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Jorg Teichmann, Edin K. Suwarganda, Claudia Lendewig, Barry D. Wilson, Wee Kian Yeo, Ramlan Abdul Aziz and Dietmar Schmidtbleicher

Context:

The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances.

Objective:

This study investigated the effectiveness of the UDP in the last 6 wk of rehabilitation.

Design:

Pre–post study with 2-tailed paired t tests for limited a priori comparisons to examine differences.

Setting:

National Sports Institute of Malaysia.

Participants:

24 Malaysian national athletes.

Interventions:

7 sessions/wk of 90 min with 3 sessions allocated for 5 or 6 UDP exercises.

Main Outcomes:

Significant improvements for men and women were noted. Tests included 20-m sprint, 1-repetition-maximum single-leg press, standing long jump, single-leg sway, and a psychological questionnaire.

Results:

For men and women, respectively, average strength improvements of 22% (d = 0.96) and 29% (d = 1.05), sprint time of 3% (d = 1.06) and 4% (d = 0.58), and distance jumped of 4% (d = 0.59) and 6% (d = 0.47) were noted. In addition, athletes reported improved perceived confidence in their abilities. All athletes improved in each functional test except for long jump in 2 of the athletes. Mediolateral sway decreased in 18 of the 22 athletes for the injured limb.

Conclusion:

The prevention training with UDP resulted in improved conditioning and seems to decrease mediolateral sway.

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Robert C. Hilliard, Lindsey Blom, Dorice Hankemeier and Jocelyn Bolin

Context:

Athletic identity has been associated with rehabilitation overadherence in college athletes.

Objectives:

To explore which constructs of athletic identity predict rehabilitation overadherence, gauge athletes’ views of the most salient aspect of their athletic participation, and understand their perceptions of the reasons they adhere to their rehabilitation program.

Design:

Cross-sectional, mixed methods.

Setting:

University athletic training clinics and online.

Participants:

Currently injured college athletes (N = 80; 51 male, 29 female).

Main Outcome Measures:

Athletic Identity Measurement Scale (AIMS), Rehabilitation Overadherence Questionnaire (ROAQ), and 2 open-ended questions about athletic participation and rehabilitation adherence.

Results:

Higher levels of athletic identity were associated with higher levels of rehabilitation overadherence (r = .29, P = .009). Hierarchical multiple regression used on AIMS subscales to predict ROAQ subscales did not reveal a significant model for the subscale “ignore practitioner recommendations.” However, a significant model was revealed for the subscale “attempt an expedited rehabilitation,” F 5,73 = 2.56, P = .04, R 2 = .15. Negative affectivity was the only significant contribution to the equation (β = 0.33, t = 2.64, P = .01). Content analysis revealed that bodily benefits, sport participation, personal achievement, social relationships, and athlete status were perceived to be the most important aspects of being an athlete. The themes of returning to competition, general health, and relationship beliefs were identified as the major factors for adhering to a rehabilitation program.

Conclusions:

Negative affectivity accounted for a significant but low amount of variance for rehabilitation overadherence, suggesting that athletic trainers should pay attention to personal variables such as athletic identity that might influence the rehabilitation process. Using the knowledge of why athletes adhere to their rehabilitation and what is most important to them about being an athlete, athletic trainers can use appropriate interventions to facilitate proper rehabilitation adherence.

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Aleksandra Luszczynska, Agnieszka Gregajtys and Charles Abraham

An intervention designed to enhance preaction self-efficacy beliefs (i.e., beliefs about ability to initiate behavior despite anticipated barriers during the initiation period) was tested in patients with spondylosis in relation to initiation of exercises recommended by a consultant in orthopedic rehabilitation. Sixty patients (age 28–83 years; 44% men) with spondylosis who had not previously performed exercises recommended for degenerative spine diseases were randomly assigned to a control (education session) or intervention group. Three weeks later, intervention patients performed recommended exercises more frequently than controls. Regression analysis for all patients showed that preintervention, preaction self-efficacy predicted exercise. Age and preintervention self-efficacy moderated the intervention effects. Among older patients, only those with weak preintervention, preaction self-efficacy beliefs benefited from the intervention, whereas among younger patients, only those with strong preintervention, preaction self-efficacy beliefs benefited from the intervention.

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Gareth R. Jones, Jennifer M. Jakobi, Albert W. Taylor, Rob J. Petrella and Anthony A. Vandervoort

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 ± 6.0 years; 24 women; 71 ± 23 days post–hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity–strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post–hip fracture.

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Leslie Podlog, Sophie M. Banham, Ross Wadey and James C. Hannon

The purpose of this study was to examine athlete experiences and understandings of psychological readiness to return to sport following a serious injury. A focus group and follow-up semistructured interviews were conducted with seven English athletes representing a variety of sports. Three key attributes of readiness were identified including: (a) confidence in returning to sport; (b) realistic expectations of one’s sporting capabilities; and (c) motivation to regain previous performance standards. Numerous precursors such as trust in rehabilitation providers, accepting postinjury limitations, and feeling wanted by significant others were articulated. Results indicate that psychological readiness is a dynamic, psychosocial process comprised of three dimensions that increase athletes’ perceived likelihood of a successful return to sport following injury. Findings are discussed in relation to previous research and practical implications are offered.

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Joni S. Yates, Stephanie Studenski, Steven Gollub, Robert Whitman, Subashan Perera, Sue Min Lai and Pamela W. Duncan

This study evaluated the feasibility, safety, and findings from a protocol for exercise-bicycle ergometry in subacute-stroke survivors. Of 117 eligible candidates, 14 could not perform the test and 3 discontinued because of cardiac safety criteria. In the 100 completed tests, peak heart rate was 116 ± 19.1 beats/min; peak VO2 was 11.4 ± 3.7 ml · kg · min−1, peak METs were 3.3 ± 0.91, exercise duration was 5.1 ± 2.84 min., and Borg score was 14 ± 2.6. Among 71 tests, anaerobic threshold was achieved in 3.0 ± 1.7 min with a VO2 of 8.6 ± 1.7 ml · kg · min−1. After screening, this protocol is feasible and safe in subacute-stroke survivors with mild to moderate deficits. These stroke survivors have severely limited functional exercise capacity. Research and clinical practice in stroke rehabilitation should incorporate more comprehensive evaluation and treatment of endurance limitations.

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Lindsey K. Lepley and Timothy A. Butterfield

Eccentric exercise is able to mechanically engage muscle, initiating strain-sensing molecules that promote muscle recovery by inducing beneficial adaptations in neural activity and muscle morphology, 2 critical components of muscle function that are negatively altered after injury. However, due to misinterpreted mathematic modeling and in situ and in vitro stretch protocols, a dogma that exposing muscle to eccentric exercise is associated with injury has been perpetuated in the literature. In response, clinicians have been biased toward using concentric exercise postinjury to improve the recovery of muscle function. Unfortunately, this conventional approach to rehabilitation does not restore muscle function, and reinjury rates remain high. Here, the authors present experimental evidence and theoretical support for the idea that isolated eccentric exercise is ideally suited to combat muscle inhibition and muscle strains and is an attractive alternative to concentric exercise.

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Jeffrey J. Dueweke, Tariq M. Awan and Christopher L. Mendias

Eccentric-contraction-induced skeletal muscle injuries, included in what is clinically referred to as muscle strains, are among the most common injuries treated in the sports medicine setting. Although patients with mild injuries often fully recover to their preinjury levels, patients who suffer moderate or severe injuries can have a persistent weakness and loss of function that is refractory to rehabilitation exercises and currently available therapeutic interventions. The objectives of this review were to describe the fundamental biophysics of force transmission in muscle and the mechanism of muscle-strain injuries, as well as the cellular and molecular processes that underlie the repair and regeneration of injured muscle tissue. The review also summarizes how commonly used therapeutic modalities affect muscle regeneration and opportunities to further improve our treatment of skeletal muscle strain injuries.

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Michael D. Ross, Shelly Hooten and Darren Moore

Objective:

To determine the relationship between asymmetries in lower leg girth and standing heel-rise after anterior cruciate ligament (ACL) reconstruction.

Design:

Single-group posttest.

Participants:

15 at a mean of 30 d after ACL reconstruction.

Measurements:

Lower leg girth and number of repetitions performed on the standing heel-rise test.

Results:

A significant decrease in lower leg girth and number of repetitions performed on the standing heel-rise test for the involved leg. There was also a low correlation between asymmetries in lower leg girth and standing heel-rise test (r = .25).

Conclusion:

Ankle plantar-flexor endurance should be considered when developing rehabilitation programs for the early stages after ACL reconstruction. In this study the ankle of the involved leg attained a significantly smaller angle of maximal standing plantar flexion, suggesting that ankle range of motion should also be assessed. Caution should be used in predicting standing heel-rise asymmetries from asymmetries in lower leg girth in ACL-reconstructed patients.

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Joseph B. Myers

Shoulder pain is a common complaint among overhead athletes. Oftentimes, the cause of pain is impingement of the supraspinatus, bicipital tendon, and subacromial bursa between the greater tuberosity and the acromial arch. The mechanisms of impingement syndrome include anatomical abnormalities, muscle weakness and fatigue of the glenohumeral and scapular stabilizers, posterior capsular tightness, and glenohumeral instability. In order to effectively manage impingement syndrome nonoperatively, the therapist must understand the complex anatomy and biomechanics of the shoulder joint, as well as how to thoroughly evaluate the athlete. The results of the evaluation can then be used to design and implement a rehabilitation program that addresses the cause of impingement specific to the athlete. The purpose of this article is to provide readers with a thorough overview of what causes impingement and how to effectively evaluate and conservatively manage it in an athletic population.