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Nicole L. Cosby and Jay Hertel

Patient Scenario:

A 20-y-old male Division 1 college basketball player sustained a grade 2 inversion ankle sprain during preseason that is preventing him from practicing and competing.

Clinical Outcomes Assessment:

The Foot and Ankle Ability Measure (FAAM) was administered to the injured athlete as an evaluative tool to provide the clinician with valuable subjective information on the patient’s self-reported function. The FAAM consists of 2 subscales: the activities of daily living (ADL) subscale and the sports subscale. Together the 2 subscales contain 29 questions (21 questions on the ADL and 8 on the sports subscale), which assess self-reported function and disability in the foot and ankle.

Clinical Decision Making:

The addition of the self-reported functional measures provides the clinician with more quantitative data to make clinical decisions than is possible with typical clinical exams. Self-reported functional assessments should not replace thorough clinical examination or sound clinical judgment; instead they should be an adjunct to them.

Clinical Bottom Line:

In addition to our objective assessment tools, the FAAM provides clinicians with a tool that can be used to assess function and disability through our patients’ self-reported responses. When used for evaluative purposes the FAAM can measure an individual’s changes in function and disability over time.

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Lauren C. Benson and Kristian M. O’Connor

About half of all runners sustain a running-related injury every year. Exertion may contribute to risk of injury by altering joint mechanics. The purpose of this study was to examine the effects of exertion on runners’ joint mechanics using principal component analysis (PCA). Three-dimensional motion analysis of the lower extremity was performed on 16 healthy female runners before and after their typical training run. PCA was used to determine exertion-related changes in joint mechanics at the ankle, knee, and hip. Statistical significance for repeated-measures MANOVA of the retained principal components at each joint and plane of motion was at P < .05. Exercise effects were identified at the ankle (greater rate of eversion [PC2: P = .027], and decreased plantar flexion moment [overall: P = .044] and external rotation moment [PC3: P = .003]), knee (increased adduction [overall: P = .044] and internal rotation [PC3: P = .034], and decreased abduction moment [overall: P = .045]), and hip (increased internal rotation [PC1: P = .013] and range of mid- to late-stance rotation [PC2: P = .009], and decreased internal rotation moment [PC1: P = .001]). The observed changes in running mechanics reflect a gait profile that is often linked to running injury. The effects of more strenuous activity may result in mechanics that present an even greater risk for injury.

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Adam C. Clansey, Mark J. Lake, Eric S. Wallace, Tom Feehally and Michael Hanlon

The purpose of this study was to investigate the effects of prolonged high-intensity running on impact accelerations in trained runners. Thirteen male distance runners completed two 20-minute treadmill runs at speeds corresponding to 95% of onset of blood lactate accumulation. Leg and head accelerations were collected for 20 s every fourth minute. Rating of perceived exertion (RPE) scores were recorded during the third and last minute of each run. RPE responses increased (P < .001) from the start (11.8 ± 0.9, moderate intensity) of the first run to the end (17.7 ± 1.5, very hard) of the second run. Runners maintained their leg impact acceleration, impact attenuation, stride length, and stride frequency characteristics with prolonged run duration. However, a small (0.11–0.14g) but significant increase (P < .001) in head impact accelerations were observed at the end of both first and second runs. It was concluded that trained runners are able to control leg impact accelerations during sustained high-intensity running. Alongside the substantial increases in perceived exertion levels, running mechanics and frequency domain impact attenuation levels remained constant. This suggests that the present trained runners are able to cope from a mechanical perspective despite an increased physiological demand.

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Travis J. Peterson, Rand R. Wilcox and Jill L. McNitt-Gray

Our aim was to determine how skilled players regulate linear and angular impulse while maintaining balance during the golf swing. Eleven highly-skilled golf players performed swings with a 6-iron and driver. Components contributing to linear and angular impulse generated by the rear and target legs (resultant horizontal reaction force [RFh], RFh-angle, and moment arm) were quantified and compared across the group and within a player (α = .05). Net angular impulse generated by both the rear and target legs was greater for the driver than the 6-iron. Mechanisms used to regulate angular impulse generation between clubs varied across players and required coordination between the legs. Increases in net angular impulse with a driver involved increases in target leg RFh. Rear leg RFh-angle was maintained between clubs whereas target leg RFh became more aligned with the target line. Net linear impulse perpendicular to the target line remained near zero, preserving balance, while net linear impulse along the target line decreased in magnitude. These results indicate that the net angular impulse was regulated between clubs by coordinating force generation of the rear and target legs while sustaining balance throughout the task.

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Meaghan E. Maddigan, David G. Behm and Glen R. Belfry

Context:

High intensity interval training (HIIT) has been shown to improve muscle power and endurance, as well as aerobic power.

Objective:

To assess the effects of HIIT that utilizes resistive elastic bands to improve overhand throwing velocity.

Participants:

Healthy female volunteers (n = 13) ranging in age from 18–29 years.

Interventions:

Participants were randomly assigned to either a control group or an experimental group that exercised 3 days per week for 3 weeks. Each training session involved performance of 5 sets of 20 throwing motions against elastic band resistance, which was performed by both extremities.

Main Outcome Measures:

Maximal oxygen consumption was measured during performance of a graded exercise test that utilized an upper extremity cycle ergometer. A radar gun was used to assess peak throwing velocity and the extent to which throwing velocity was sustained during performance of a 20-throw endurance test.

Results:

After completing the training, the experimental group exhibited faster peak throwing velocity (61.6 ± 6.6 km/hr to 63.2 ± 8.6 km/hr) and a reduced fatigue index (1.18 ± 0.16 to 1.01 ± 0.02). Training also resulted in a 14% improvement in maximum oxygen consumption (1.40 ± 0.46 L/min to 1.60 ± 0.49 L/ min) and longer time to fatigue (9.99 ± 1.84 min to 11.43 ± 2.29 min).

Conclusion:

The high-intensity interval training program was effective for improvement of overhand throwing performance.

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Annina B. Schmid, Linda Dyer, Thomas Böni, Ulrike Held and Florian Brunner

Context:

Various studies report decreased muscle activation in the concavity of the curve in patients with scoliosis. Such decreased muscle-performance capacity could lead to sustained postural deficits.

Objective:

To investigate whether specific asymmetrical sports therapy exercises rather than symmetrical back strengthening can increase EMG amplitudes of paraspinal muscles in the concavity of the curve.

Design:

Cross-sectional.

Setting:

Laboratory.

Participants:

16 patients with idiopathic scoliosis.

Interventions:

Patients performed 4 back-strengthening exercises (front press, lat pull-down, roman chair, bent-over barbell row) during 1 test session. Each exercise was performed in a symmetrical and asymmetrical variant and repeated 3 times.

Main Outcome Measure:

EMG amplitudes of the paraspinal muscles were recorded in the thoracic and lumbar apexes of the scoliotic curve during each exercise. Ratios of convex- to concave-side EMG activity were calculated.

Results:

Statistical analysis revealed that the asymmetrical variants of front press at the lumbar level (P = .002) and roman chair and bent-over barbell row at the thoracic level (P < .0001, .001 respectively) were superior in increasing EMG amplitudes in the concavity of the scoliotic curve.

Conclusions:

Specific asymmetrical exercises increase EMG amplitudes of paraspinal muscles in the concavity. If confirmed in longitudinal studies measuring improvements of postural deficits, these exercises may advance care of patients with scoliosis.

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Laura C. Reid, Jason R. Cowman, Brian S. Green and Garrett F. Coughlan

Global positioning systems (GPS) are widely used in sport settings to evaluate the physical demands on players in training and competition. The use of these systems in the design and implementation of rehabilitation and return-to-running programs has not yet been elucidated.

Objective:

To demonstrate the application of GPS technology in the management of return to play in elite-club Rugby Union.

Design:

Case series.

Setting:

Professional Rugby Union club team.

Participants:

8 elite Rugby Union players (age 27.86 ± 4.78 y, height 1.85 ± 0.08 m, weight 99.14 ± 9.96 kg).

Intervention:

Players wore GPS devices for the entire duration of a club game.

Main Outcome Measures:

Variables of locomotion speed and distance were measured.

Results:

Differences in physical demands between playing positions were observed for all variables.

Conclusions:

An analysis of the position-specific physical demands measured by GPS provides key information regarding the level and volume of loads sustained by a player in a game environment. Using this information, sports-medicine practitioners can develop rehabilitation and return-to-running protocols specific to the player position to optimize safe return to play.

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Robert J. Delmore, Kevin G. Laudner and Michael R. Torry

Context:

Hip-adductor strains are among the most common lower-extremity injuries sustained in athletics. Treatment of these injuries involves a variety of exercises used to target the hip adductors.

Objective:

To identify the varying activation levels of the adductor longus during common hip-adductor exercises.

Design:

Descriptive study.

Setting:

Laboratory.

Participants:

24 physically active, college-age students.

Intervention:

None.

Main Measurement Outcomes:

Peak and average electromyographic (EMG) activity of the adductor longus muscle during the following 6 hip-adductor rehabilitation exercises: side-lying hip adduction, ball squeezes, rotational squats, sumo squats, standing hip adduction on a Swiss ball, and side lunges.

Results:

The side-lying hip-adduction exercise produced more peak and average activation than any other exercise (P < .001). Ball squeezes produced more peak and average activation than rotational squats, sumo squats, and standing adduction on a Swiss ball (P < .001). Ball squeezes had more average activation than side lunges (P = .001). All other variables for peak activation during the exercises were not statistically significant (P > .08). These results allowed the authors to provide an overall ranking system (highest to lowest muscle activation): side-lying hip adduction, ball squeezes, side lunges, standing adduction on a Swiss ball, rotational squats, and sumo squats.

Conclusion:

The study provides a ranking system on the activation levels of the adductor longus muscle for 6 common hip-adductor rehabilitation exercises, with the side-lying hip-adduction and ball-squeeze exercises displaying the highest overall activation.

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Harpa Helgadottir, Eythor Kristjansson, Sarah Mottram, Andrew Karduna and Halldor Jonsson Jr.

Clinical theory suggests that altered alignment of the shoulder girdle has the potential to create or sustain symptomatic mechanical dysfunction in the cervical and thoracic spine. The alignment of the shoulder girdle is described by two clavicle rotations, i.e, elevation and retraction, and by three scapular rotations, i.e., upward rotation, internal rotation, and anterior tilt. Elevation and retraction have until now been assessed only in patients with neck pain. The aim of the study was to determine whether there is a pattern of altered alignment of the shoulder girdle and the cervical and thoracic spine in patients with neck pain. A three-dimensional device measured clavicle and scapular orientation, and cervical and thoracic alignment in patients with insidious onset neck pain (IONP) and whiplash-associated disorder (WAD). An asymptomatic control group was selected for baseline measurements. The symptomatic groups revealed a significantly reduced clavicle retraction and scapular upward rotation as well as decreased cranial angle. A difference was found between the symptomatic groups on the left side, whereas the WAD group revealed an increased scapular anterior tilt and the IONP group a decreased clavicle elevation. These changes may be an important mechanism for maintenance and recurrence or exacerbation of symptoms in patients with neck pain.

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Gregory M. Gutierrez, Nicole D. Jackson, Kristin A. Dorr, Sarah E. Margiotta and Thomas W. Kaminski

Context:

Lateral ankle sprains occur more frequently than any other orthopedic injury. Athletes often report sustaining more injuries late in competition when fatigue is present.

Objective:

To evaluate neuromuscular function of the ankle musculature after fatigue. Design: Experimental, pretest-posttest.

Setting:

Research laboratory.

Participants:

Ten female and 9 male college-aged subjects.

Intervention:

Fatigue was induced via continuous concentric and eccentric muscle actions of the ankle: inversion (INV), eversion (EV), plantar flexion (PF), and dorsiflexion (DF).

Main Outcome Measures:

Peak torque (PT), peak EMG, and median frequency (MF) were calculated prefatigue and postfatigue in the tibialis anterior (TA), peroneus longus (PER), and lateral gastrocnemius (GAS) muscles.

Results:

Main effects were noted for test (P < 0.0125) in all statistical tests performed indicating changes in PT, peak EMG, and MF after fatigue.

Conclusions:

A significant decrease in MF of the PER muscle after PF fatigue and corresponding with a decreased firing rate, may be of importance, especially with regard to the role in countering the violent moment seen with inversion ankle sprains.