared with nonelastic tape or no-tape conditions. KT was also found to be ineffective at improving hip and knee kinematics in healthy runners and cyclists. However, preliminary research has demonstrated improved neuromuscular control in a population displaying excessive knee valgus during a drop jump landing, after the application of KT. Clinicians should be cautious of these conflicting results and apply the best available evidence to their evaluation of the patient’s status. Strength of Recommendation : There is grade B evidence that the use of KT on an athletic population does not improve biomechanical measures of ankle stability. There is inconclusive, grade B evidence that KT improves neuromuscular control at the knee in symptomatic populations.