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Eleftherios Paraskevopoulos, Georgios Gioftsos, Georgios Georgoudis, and Maria Papandreou

Adherence to exercise rehabilitation has been shown to be an important factor that may influence successful treatment. In professional athletes, a significant reduction in exercise adherence delays recovery. The aim of this study was to explore barriers to and facilitators of exercise rehabilitation adherence in injured volleyball athletes. Eight professional volleyball athletes were recruited, and qualitative data were collected using semistructured interviews. All athletes had completed their rehabilitation program after they had suffered a musculoskeletal injury. All data were analyzed using thematic analysis after the investigators ensured that saturation had been reached. Pain was identified as a significant barrier to exercise adherence by all athletes. The provision of social support, including mental, practical, and task related, also had a significant positive impact. The athletes’ ability to develop the necessary coping strategies and confidence on performing exercises at home was also mentioned as a factor that affected exercise adherence, although less often.

Open access

Melissa Theige and Shannon David

effective at rehabilitating some athletes with acetabular labral tears. However, this method should not be applied to every athlete based on the low strength of current research. Treatment plans should be decided upon on a case-by-case basis. Strength of Recommendation The studies located were of low

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Timothy A. Kulpa, Jamie Mansell, Anne Russ, and Ryan Tierney

did not discuss limitations of their studies and two studies 25 , 27 failed to report measures of variability. Clinical Bottom Line There is moderate evidence to support the inclusion of aerobic and SST exercise in the multimodal treatment plan for patients after concussions. All five articles

Open access

Emily R. Hunt, Cassandra N. Parise, and Timothy A. Butterfield

of patient function, as well as patient strength at long-term follow-ups. However, patient goals, normal activities of daily living, and sport activity level should all be taken into consideration when choosing the best treatment plan for patients. Furthermore, the absence of randomized control

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Doyglas R. Keskula, Jewell B. Duncan, and Virginia L. Davis

This paper describes the rehabilitation of a patient following a medial meniscus transplant. Both preoperative and postoperative history and relevant physical findings are presented. Rehabilitation goals and the corresponding treatment plan are discussed, with an emphasis on functional outcomes. A general framework for treatment addressing impairment and functional goals is outlined. Progression of the rehabilitation program was based on surgical precautions and the patient's tolerance to the exercise progression. This case study demonstrates that appropriate surgical intervention combined with a properly designed rehabilitation program contributed to the improved functional abilities of this patient.

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Danny Pincivero, Joe H. Gieck, and Ethan N. Saliba

A treatment and rehabilitation protocol was implemented on a university football player sustaining a second-degree lateral ankle sprain. The initial treatment plan involved the application of the RICE principle (rest, ice, compression, and elevation). This particular rehabilitation protocol was aimed at restoring range of motion and function at the earliest possible time with the use of a cryokinetic technique developed by Knight and with progressive exercise. The subject in this case study returned to full participation 6 days postinjury. The results from this report indicate that a program of cryokinetics and functional progressive exercise performed within pain-free limits can greatly enhance the return of an athlete to competition.

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Karen M. Griffin, Cindy O. Henry, and J. W. Thomas Byrd


To explain the basic fundamentals of patient assessment after hip arthroscopy, formulation of a treatment plan, and detailed essentials of postoperative rehabilitation.

Data Sources:

Established literature and the evolution of a protocol developed in treating over 150 hip-arthroscopy patients and numerous patients with symptomatic hip disease.

Data Synthesis:

Although the pathological process being addressed and the surgical technique employed in its management influence the protocol, the common goals of rehabilitation are to reduce discomfort and improve function. These common goals, first realized in the postoperative rehabilitation process, have been found to have similar application in the conservative management of patients with symptomatic hip disease.


Arthroscopy has necessitated the development of a postoperative rehabilitation protocol. Principles previously employed in other joints are now finding application in the hip.

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Lori A. Michener

Outcome measures can be classified as clinician rated and patient rated. Clinician-rated measures predominantly assess impairments, whereas patient-rated measures, also known as patient-based measures, are designed to evaluate the impact of the injury on a patient’s daily activities, work, and recreation. Currently, there is a greater reliance on clinician-rated impairment measures for clinical decision making, specifically with treatment planning and assessing outcomes of care. To comprehensively evaluate the effect of an injury, patient-rated outcome measures must be used because they allow for the assessment of a patient’s ability to perform daily activities and participate in work and recreation that is affected by an injury. Clinician-rated impairment measures should be used to guide the development of a treatment program, and patient-rated measures should be used for both treatment-program development and assessing treatment outcomes in daily clinical practice. The purposes of this article are to describe patient- and clinician-rated outcome measures and to provide guidance and illustrate the benefits of the use of these measures in clinical decision making and documenting outcomes of care.

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Alyssa Muething, Shellie Acocello, Kimberly A. Pritchard, Stephen F. Brockmeier, Susan A. Saliba, and Joseph M. Hart


Understanding how muscles activate in a population with a previous glenohumeral-joint (GH) injury may help clinicians understand how to build a conservative treatment plan to strengthen or activate the specific muscles in an attempt to reduce recurrent shoulder injury and development of GH laxity.


To investigate muscle-activation differences between the previously injured limb of individuals with a history of GH-joint injury and healthy matched controls during functional isometric contractions.


Case control.


University research laboratory.


17 individuals (8 women, 9 men; age 22.3 ± 2.6 y, height 172.4 ± 8.8 cm, mass 75.4 ± 16.5 kg) with previous unilateral shoulder pain and 17 (8 women, 9 men; age 22.9 ± 3.9 y, height 170.9 ± 11.3 cm, mass 73.6 ± 22.9 kg) with no history of shoulder pain or injury.


Diagnostic ultrasound measurements of the supraspinatus were completed in both resting and contracted states to assess changes in muscle thickness. Manual muscle tests (anterior deltoid, upper trapezius, infraspinatus, lower trapezius, serratus anterior) and functional isometric contractions (forward flexion, scaption, abduction) were measured using electromyography.

Main Outcome Measures:

Peak, normalized activation of each muscle and supraspinatus thickness activation ratio were compared between groups and bilaterally within groups using separate ANOVAs.


The anterior deltoid was significantly less activated during all functional isometric tasks in previously injured subjects than in healthy subjects (P = .024). In previously injured subjects, the involved limb-lower trapezius was significantly less activated during scaption and abduction tasks than the contralateral side (P = .022 and P = .031, respectively).


There were decreases in muscle activation in the anterior deltoid between previously injured and healthy people, as well as in the lower trapezius, in previously injured subjects. Understanding the source of muscle-activation deficits can help clinicians focus rehabilitation exercises on specific muscles.

Open access

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.