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A Dynamic Warm-Up Improves Titleist Performance Institute Screen Scores in Adult Golfers

Andrew Skibski, Pradeep Vanguri, Jeffrey R. Stout, Christopher D. Ingersoll, and L. Colby Mangum

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.

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Early Surgical Treatment of Posttraumatic Myositis Ossificans of the Vastus Intermedius Muscle

Pave Kalebić, Silvije Šegulja, Bojan Miletić, Hrvoje Vlahović, and Gordana Starčević-Klasan

Context: This case study demonstrates the effectiveness of early surgical excision of the traumatic myositis ossificans of the vastus intermedius muscle in an elite football player and return to sports activity within 3 months from the initial injury. Case presentation: A 27-year-old male professional football player presented with progressive pain and loss of range of motion after sustaining a severe, right quadriceps contusion 4 weeks earlier. After unsuccessful conservative therapy, the differential diagnosis of myositis ossificans was suspected and confirmed on radiographic examination. MRI revealed significant edema encompassing a substantial portion of the vastus intermedius muscle. Management and outcomes: Surgical treatment was considered for the right thigh mass, being symptomatic 1 month after the onset and refractory to conservative treatment and rehabilitation program. At 2 months postsurgery, the patient was asymptomatic and had completed a rehabilitation program. Conclusion: Early surgical treatment followed-up with a rehabilitation program results with a complete recovery of muscle strength and range of motion. At 3 months postinitial injury, the patient was considered fully recovered and had returned to the match without reporting pain or other symptoms.

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Perceived Team Motivational Climate, Athletic Identity, and Academic Endeavors Among High School Athletes

Jacob M. Chamberlin, Mary D. Fry, Haiying Long, and Susumu Iwasaki

The purpose of this study was to examine whether athletes’ perceptions of a caring (C) and task-involving (TI) sport climate significantly predict their career decision self-efficacy; career exploration and engagement; academic support from coaches and teammates; and athletic and academic identity, after controlling for athletes’ demographic information. High school athletes (N = 228; 75 females and 146 males) completed a survey that included the measures of interest. A series of hierarchical regression analyses revealed that students’ perceptions of a C/TI climate were positive predictors of their career decision self-efficacy (TI), academic identify (TI), and coach support of their academics (C/TI). The findings of this study build on the work of Poux and Fry published in 2015 with college athletes. When coaches foster a C/TI climate, they may be promoting holistic development of their athletes by encouraging them to invest in their academic program and prepare for future careers.

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Return to Sport After Partum in Patients With Diastasis of the Rectus Abdominis Muscles: Ultrasound Evaluation and Rehabilitation Protocol

Fabio Vita, Danilo Donati, Vincenza Amouso, Salvatore Massimo Stella, Marta Fantini, Roberto Tedeschi, Marco Miceli, Stefano Galletti, and Cesare Faldini

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.

Open access

Electromyography-Informed Estimates of Joint Contact Forces Within the Lower Back and Knee Joints During a Diverse Set of Industry-Relevant Manual Lifting Tasks

Felicia R. Davenport, Jennifer K. Leestma, Adriana Staten, Krishan Bhakta, Joshua Fernandez, Anirban Mazumdar, Aaron J. Young, and Gregory S. Sawicki

Repetitive manual labor tasks involving twisting, bending, and lifting commonly lead to lower back and knee injuries in the workplace. To identify tasks with high injury risk, we recruited N = 9 participants to perform industry-relevant, 2-handed lifts with a 11-kg weight. These included symmetrical/asymmetrical, ascending/descending lifts that varied in start-to-end heights (knee-to-waist and waist-to-shoulder). We used a data-driven musculoskeletal model that combined force and motion data with a muscle activation-informed solver (OpenSim, CEINMS) to estimate 3-dimensional internal joint contact forces (JCFs) in the lower back (L5/S1) and knee. Symmetrical lifting resulted in larger peak JCFs than asymmetrical lifting in both the L5/S1 (+20.2% normal [P < .01], +20.3% shear [P = .001], +20.6% total [P < .01]) and the knee (+39.2% shear [P = .001]), and there were no differences in peak JCFs between ascending versus descending motions. Below-the-waist lifting generated significantly greater JCFs in the L5/S1 and knee than above-the-waist lifts (P < .01). We found a positive correlation between knee and L5/S1 peak total JCFs (R2 = .60, P < .01) across the task space, suggesting motor coordination that favors sharing of load distribution across the trunk and legs during lifting.

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Outdoor Overground Gait Biomechanics and Energetics in Individuals With Transtibial Amputation Walking With a Prescribed Passive Prosthesis and a Bionic Myoelectric Prosthesis

Nicole Stafford, Eddie B. Gonzalez, and Daniel Ferris

The metabolic cost of walking for individuals with transtibial amputation is generally greater compared with able-bodied individuals. One aim of powered prostheses is to reduce metabolic deficits by replicating biological ankle function. Individuals with transtibial amputation can activate their residual limb muscles to volitionally control bionic ankle prostheses for walking; however, it is unknown how myoelectric control performs outside the laboratory. We recruited 6 individuals with transtibial amputation to walk an outdoor course with the Open Source Leg prosthesis under continuous proportional myoelectric control and compared it with their passive device. There were no significant differences (P = .142) in cost of transport between prostheses. Participants significantly increased residual limb vastus lateralis (P = .042) and rectus femoris (P = .029) muscle activity during early and midstance phase of walking with the powered prosthesis compared with their passive device. All but one participant preferred walking with myoelectric control compared with their passive prosthesis. The additional mass of the powered ankle prosthesis coupled with increased residual quadriceps activity could explain why the energy cost of walking was not lower compared with a passive prosthesis. This study demonstrates participants can volitionally control a bionic ankle prosthesis to navigate real-world environments.

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Clinician Knowledge of Anterior Cruciate Ligament Reconstruction Rehabilitation Practices: A Preliminary Survey Study

Xavier D. Thompson, Gabrielle M. DelBiondo, and Joe M. Hart

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.

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A Concussion Management Policy Change Promoted Earlier Initiation of Rehabilitation Services and Improved Clinical Recovery Outcomes in Concussion

Elizabeth F. Teel, Danielle Dobney, Deborah Friedman, Lisa Grilli, Christine Beaulieu, and Isabelle J. Gagnon

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.

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Fostering the Physical-Literacy Development of Individuals Experiencing Disability Through the Use of PLayTubs: A Pilot Study

Kiana Stacey, Nicholas Gosse, and Kyle Pushkarenko

Physical literacy (PL) is increasingly being implemented as a means for holistic development for children and youth. Despite this, children experiencing disabilities and their families continue to face barriers that impede participation in physical activities and subsequent PL development. To empower families to actively engage in their PL development, this study sought to provide an accessible, home- and play-based, parent-facilitated intervention, namely, PLayTubs. The purpose was to explore parents’ subjective understanding, involvement, and attitudes toward facilitating physical activity opportunities contributing to PL development through this intervention. Four parents with a child (<12 years old) diagnosed with a developmental impairment participated in a 10-week PLayTub experience. Data were collected via semistructured interviews with parents and their children. Making use of an interpretive description methodology and an ecological-dynamics conceptual framework, this study resulted in three themes: (a) a catalyst for autonomy, (b) more than just movement, and (c) an accessible alternative. Parents found that PLayTubs fostered autonomous participation and individual agency, enhanced connections and togetherness, and allowed for the creation of meaningful experiences with physical activity. These positive insights demonstrate the benefit of home-based interventions for this population and highlight the need for larger studies in the future.

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Immediate and Short-Term Effect of Scapula Retraction Exercises on Subacromial Space: Do We Have Enough Evidence in Patients With Subacromial Pain?

Leyla Eraslan, Ozan Yar, Gazi Huri, and Irem Duzgun

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, η 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, η 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.