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Lisa Gorman

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Kanako Shimoura, Yasuaki Nakayama, Yuto Tashiro, Takayuki Hotta, Yusuke Suzuki, Seishiro Tasaka, Tomofumi Matsushita, Keisuke Matsubara, Mirei Kawagoe, Takuya Sonoda, Yuki Yokota and Tomoki Aoyama

Context: The functional movement screen (FMS) is an assessment tool for movement dysfunction, which is used to reduce the risk of injury. Although the relationship between the FMS composite score and injuries has been extensively studied, the association between FMS scores and injuries in only college basketball players remains unknown. Objective: To examine the relationship between the FMS score and injuries in basketball players. Design: Cross-sectional study. Setting: University research laboratory. Participants: Eighty-one male college basketball players (average age 20.1 [1.3] y) participated. Main Outcome Measures: The FMS composite score was calculated from 7 movement tests. The incidence of injuries over a 1-year period prior to the test day was determined based on a questionnaire. Individuals were categorized into 2 groups: injury (with a serious basketball-related injury resulting in the loss of practice and game time for at least 4 wk) and noninjury groups. Mann–Whitney U and chi-square tests were used to evaluate group differences in the composite FMS and 7 movement scores, respectively. Furthermore, the scores significant on univariate analyses were submitted to a multivariate logistic analysis, adjusting for participant characteristics. Results: The composite FMS scores of the 2 groups were not significantly different (P = .38). Among the 7 tasks, only the deep squat and hurdle step showed significant group differences (P = .03 and P = .001, respectively). The multivariate logistic analysis revealed that deep squat (odds ratio, 6.48; 95% confidence interval, 1.23–34.01; P = .03) and hurdle step scores (odds ratio, 25.80; 95% confidence interval, 1.81–368.73; P = .02) were significantly associated with injuries, even after adjustment for participant characteristics. Conclusions: Deep squat and hurdle step scores may be associated with injuries in basketball players. Further research should be conducted to confirm that these 2 scores can predict the incidence of injuries in basketball players.

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Matthew K. Seeley, Ryan P. Sandberg, Joshua F. Chacon, Merrill D. Funk, Neil Nokes and Gary W. Mack

Context:

Individuals using traditional axillary crutches to ambulate expend approximately twice as much energy as individuals who perform able-bodied gait. A relatively novel spring-loaded crutch now being marketed may reduce metabolic energy expenditure during crutch ambulation. This idea, however, had not yet been tested.

Objective:

To determine whether the novel spring-loaded crutch reduces oxygen consumption during crutch ambulation, relative to traditional-crutch ambulation. A secondary purpose was to evaluate the design for subject-perceived comfort and ease of use.

Design:

Within-subject.

Setting:

Indoor track.

Participants:

10 able-bodied men and 10 able-bodied women.

Interventions:

The independent variable was crutch design. Each subject ambulated using 3 different crutch designs (traditional, spring-loaded, and modified spring-loaded), in a randomized order.

Main Outcome Measures:

The primary dependent variable was oxygen consumption. Secondary dependent variables were subject-perceived comfort and ease of use, as rated by the subjects using a 100-mm visual analog scale. Dependent variables were compared among the 3 crutch designs using a 1-way repeated-measures ANOVA (α = .05).

Results:

Oxygen consumption during spring-loaded-crutch ambulation (17.88 ± 2.13 mL · kg−1 · min−1) was 6.2% greater (P = .015; effect size [ES] = .50) than during traditional axillary-crutch ambulation (16.84 ± 2.08 mL · kg−1 · min−1). There was no statistically significant difference (P = .068; ES = −.45) for oxygen consumption between spring-loaded-crutch ambulation and ambulation using the modified crutch (17.03 ± 1.61 mL · kg−1 · min−1). Subjects perceived the spring-loaded crutch to be more comfortable (P < .001; ES = .56) than the traditional crutch. There was no difference (P = .159; ES = −.09) between the spring-loaded and traditional crutches for subject-perceived ease of use.

Conclusions:

Compared with traditional axillary crutches, the novel spring-loaded crutch may be more comfortable but does not appear to benefit subjects via reduced metabolic energy expenditure.

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Steven Nagib and Shelley W. Linens

Clinical Scenario: Every year, millions of people suffer a concussion. A significant portion of these people experience symptoms lasting longer than 10 days and are diagnosed with postconcussion syndrome. Dizziness is the second most reported symptom associated with a concussion and may be a predictor of prolonged recovery. Clinicians are beginning to incorporate vestibular rehabilitation therapy (VRT) in their postconcussion treatment plan, in order to address the dysfunctional inner ear structures that could be causing this dizziness. Focused Clinical Question: Can VRT help postconcussion syndrome patients experiencing prolonged dizziness by improving their perceived disability? Summary of Key Findings: Three studies were included: 1 randomized control trial, 1 retrospective chart review, and 1 exploratory study. The randomized control trial compared cervical spine therapy alone to cervical spine therapy in conjunction with VRT to obtain medical clearance for sport. The chart review explored VRT as a treatment for reducing dizziness and improving balance and gait dysfunction. The exploratory study implemented VRT in conjunction with light aerobic exercise to improve perceived disability associated with dizziness postconcussion. All 3 studies found statistically significant decreases (improvements) in Dizziness Handicap Index scores. Clinical Bottom Line: There is preliminary evidence suggesting that VRT can improve perceived disability in patients with postconcussion syndrome experiencing prolonged dizziness. There is a decrease (improvement) in Dizziness Handicap Index scores across all 3 studies. VRT is a relatively safe treatment option, with no adverse reactions or case reports. Strength of Recommendation: There is level 2 and level 3 evidence supporting the use of VRT to treat patients suffering from dizziness postconcussion.

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Mary Lynn Manduca and Stephen J. Straub

Clinical Scenario: Hamstring strains are common athletic injuries, with a high-recurrence rate (34%). Recently, platelet-rich plasma (PRP) injections have gained popularity as a potential treatment option to accelerate healing of hamstring injury. Focused Clinical Question: Does the combination of PRP injection and rehabilitation decrease recovery time of acute hamstring injury as compared to rehabilitation alone in college athletes? Summary of Key Findings: A literature search resulted in 3 randomized controlled trials. One study showed benefits in various outcome measures with PRP, compared to rehabilitation alone, while 2 showed no benefits. One study reported improved pain, ultrasonography regenerative indications, and recovery time with PRP injection following acute hamstring injury; however, larger studies have shown no benefits. The literature demonstrates conflicting evidence regarding benefits of PRP injections in hamstring injuries. Clinical Bottom Line: At this time, PRP injections cannot be recommended as having value for hamstring injuries, compared to rehabilitation alone. Strength of Recommendation: Due to inconsistent or limited quality patient-oriented evidence in existing literature, the strength of this recommendation is grade B, based on the strength of recommendation taxonomy.

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Robert Rodriguez

Clinical Scenario: Ice hockey and soccer are both dynamic sports that involve continuous, unpredictable play. These athletes consistently demonstrate higher rates of groin strains compared with other contact sports. Measuring the hip adductor/abductor ratio has the potential to expose at-risk players, reduce injury rates, and preserve groin health in players with chronic strains. Focused Clinical Question: What is the clinical utility of measuring the hip adductor/abductor ratio for preseason and in-season ice hockey and soccer players? Summary of Key Findings: Three studies, all of which were prospective cohort designs, were included. One study involved assessing preseason strength and flexibility as a risk factor for adductor strains in professional ice hockey players. Another study performed with the same professional hockey team used preseason hip adductor/abductor strength ratios to screen for those players who would benefit from a strengthening intervention aimed at reducing the incidence of adductor strains. The final study, which was performed in elite U17 soccer players, assessed the effectiveness of monthly in-season strength monitoring as a guide to trigger in-season interventions to decrease injury incidence. Clinical Bottom Line: Measuring the hip adductor/abductor strength ratio in hockey and soccer players can be a beneficial preseason and in-season tool to predict future groin strain risk and screen for athletes who might benefit from a strengthening intervention. Strength of Recommendation: Level 3 evidence exists to support monitoring the hip adductor/abductor strength ratio to assess and reduce the risk of adductor strains in ice hockey and soccer players.

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Constantine P. Nicolozakes, Daniel K. Schneider, Benjamin D. Roewer, James R. Borchers and Timothy E. Hewett

Context: The functional movement screen (FMS™) is used to identify movement asymmetries and deficiencies. While obesity has been reported to impede movement, the correlation between body mass index (BMI), body fat percentage (BF%), and FMS™ in athletes is unknown. Objective: To determine if there is a relationship between BMI, BF%, and FMS™ scores in a sample of National Collegiate Athletic Association Division I football athletes. Design: Cross-sectional study. Setting: Biodynamics laboratory. Participants: A total of 38 male freshman football players (18.0 [0.7] y, 185.3 [5.5] cm, and 103.9 [20.3] kg). Interventions: Height, weight, and BF% were collected, and subjects underwent the FMS™ conducted by a certified athletic trainer. Main Outcome Measures: The dependent variables were BMI, BF%, composite FMS™ score, and 7 individual FMS™ test scores. Subjects were grouped as normal BMI (BMI < 30 kg/m2) or obese (BMI ≥ 30 kg/m2). A composite FMS™ score of ≤14 and an individual FMS™ score of ≤1 were classified as cutoffs for poor movement performance. Results: A negative correlation between composite FMS™ score and BMI approached significance (P = .07, ρ = .296). A negative correlation between composite FMS™ score and BF% was significant (P = .01, ρ = −.449). There was a significant difference in the number of obese subjects scoring below the composite FMS™ cutoff (χ 2 = 5.179, P = .02) and the individual FMS™ cutoff on the deep squat (χ 2 = 6.341, P = .01), hurdle step (χ 2 = 9.870, P = .002), and in-line lunge (χ 2 = 5.584, P = .02) when compared with normal BMI subjects. Conclusions: Increased BF% and BMI relate to lower composite FMS™ and individual FMS™ test scores, indicating potentially poor movement patterns in larger National Collegiate Athletic Association football athletes. Future research should focus on examining lower extremity–specific FMS™ tasks individually from composite FMS™ scores.

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Michael S. Guss, John P. Begly, Austin J. Ramme, David P. Taormina, Michael E. Rettig and John T. Capo

Context: Major League Baseball (MLB) players are at risk of hook of hamate fractures. There is a paucity of data assessing the effect of a hook of hamate fracture on MLB players’ future athletic performance. Objective: To determine if MLB players who sustain hook of hamate fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Design: Retrospective case-control design. Setting: Retrospective database study. Participants: 18 MLB players who sustained hook of hamate fractures. Methods: Data for 18 MLB players with hook of hamate fractures incurred over 26 seasons (1989–2014) were obtained from injury reports, press releases, and player profiles (www.mlb.com and www.baseballreference.com). Player age, position, number of years in the league, mechanism of injury, and treatment were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury for the main performance variable—Wins Above Replacement—were obtained. Eighteen controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Main Outcome Measures: Postinjury performance compared with preinjury performance and matched-controls. Results: Mean age at the time of injury was 25.1 years with a mean of 4.4 seasons of MLB experience prior to injury. All injuries were sustained to their nondominant batting hand. All players underwent operative intervention. There was no significant change in Wins Above Replacement or isolated power when preinjury and postinjury performance were compared. When compared with matched-controls, no significant decline in performance in Wins Above Replacement the first season and second season after injury was found. Conclusion: MLB players sustaining hook of hamate fractures can reasonably expect to return to their preinjury performance levels following operative treatment.

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Mahsa Jafari, Vahid Zolaktaf and Gholamali Ghasemi

protocol used in this research is based on the guidelines of National Academy of Sport Medicine (NASM). The NASM corrective exercise continuum recommends a 4-stage process to improve neuromusculoskeletal functional impairment by practicing functional movements. It suggests that the use of inhibiting

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Carlos Amo, Miguel Ortiz del Castillo, Rafael Barea, Luis de Santiago, Alejandro Martínez-Arribas, Pedro Amo-López and Luciano Boquete

Objective:

Propose a simplified method applicable in routine clinical practice that uses EEG to assess induced gamma-band activity (GBA) in the 30–90 Hz frequency range in cerebral motor areas.

Design:

EEG recordings (25 healthy subjects) of cerebral activity (at rest, motor task). GBA was obtained as power spectral density (PSD). GBA — defined as the gamma index (Iγ) — was calculated using the basal GBA (γB) and motor GBA (γMOV) PSD values.

Results:

The mean values of Iγ were (Iγ R (right hand) = 1.30, Iγ L (left hand) = 1.22). Manual laterality showed a correlation with Iγ.

Conclusions:

Iγ may provide a useful way of indirectly assessing operation of activated motor neuronal circuits. It could be applied to diagnosis of motor area pathologies and as follow up in rehabilitation processes. Likewise, Iγ could enable the assessment of motor capacity, physical training and manual laterality in sport medicine.