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Context: Musculoskeletal ultrasound imaging is a valid and reliable tool to measure muscle morphology, but minimal research explores its utility in assessing acute morphology changes after exercise in active populations. The purpose of this study was to assess changes in ultrasound-based measures of muscle thickness (MT) and quality (MQ) in response to a single bout of short-duration, high-intensity bodyweight exercise in the acute and postacute recovery timeframe. Design: Interventional study. Methods: Nineteen healthy, recreationally active young men and women (27.1 [8.3] y) completed a dynamic bodyweight exercise circuit primarily focused on the lower body. B-mode ultrasound images were obtained of the rectus femoris in resting and contracted conditions preexercise, ∼15 minutes, and 24 hours postexercise. Knee-extensor strength and MQ (muscle strength [in newtons]/resting MT [in centimeters]) were also assessed at the same timepoints. Results: Resting and contracted MT increased (13.0%; 6.9%) from pre- to 15 minute postexercise, returning to baseline at 24 hours postexercise. Δ MT decreased (−24.5%) from pre- to 15 minutes postexercise and was not different from either 15 minutes postexercise or baseline by the 24-hour timepoint. Knee extension strength and MQ decreased (−15.6%; 24.2%) from pre- to 15 minutes postexercise and remained below baseline at 24 hours postexercise. Conclusion: MT measures alone suggested faster recovery from an exercise circuit than knee-extensor strength or MQ, though the combined metric of MQ may be useful for longitudinal monitoring of muscle recovery timelines in rehabilitation programs.

Context: To cross-cultural translate the Cumberland Ankle Instability Tool (CAIT) to Turkish version (CAIT-T) and to evaluate the validity, reliability, and cutoff score of CAIT-T for Turkish athletic population. Design: The English version of CAIT was translated to CAIT-T based on a guideline of cross-cultural adaptation. Fifty-two athletes with chronic ankle instability and 63 athletes without chronic ankle instability were included in the study. Construct validity was evaluated with correlations between the CAIT-T, Turkish version of Foot Ankle Ability Measure (FAAM-T), and Numeric Rating Scale. CAIT-T was completed twice by each participant at 7 to 10 days intervals to assess test–retest reliability based on the intraclass correlation coefficient, whereas Cronbach alpha evaluated internal consistency. Discriminative validity and content validity of the CAIT-T also evaluated. Results: In construct validity, strong positive correlation was found between CAIT-T and Numeric Rating Scale perceived ankle instability (rho = −.771, P < .001), as well as moderate negative correlations with FAAM-T-activities of daily living and FAAM-T-sports (rho = −.448, P < .001 and rho = −0.541, P < .001, respectively). The CAIT-T demonstrated strong test–retest reliability (intraclass correlation coefficient score of .98) with a good internal consistency (Cronbach α: .85). Receiver operating characteristic curve showed a cutoff score of 26.5 (Youden index: 0.78, sensitivity: 0.57, specificity: 0.90.5). No ceiling or floor effects were observed. Conclusions: CAIT-T is a valid and reliable questionnaire for the assessment of chronic ankle instability in the Turkish athletic population.

Clinical Scenario: Sacroiliac joint dysfunction (SIJD) is pain in the sacroiliac region that can be debilitating and difficult to treat. Many interventions can be used to treat SIJD, including exercise and manual manipulation. The effectiveness of these treatments by themselves, or in conjunction, is not well understood. Clinical Question: In active individuals with SIJD, is an exercise intervention, manual manipulation, or a combination of the 2 effective in reducing pain and improving function? Summary of Key Findings: Three studies were included in this critically appraised topic. One study found that both exercise therapy and manipulation therapy decreased pain and improved function, but found no between-group differences. The other 2 studies found that exercise therapy, manipulation therapy, and the combination of the 2 were effective in decreasing pain and improving function in the participants. Clinical Bottom Line: The results of the studies suggested that exercise therapy, manual therapy, and a combination of the 2 therapies can be effective in reducing pain and dysfunction in patients with SIJD. While manual therapy techniques alone may be effective in reducing SIJD pain short term, exercise therapy or a combination of the 2 may be more effective in reducing pain long term. Strength of Recommendation: There appears to be level B evidence supporting the use of exercise therapy, manual therapy, or a combination of the 2 for the treatment of SIJD. This recommendation is based on the inconsistent or limited quality patient-oriented evidence presented in the 3 included studies, as defined by the Strength of Recommendation Taxonomy.

Context: The Balance Error Scoring System (BESS) is the most commonly used balance test during concussion assessment; however, the test has known limitations related to fatigue. Jumping and landing along with running are common athletic activities that adversely affect postural control. However, the effect of neither subexertional running nor jumping and landing tasks on the BESS is known. Therefore, the purpose of this study was to investigate the effects of a brief exercise bout of running or jumping on BESS performance. Design: We recruited 52 recreationally active participants who were divided into 3 groups: (1) Drop Jump (Landing), Treadmill Running (Run), and Control. Methods: All participants performed a preintervention BESS test and were then randomly assigned to a group. The jumping group performed 10 drop jumps from a 50 cm box, 30 seconds between trials, the running group performed a 3-minute treadmill run, and the control group sat quietly for 5 minutes. All participants then completed a second BESS test. The primary analysis was a 2 (time) by 3 (group) repeated-measure analysis of variance with sex as a covariate. Results: There was a significant interaction (F = 7.396, P = .002). On post hoc, there was a significant improvement (lower) score in the Control group (PRE: 13.9 [4.5]; POST: 10.5 [2.9]; P = .019, d = 0.89) but no significant differences in either the running (P = .579) or landing (P = .849) groups. Conclusions: A relatively brief exercise intervention resulted in participants failing to improve a subsequent BESS assessment, whereas control participants who rested for 5 minutes committed fewer (3.4) errors. These results suggest that sports health care providers should recognize that even low- to moderate-intensity brief exercise can result in a failure to improve with repeat BESS administration.

Context: Running is a popular form of physical activity but can increase an individual’s lower-extremity injury risk. Running gait analysis via inertial measurement units (IMUs) is a method for collecting important gait data that is related to developing lower-extremity injuries, such as increased load from low step rate (SR), and long stride length (SL). IMU data can be derived from both foot- and shank-placed IMUs, but foot-placed sensors (RunScribe IMUs) need validation against shank-placed sensors. Purpose: Determine criterion validity of RunScribe foot-placed IMUs against MyoMotion shank-placed IMU for SR and SL. Design: cross-sectional laboratory study. Methods: Nine participants (5 males, 4 females; age: 28.33 [5.78]; height: 1.75 [0.11]; mass: 74.06 [16.24]) volunteered for our study. Following a 5-minute warm-up, participants ran on a treadmill for 5 minutes at a self-selected speed. After ∼2.5 minutes, MyoMotion data were collected for 10 seconds. The RunScribe IMUs collected data throughout the full duration of the run. Criterion validity of SR and SL between the foot- and shank-placed IMUs was determined using bivariate Pearson correlations, intraclass correlation coefficients (3,1), and Bland–Altman plots with 95% limits of agreement analysis. Results: A very strong correlation for SR (r = .90, N = 9, P ≤ .001), and a strong correlation for SL (r = .80, N = 9, P < .001) were found between the foot and shank-placed IMUs. Excellent reliability was found for SR (intraclass correlation coefficient = .91, P ≤ .001, 95% CI, .639–.978), and good reliability was found for SL (intraclass correlation coefficient = .800, P = .003, 95% CI, .340–.951) between the foot and shank-placed IMUs. The mean difference of SR and SL was −2.111 and −0.142, respectively, indicating good agreement between the foot and shank-placed IMUs. Conclusions: Foot-placed RunScribe IMUs are a valid alternative for measuring SR and SL compared with shank-placed IMUs.

In sports settings, it is important to understand and assess the effects of cognitive–motor interference on sport-specific tasks throughout strength and conditioning programs to better represent the athletic environment. This study used a low-cost movement assessment system, the Mizzou Point-of-care Assessment System, to measure the effects of visual and auditory cognitive–motor dual tasking on countermovement jump (CMJ) performance. Thirty-one recreationally active adults (21.1 [1.9] y, 168.9 [11.8] cm, 69.1 [13.6] kg) participated. Participants performed 3 trials of CMJ under 3 conditions: control, audio dual tasking, and visual dual tasking. Tasks were assessed using a low-cost system comprising a custom force plate, depth camera, and interface board. Repeated-measures analysis of variance with post hoc t tests revealed significant decreases in several kinematic and kinetic outcome measures, including time in the concentric phase (in seconds; 95% CI mean difference audio–control = −0.045 to 0.0054; visual–control = −0.045 to 0.0054), time to takeoff (in seconds; audio–control = −0.026 to 0.086; visual–control = −0.026 to 0.086), jump height (in meters; audio–control = −0.0081 to 0.048; visual–control = −0.01 to 0.05), maximum knee flexion (in degrees) at jump (audio–control = 1.47 to 9.89; visual–control = −1.58 to 9.66), hip flexion (in degrees) at maximum knee flexion during jump (audio–control = 0.00 [0.00 to 0.00]; visual–control = 0.00 [0.00 to 0.00]), and several others for both dual tasking conditions compared with control but not between audio and visual conditions. Results indicate that both dual task conditions negatively impact CMJ performance and that their effects can be effectively quantified using a low-cost assessment tool.

Context: Investigating parameters related to physical capacities, muscular imbalance between the limbs, and injury reports in judo athletes with vision impairments (VI) is something extremely relevant for competitive performance, especially considering the absence of vision, which can be a determining factor in these aspects. For this, this study aimed to explore the interlimb asymmetry and bilateral strength index in upper and lower limbs in judo athletes with VI and describe the injury reports and the association with the muscular imbalance. Design: A cross-sectional study. Methods: Eighteen judo athletes with VI participated in this cross-sectional study. Athletes performed the following physical tests: handgrip strength, countermovement jump, and medicine ball throw. All tests were performed unilaterally and bilaterally to calculate the interlimb asymmetry and the bilateral strength index. After this, an injury questionnaire was applied, considering injuries that occurred in the previous 6 months. Student t tests and chi-square tests were used to compare groups and test the associations between injury reports, adopting the level of 5%. Results: The results demonstrated that performance was higher for male compared with female athletes (P < .05) and asymmetry was influenced by sex (higher for male; P < .05) and the origin of the impairment (higher for acquired; P < .05). Furthermore, the bilateral strength deficit was more present in injured groups (mainly in medicine ball throw and countermovement jump). Finally, the most common mechanism of injury was direct contact with another athlete. Conclusion: Muscle imbalances were identified in male and female VI judo athletes and seem to be related to injury reports.

Context: Detailed rehabilitation protocols after stem cell treatment are lacking. This case highlights the rehabilitation of a patient treated with human umbilical cord blood-derived mesenchymal stem cell implantation for a large osteochondritis dissecans lesion of the knee. Case presentation: A 17-year-old male adolescent wrestler experienced persistent left knee pain for 1 year, unresponsive to 6 months of conservative treatment. MRI revealed a large osteochondritis dissecans lesion (38 × 18 mm) in the lateral femoral condyle, which was treated with human umbilical cord blood-derived mesenchymal stem cell implantation. Management and outcomes: Rehabilitation was conducted in 4 phases. The protection phase (1–8 wk) emphasized weight-bearing restrictions, continuous passive motion, and early gait training. The gait recovery phase (9–12 wk) incorporated stationary cycling and open kinetic chain exercises. During the maturation phase (13–24 wk), maximal strength and proprioception exercises were introduced with antigravity treadmill running. The final recovery phase (24–52 wk) focused on plyometric drills and sport-specific activities. Team training resumed at 32 weeks, and return to full competitive training occurred at 52 weeks. The limb symmetry index for isokinetic knee-extensor strength and single-leg hop test reached 95.2% and 97.9%, respectively, by 12 months, indicating near-complete functional recovery. The modified MRI of cartilage repair tissue score improved from 40 to 60 points between 1 and 3 years postsurgery. Second-look arthroscopy revealed an International Cartilage Repair Society grade 1 at 35 months. International Knee Documentation Committee scores increased from 17.2 preoperatively to 98.9 at 2 years, while visual analog scale scores decreased from 10 to 2 over 3 years. Conclusions: Accelerated weight bearing, early gait training, and phased strength exercises facilitated substantial improvements in function and cartilage healing in an adolescent wrestler with a large osteochondritis dissecans lesion. Further studies with larger cohorts are recommended to confirm these findings.