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Glenn E. Cashman

Context:

It has been postulated that subjects with weak hip abductors and external rotators may demonstrate increased knee valgus, which may in turn raise risk of injury to the lower extremity. Recent studies have explored the potential link between hip strength and knee kinematics, but there has not yet been a review of this literature.

Objective:

To conduct a systematic review assessing the potential link between hip-abductor or external-rotator strength and knee-valgus kinematics during dynamic activities in asymptomatic subjects.

Evidence Acquisition:

An online computer search was conducted in early February 2011. Databases included Medline, EMBASE, CINAHL, SPORTDiscus, and Google Scholar. Inclusion criteria were English language, asymptomatic subjects, dynamometric hip-strength assessment, single or multicamera kinematic analysis, and statistical analysis of the link between hip strength and knee valgus via correlations or tests of differences. Data were extracted concerning subject characteristics, study design, strength measures, kinematic measures, subject tasks, and findings with regard to correlations or group differences.

Evidence Synthesis:

Eleven studies were selected for review, 4 of which found evidence that subjects with weak hip abductors or external rotators demonstrated increased knee valgus, and 1 study found a correlation to the contrary.

Conclusions:

There is a small amount of evidence that healthy subjects with weak hip abductors and perhaps weak external rotators demonstrate increased knee valgus. However, due to the variation in methodology and lack of agreement between studies, it is not possible to make any definitive conclusions or clinical recommendations based on the results of this review. Further research is needed.

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Michael F. Bergeron

In contrast to muscle cramps that are brought on by muscle overload or fatigue, exertional heat cramps seem to be prompted by extensive sweating and a significant sweat-induced whole-body sodium deficit. As a result of a consequent contracted interstitial compartment, axon terminals of selected motor neurons can become hyper-excitable and spontaneously discharge. Barely detectable muscle fasciculations or “twitches” in the affected muscles can rapidly progress to debilitating muscle cramps in just 20 to 30 minutes. To aid recovery, salt (NaCl) and water lost from sweating should be sufficiently replaced so as to restore the extracellular volume and interstitial fluid spaces. Sweat sodium, chloride, and fluid losses incurred during training and competition need to be closely matched by daily salt and fluid intake, in order to prevent an excessive sodium deficit, maintain sufficient fluid balance, and avoid exertional heat cramps.

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Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García and Victor Paredes-Hernández

Context: Despite the presence of various injury prevention programs, the rate of hamstring injuries and reinjuries is increasing in soccer, warranting the need for a soccer-specific rehabilitation program. Objective: To develop and validate a new, functional on-field program for the rehabilitation and readaptation of soccer players after a hamstring strain injury through a panel of experts; and determine the usefulness of the program through its application in professional soccer players. Design: A 13-item program was developed, which was validated by a panel of experts and later applied to professional soccer players. Setting: Soccer training ground. Participants: Fifteen strength and conditioning and rehabilitation fitness coaches with a professional experience of 15.40 (1.57) years in elite clubs and national teams in Europe validated the program. The program was later applied to 19 professional soccer players of the Spanish First Division (La Liga). Interventions: Once a player sustained a clinically diagnosed injury, the player would first be subject to mobilization and strengthening exercises in the gym after undergoing treatment by percutaneous needle electrolysis. The player would then complete an on-field readaptation program consisting of 13 drills arranged in a progressive manner in terms of complexity. The drills integrated various aspects of repeated sprint abilities, retraining and reeducation of biomechanical patterns, and neuromuscular control of the core and lower limbs. Main Outcome Measures: Aiken’s V for each item of the program and number of days taken by the players to return to play. Results: The experts evaluated all items of the program very highly, as seen from Aiken’s V values between 0.78 and 0.98 (0.63–0.99) for all drills, while the return to play was in 22.42 (2.32) days. Conclusion: This program has the potential to help a player suffering from a hamstring strain injury to adapt to real-match conditions in the readaptation phase through the application of sports-specific drills that were very similar to the different injury mechanisms.

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Ross Armstrong

specificity of 0.9, and, with lumbar flexion removed, a score of 0.5 provided a sensitivity of 1.0 and a specificity of 0.9. These values may aid injury management and training load monitoring by allowing clinicians to monitor dancers within this sensitivity and specificity continuum for specific total

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Virginie de Bressy de Guast, Jim Golby, Anna Van Wersch and Fabienne d’Arripe-Longueville

This study presents a complete psychological skills training (PST) program with a wheelchair athlete and examines the program effectiveness using a mixed-method approach. After initial testing, the athlete followed a two-month program of self-confidence building, motivational, visualization/relaxation, and injury management techniques. Quantitative and qualitative methods were used to examine the impacts on performance and psychological abilities. The triangulated results suggest that the PST program was perceived as effective by the athlete in terms of his sporting performances and mental skills. The characteristics and implications of a PST program with this wheelchair athlete are discussed, as well as the study limitations and the perspectives for future research.

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William R. Holcomb

Electrical therapy is a popular therapeutic modality for the management and rehabilitation of athletic injuries. Electrical stimulation is commonly used to elicit muscle contraction, reduce edema, and control pain. However, electrical therapy can also be a tremendous challenge for clinicians. The purpose of this paper is to present current and accurate information that will serve as a guide In the use of electrical therapy for the effective management of athletic injuries. With an understanding of the basic current types provided by various electrical stimulators and the modifications of the currents that are available, electrical therapy becomes an invaluable tool for injury management and rehabilitation.

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William J. Kraemer, Jill A. Bush, Robbin B. Wickham, Craig R. Denegar, Ana L. Gomez, Lincoln A. Gotshalk, Noel D. Duncan, Jeff S. Volek, Robert U. Newton, Margot Putukian and Wayne J. Sebastianelli

Context:

Prior investigations using ice, massage, or exercise have not shown efficacy in relieving delayed-onset muscle soreness.

Objectives:

To determine whether a compression sleeve worn immediately after maximal eccentric exercise enhances recovery.

Design:

Randomized, controlled clinical study.

Setting:

University sports medicine laboratory.

Participants:

Fifteen healthy, non-strength-trained men, matched for physical criteria, randomly placed in a control group or a continuous compression-sleeve group (CS).

Methods and Measures:

Subjects performed 2 sets of 50 arm curls. 1RM elbow flexion at 60°/s, upper-arm circumference, resting-elbow angle, serum creatine kinase (CK), and perception-of-soreness data were collected before exercise and for 3 days.

Results:

CK was significantly (P < .05) elevated from the baseline value in both groups, although the elevation in the CS group was less. CS prevented loss of elbow extension, decreased subjects’ perception of soreness, reduced swelling, and promoted recovery of force production.

Conclusions:

Compression is important in soft-tissue-injury management.

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John Heil

Expectations regarding pain tolerance are imbedded in the culture of sport, and bear heavily on pain and injury management. The athlete’s experience of pain is an encounter with core issues in the ethos of sport. As such, pain behavior not only influences performance but also is seen as defining character. This case study looks at the pain experience of a track and field athlete over a several-hour period from initial injury to stabilization, blending the perspective of athlete and sport psychologist. As the injury experience evolved, a complex set of interacting biological, psychological and social factors came into play, which alternately facilitated and inhibited the pain experience and which influenced action taken in response to pain.

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Ian W. Ford and Sandy Gordon

A two-part study was used to survey sport trainers and athletic therapists on both the frequency and significance of emotions and behaviors displayed by athletes during treatment and the importance of psychological techniques in injury management. A questionnaire, developed from a preliminary study with experienced sport trainers (Part 1), was mailed to sport trainers in Australia and New Zealand and athletic therapists in Canada(Part 2). Responses from Australian (n = 53), New Zealand (n = 11), and Canadian (n = 32) participants suggested that (a) wanting to return to play too soon, anxiety and frustration, noncompliance, and denial were experienced frequently by injured athletes during rehabilitation and significantly hindered effective recovery; (b) psychological skills training and learning to deal with psychological responses to injury would facilitate more effective treatment; and (c) athletes' self-presentation styles influence the support and attention received from trainers/therapists. Findings suggest that the applied sport psychology content of professional training programs for sport trainers and athletic therapists should be extended.

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Neil Maguire, Paul Chesterton and Cormac Ryan

Context: Pain education is a fundamental part of a holistic approach to athlete injury management. Objective: To investigate the effect of pain neuroscience education (PNE) on sports therapy and rehabilitation students (1) knowledge of persistent pain, (2) attitudes toward athletes with persistent pain, and (3) clinical recommendations for athletes with persistent pain. Design: Parallel groups, single-blind randomized control trial. Setting: A university in the United Kingdom. Participants: Sixty-one undergraduate and postgraduate sports therapy and rehabilitation students. Interventions: The PNE session (intervention group) provided detailed information on the neuroscience of persistent pain, the modulating role of psychosocial factors on pain biology, and how this information could be used to inform clinical practice. The red flags (control group) session provided information on screening patients with persistent pain for serious/sinister pathologies. Each education session lasted 70 minutes. Outcome measures: (1) Knowledge—the Revised Pain Neurophysiology Questionnaire; (2) Attitudes—the Health Care Pain Attitudes and Impairment Relationship Scale; and (3) Clinical recommendations—an athlete case vignette. Results: Posteducation, the PNE group had a greater increase in pain neuroscience knowledge (mean difference 3.2; 95% confidence interval [95% CI], 2.1 to 4.3; P < .01) and improved attitudes (mean difference −10.1; 95% CI, −16.6 to −3.6; P < .01). In addition, students in the PNE group were more likely to make appropriate clinical recommendations (odds ratio [OR]; 95% CI) regarding return-to-work (OR = 6.1; 95% CI, 1.1 to 32.3; P = .03), exercise (OR = 10.7; 95% CI, 2.6 to 43.7; P ≤ 01), and bed rest (OR = 4.3; 95% CI, 1.5 to 12.8; P = 01). Conclusion: A brief PNE session can, in the immediate term, increase sports therapy and rehabilitation students’ knowledge of pain neuroscience, improve attitudes toward athletes with pain, and shift their clinical recommendations in line with current guidelines. Such changes could lead to enhanced rehabilitation for athletes with persistent pain.