Showing papers in "The International journal of sports physical therapy in 2015"

The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review.

Abstract: Background Self‐myofascial release (SMR) is a popular intervention used to enhance a client's myofascial mobility. Common tools include the foam roll and roller massager. Often these tools are used as part of a comprehensive program and are often recommended to the client to purchase and use at home. Currently, there are no systematic reviews that have appraised the effects of these tools on joint range of motion, muscle recovery, and performance.

Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes

Abstract: Background: Increased flexibility is often desirable immediately prior to sports performance. Static stretching (SS) has historically been the main method for increasing joint range‐of‐motion (ROM) acutely. However, SS is associated with acute reductions in performance. Foam rolling (FR) is a form of self‐myofascial release (SMR) that also increases joint ROM acutely but does not seem to reduce force production. However, FR has never previously been studied in resistance‐trained athletes, in adolescents, or in individuals accustomed to SMR.

Relationship between the y balance test scores and soft tissue injury incidence in a soccer team

Abstract: Background Although the dynamic balance has been proposed as a risk factor for sports-related injuries, few researchers have used the Y balance test to examine this relationship. The purpose of this study was to determine if the Y Balance Test (YBT) is a valid test for determining subjects susceptible to soft tissue injury among soccer players on a professional team. Study design Prospective cohort. Methods and measures Prior to the 2011 football (soccer) season, the anterior, posteromedial and posterolateral YBT reach distances and limb lengths of 74 soccer players were measured. Athletes' physiotherapists documented how many days the players were unable to play due to the injuries. After normalizing for lower limb length, each of the reach distances, right/left reach distance difference and composite reach distance were examined using odds ratios and logistic regression analysis. Results Logistic regression models indicated that players with a difference of equal or greater than 4cm between lower limbs in posteromedial direction were 3.86 more likely to sustain a lower extremity injury (p=0.001). Results indicate that players who had lower scores than the mean in each reach direction, independently, were almost two times more likely to sustain an injury. Conclusions The results suggest that YBT can be incorporated into physical examinations to identify soccer players who are susceptible to risk of injury. Level of evidence 2b.

Association between the functional movement screen and injury development in college athletes.

Abstract: Background As the number of sports participants continues to rise, so does the number of sports injuries. Establishing a valid method of identifying athletes at elevated risk for injury could lead to intervention programs that lower injury rates and improve overall athlete performance. The Functional Movement Screen (FMS)™ is an efficient and reliable method to screen movement patterns during the performance of specific tasks. The purpose of this study is to explore the association between pre-season FMS TM scores and the development of injury in a population of collegiate athletes. Study design Descriptive epidemiology study. Methods FMS™ scores were obtained for 160 collegiate athletes and injury development was tracked throughout the season. These athletes were both male and female and participated in contact and non-contact sports. Redundancies were utilized with injury data collection, including medical record reviews and interviews with team athletic trainers, to ensure that all injuries requiring medical attention were captured. At the conclusion of the season, a logistic regression analysis was performed to determine which combination of factors best predicted injury. Results Athletes with an FMS™ composite score at 14 or below combined with a self-reported past history of injury were at 15 times increased risk of injury. A positive likelihood ratio of 5.8 was calculated which improved the probability of predicting injury from 33% pretest to 74% posttest. Conclusions This study adds to the growing body of evidence demonstrating a predictive relationship between FMS™ composite scores and past history of injury with the development of future injury. Level of evidence 3, Non-random prospective cohort design.

Current concepts of plyometric exercise

Abstract: As knowledge regarding rehabilitation science continues to increase, exercise programs following musculoskeletal athletic injury continue to evolve. Rehabilitation programs have drastically changed, especially in the terminal phases of rehabilitation, which include performance enhancement, development of power, and a safe return to activity. Plyometric exercise has become an integral component of late phase rehabilitation as the patient nears return to activity. Among the numerous types of available exercises, plyometrics assist in the development of power, a foundation from which the athlete can refine the skills of their sport. Therefore, the purpose of this clinical commentary is to provide an overview of plyometrics including: definition, phases, the physiological, mechanical and neurophysiological basis of plyometrics, and to describe clinical guidelines and contraindications for implementing plyometric programs.

Functional movement screen normative values and validity in high school athletes: can the fms™ be used as a predictor of injury?

Abstract: BACKGROUND: Limited information exists regarding injury risk factors for high school athletes. The Functional Movement Screen (FMS™) has been used to identify functional movement impairments and asymmetries, making it a potential predictor of injury. HYPOTHESIS/PURPOSE: To determine if the FMS™ is a valid predictor of injury in high school athletes and to identify a potential new FMS™ cutoff score for this population. STUDY DESIGN: Prospective Cohort. METHODS: 167 high school athletes among several sports were scored using the FMS™ and were monitored for injury during a single season. Likelihood ratios were calculated to determine how much a subject's total FMS™ score influenced the post-test probability of becoming injured. RESULTS: Of the 167 participants, 39 sustained a musculoskeletal injury. Of all component scores, the in-line lunge scores were significantly higher for injured players. For shoulder mobility, scores were significantly lower for injured players. No statistically significant associations were found between total FMS™ scores and injury status. CONCLUSION: The FMS™ may be useful for recognizing deficiency in certain movements, however this data suggests that the FMS™ should not be used for overall prediction of injury in high school athletes throughout the course of a season. Normative data from a large sample size is now available in the high school athlete demographic. LEVEL OF EVIDENCE: 3. Language: en

Concurrent validity and reliability of 2d kinematic analysis of frontal plane motion during running

Abstract: Purpose: Three‐dimensional motion analysis is the “gold standard” for evaluating kinematic variables during treadmill running. However, its use is limited by temporal and financial restraints. Therefore, the purpose of this study was to assess the concurrent validity and reliability of 2D video analysis for frontal plane kinematic variables during treadmill running.

Demographic and epidemiological trends in patellofemoral pain

Abstract: BACKGROUND Understanding the demographics of patellofemoral pain is important to determine the best practices in diagnosis and treatment of this difficult pathology. The occurrence of patellofemoral pain has been reported from isolated sports medicine clinics and from within the military, but its incidence has never been examined in the general population within the United States. PURPOSE The purpose of this study was to examine the reported occurrence of patellofemoral pain for those individuals seeking medical care and to compare that to all other pathologies that result in anterior knee pain, such as tendinopathies, patella subluxation, osteoarthritis, or meniscal and bursal conditions. Occurrence rates were examined across sex, age and region within a large healthcare provider database that contains over 30 million individuals. METHODS Data were queried with the PearlDiver Patient Record Database, a national database containing orthopedic patient records. Two common International Classification of Disease, Ninth Revision (ICD-9) codes for patellofemoral pain (717.7 - Patella Chondromalacia and 719.46 - Pain in joint, lower leg) were utilized and were searched from the years 2007-2011. The top twenty additional ICD-9 codes that were concurrently coded with 717.7 and 719.46 were removed from the data. Chi-squared and Mantel-Haenszel tests were utilized to identify statistically significant differences in the diagnosis of patellofemoral pain between sex, age, and year. RESULTS During this five-year period, there were 2,188,753 individuals diagnosed with patellofemoral pain. The diagnosis was more common in females compared to males with 1,211,665 and 977,088 cases respectfully (p<0.001). Statistically significant differences between ages was found, with 50-59 year olds having the most cases with 578,854, p<0.001. And, during the five-year examination period, there was a steady increase between 2007-2011, p<0.01. CONCLUSION Patellofemoral pain was diagnosed between 1.5% and 7.3% of all patients seeking medical care within the United States. Females experienced patellofemoral pain more often than males and there was a steady increase of cases in the United States during the 2007-2011 examination period. The diagnosis of patellofemoral pain increased with age and the 50-59 year old age group had the most cases. LEVEL OF EVIDENCE 2b.

Reliability of video-based quantification of the knee- and hip angle at foot strike during running.

Abstract: Introduction: In clinical practice, joint kinematics during running are primarily quantified by two‐dimensional (2D) video recordings and motion‐analysis software. The applicability of this approach depends on the clinicians’ ability to quantify kinematics in a reliable manner. The reliability of quantifying knee‐ and hip angles at foot strike is uninvestigated.

Why are eccentric exercises effective for achilles tendinopathy

Abstract: Achilles Tendinopathy is a complex problem, with the most common conservative treatment being eccentric exercises. Despite multiple studies assessing this treatment regime little is known about the mechanism of effect. This lack of understanding may be hindering therapeutic care and preventing optimal rehabilitation. Of the mechanisms proposed, most relate to tendon adaptation and fail to consider other possibilities. The current consensus is that tendon adaptation does not occur within timeframes associated with clinical improvements, therefore the clinical benefits must occur through another unidentified pathway. This clinical commentary critically reviews each of the proposed theories and highlights that muscle alterations are observed prior to onset of Achilles Tendinopathy and during the disease. Evidence shows that the observed muscle alterations change with treatment and that these adaptations have the ability to reduce tendon load and thereby improve tendon health. The purpose of this clinical commentary is to review previous theories regarding the mechanisms by which eccentric exercise might affect Achilles tendinopathy and offers a novel mechanism by which the plantarflexor muscles may shield the Achilles tendon. Level of Evidence 5

Normative values for the functional movement screentm in adolescent school aged children

Abstract: Background International sports programs have established pre‐participation athletic screening procedures as an essential component to identify athletes that are at a high risk of becoming injured. The Functional Movement Screen (FMS™) is a screening instrument intended to evaluate deficiencies in the mobility and stability of an athlete that might be linked to injury. To date, there are no published normative values for the FMS™ in adolescent school aged children. The purpose of this study was to establish normative values for the FMS™ in adolescent school aged children (10 to 17 years). Secondary aims were to investigate whether the performance differed between boys and girls and between those with or without previous history of injury.

Relationships between functional movement tests and performance tests in young elite male basketball players

Abstract: Sprinting and jumping are two common and important components of high-level sport performance. The weight-bearing dorsiflexion test (WB-DF) and Star Excursion Balance Test (SEBT) are tools developed to identify athletes at risk for lower extremity injury and may be related to running and jumping performance among athletes. The purposes of the present study were: 1) to identify any relationships between functional movement tests (WB-DF and SEBT) and performance tests (jumping, sprinting and changing direction); 2) to examine any relationships between asymmetries in functional movements and performance tests.Descriptive cohort study.Fifteen elite male basketball players (age: 15.4 ± 0.9 years) were assessed during a three-week period to determine the reliability of functional screening tools and performance tests and to examine the relationships between these tests. Relative (intraclass correlation coefficient) and absolute (coefficient of variation) reliability were used to assess the reproducibility of the tests.Significant correlations were detected between certain functional movement tests and performance tests. Both left and right excursion composite scores related to slower performance times in sprint testing, demonstrating that greater dynamic reach relates to decreased quickness and acceleration among these elite basketball athletes. The various relationships between dynamic functional movement testing, speed, and jump performance provide guidance for the strength and conditioning professional when conducting and evaluating data in an effort to improve performance and reduce risk of injury.The results of the present study suggest that these functional and performance tests do not measure the same components of human movement, and could be paired as outcome measures for the clinical and sport assessment of lower extremity function.2b.

Current concepts in periodization of strength and conditioning for the sports physical therapist

Abstract: The rehabilitation process is driven by the manipulation of training variables that elicit specific adaptations in order to meet established goals. Periodization is an overall concept of training that deals with the division of the training process into specific phases. Programming is the manipulation of the variables within these phases (sets, repetitions, load) that are needed to bring about the specific adaptations desired within that particular period. The current body of literature is very limited when it comes to how these variables are best combined in an injured population since most of the periodization research has been done in a healthy population. This manuscript explores what is currently understood about periodization, gives clinical guidelines for implementation, and provides the sports physical therapist with a framework to apply these principles in designing rehabilitation programs. Level of Evidence 5

The minimum clinically important difference on the visa-a and lefs for patients with insertional achilles tendinopathy.

Abstract: STUDY DESIGN Cohort study of subjects with insertional Achilles tendinopathy (IAT). OBJECTIVES The purpose of this study was to establish the minimum clinically important difference (MCID) on the Victorian Institute of Sport Assessment - Achilles Questionnaire (VISA-A) and the Lower Extremity Functional Scale (LEFS) for patients with IAT. BACKGROUND The VISA-A and LEFS are two measures commonly utilized for patients with IAT. Previous authors have estimated the MCID for the VISA-A, but a MCID has not been formally established. The MCID for the LEFS has been established for patients with lower extremity conditions in general, but it is not clear if this MCID is applicable to patients with IAT. METHODS Fifteen subjects participating in a randomized controlled trial studying the effectiveness of intervention for IAT over a 12-week period were included in this study. Subjects completed the VISA-A and LEFS forms at baseline and 12 weeks after the initiation of treatment. All subjects also completed a 15-point global rating of change (GROC) questionnaire at 12 weeks after the initiation of treatment. Subjects were classified as improved or stable based on their GROC scores. RESULTS The area under the curve (AUC) for the VISA-A was 0.97 and a MCID of 6.5 points was identified. The AUC for the LEFS was 0.97 and a MCID of 12 points was identified. CONCLUSION The VISA-A and LEFS are both useful outcome measures to assess response in patients with IAT. LEVEL OF EVIDENCE 3.

Y balance test™ anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction

Abstract: Background Restoration of symmetrical strength, balance, and power following anterior cruciate ligament reconstruction (ACL‐R) are thought to be important factors for successful return to sports. Little information is available regarding early rehabilitation outcomes and achieving suggested limb indices of 90% on functional performance measures at the time of return to sports (RTS).

The effects of anticipation on the mechanics of the knee during single-leg cutting tasks: a systematic review.

Abstract: ACL injuries are common in sports, which has resulted in the development of risk screening and injury prevention programs to target modifiable neuromuscular risk factors. Previous studies which have analyzed single-leg cutting tasks have reported that the anticipation status of the task (pre-planned vs. unanticipated) has a significant effect on the mechanics of the knee.The purpose of this systematic review is to assess the effect of anticipation on the mechanics of the knee in the sagittal, frontal, and transverse planes during tasks which athletes frequently perform during competition.Systematic Review.The following databases were searched using relevant key words and search limits: Pub Med, SPORTDiscus, CINAHL, and Web of Science. A modified version of the Downs and Black checklist was used to assess the methodological quality of the articles by two independent reviewers.284 articles were identified during the initial database search. After a screening process, 34 articles underwent further review. Of these articles, 13 met the criteria for inclusion in this systematic review.It appears that tasks which do not allow a subject to pre-plan their movement strategy promote knee mechanics which may increase an athlete's risk of injury.Clinicians involved in the development and implementation of ACL injury risk screening and prevention programs may want to consider incorporating tasks which do not allow time for pre-planning. These unanticipated tasks may more closely mimic the demands of the sports environment and may promote mechanics which increase the risk of injury.Level 1b.

Hand-held Dynamometer Positioning Impacts Discomfort During Quadriceps Strength Testing: A Validity and Reliability Study.

Abstract: PURPOSE/BACKGROUND A belt-stabilized hand-held dynamometer (HHD) offers the ability to quantify quadriceps muscle strength in a clinical environment, but a limitation is participant discomfort at the interface between the HHD and the tibia. The purpose of this study was to quantify the level of discomfort associated with a modified belt-stabilized HHD configuration compared to a standard belt-stabilized configuration and an isokinetic dynamometer. The secondary purpose of this study was to determine the validity and reliability of a modified configuration used to measure quadriceps strength compared to the "gold-standard" isokinetic dynamometer. METHODS Twenty healthy participants (5 males, 15 females; age=24.7±2.2 years, height=171.1±8.8 cm, mass=72.0±18.7 kg) performed maximal knee extension isometric contractions during each of three testing conditions: isokinetic dynamometer, standard configuration with HHD placement on the tibia, and an alternative configuration with the HHD interfaced with the leg of a table. Discomfort was quantified using a Visual Analog Scale (VAS). Differences in discomfort and torque (N•m) associated with the testing positions were determined using Friedman test or repeated measures analysis of variance. Validity was quantified using Pearson correlations and within-session intrarater reliability was determined using an intraclass correlation coefficient (ICC2,1) and associated confidence intervals (95% CI). RESULTS The isokinetic dynamometer configuration resulted in the least discomfort (p< .01) and the modified configuration was more comfortable than the standard configuration (p= .003). There was a significant correlation between measures from the isokinetic dynamometer and the standard configuration (r=.87) and modified configuration (r=.93). Within-session intrarater reliability was good for both the standard configuration (ICC2,1=0.93) and modified configuration (ICC2,1=0.93) conditions. CONCLUSIONS The use of the modified belt-stabilized HHD configuration, where the HHD was interfaced with the leg of a table, offers a more comfortable alternative compared to the standard belt-stabilized configuration to obtain isometric quadriceps strength measures in a clinical environment. This configuration is also a valid and reliable alternative to the "gold standard" isokinetic dynamometer when testing isometric quadriceps strength at 90° of knee flexion. LEVEL OF EVIDENCE Diagnostic, Level 3.

The relationship between adherence behaviors and recovery time in adolescents after a sports-related concussion: an observational study

Abstract: BACKGROUND: Adherence to rehabilitation is widely accepted as vital for recovery and return to play following sports injuries. Medical management of concussion is centered around physical and cognitive rest, a theory largely based on expert opinion, not empirical evidence. Current research on this topic focuses on factors that are predictive of adherence to rehabilitation, but fails to examine if patient adherence leads to a better outcome. The purpose of this study was to determine the adherence tendencies of adolescents to treatment recommendations provided by a sports-medicine physician after a concussion and to determine if adherence to each recommendation was a predictor of treatment duration. STUDY DESIGN: Observational. METHODS: Participants were enrolled in the study at their initial visit to the Sports-Medicine Center for medical care after a sports-related concussion. Individual treatment recommendations provided by a sports-medicine physician for concussion were recorded over the course of each participant's care. Once released from medical care, each participant was contacted to complete an online questionnaire to measure self-reported adherence tendencies to each treatment recommendation. Adherence was measured by two constructs: 1) the reported receptivity to the recommendation and 2) the frequency of following the recommendation. Exploratory univariate Poisson regression analyses were used to describe the relationship between adherence behaviors and the number of days of treatment required before the participant was returned to play. RESULTS: Fifty-six questionnaires were completed, by 30 male and 26 female adolescent athletes. The self-reported adherence tendencies were very high. None of the measures of adherence to the treatment recommendations were significant predictors of the number of days of treatment; however, there was a clear tendency in five of the six rest parameters (physical rest, cognitive rest with restrictions from electronics, and cognitive rest with restrictions from school), where high levels of adherence to rest resulted in an increased average number of days of treatment (slower recovery) and those who reported being less adherent recovered faster. CONCLUSIONS: Adolescents were generally adherent to the physician recommendations. Those participants who reported being less adherent to physical and cognitive rest generally recovered faster than those who reported higher levels of adherence to these recommendations. As time progresses after the initial injury, physical and mental rest may be less effective to hasten recovery than more active treatment recommendations. LEVEL OF EVIDENCE: Level 2. Language: en

Reliability and accuracy of a goniometer mobile device application for video measurement of the functional movement screen deep squat test.

Abstract: Background/Purpose The squat is a fundamental movement of many athletic and daily activities. Methods to clinically assess the squat maneuver range from simple observation to the use of sophisticated equipment. The purpose of this study was to examine the reliability of Coach's Eye (TechSmith Corp), a 2‐dimensional (2D) motion analysis mobile device application (app), for assessing maximal sagittal plane hip, knee, and ankle motion during a functional movement screen deep squat, and to compare range of motion values generated by it to those from a Vicon (Vicon Motion Systems Ltd) 3‐dimensional (3D) motion analysis system.

Effect of restricted hip flexor muscle length on hip extensor muscle activity and lower extremity biomechanics in college-aged female soccer players.

Abstract: Background Hip flexor tightness is theorized to alter antagonist muscle function through reciprocal inhibition and synergistic dominance mechanisms. Synergistic dominance may result in altered movement patterns and increased risk of lower extremity injury.

The validity and reliability of a new instrumented device for measuring ankle dorsiflexion range of motion

Abstract: Purpose/Background: A restriction in ankle dorsiflexion range of motion (ROM) has been linked to several clinical manifestations such as metatarsalgia, heel pain, nerve entrapment, ankle joint equinus, patellar and ankle injuries. The purpose of the present study was to examine the validity and reliability of the Leg Motion system for measuring ankle dorsiflexion ROM.

Relationship between isokinetic knee strength and jump characteristics following anterior cruciate ligament reconstruction

Abstract: Background Clinicians are often challenged when making return-to-play decisions following anterior cruciate ligament reconstruction (ACL-R) Isokinetic strength and jump performance testing are common tools used to make this decision Unfortunately, vertical jump performance standards have not been clearly established and many clinicians do not have access to isokinetic testing equipment Purpose To establish normative jump and strength characteristics in ACL-R patients cleared by an orthopedic physician to return-to-play and to determine if relationships exist between knee isokinetic strength measurements and jump characteristics described using an electronic jump map system Study design Descriptive laboratory study Methods Thirty-three ACL-R patients who had been cleared to return to athletic competition participated in this study Twenty-six of these ACL-R participants were also matched to 26 asymptomatic athletes based on sex, limb, height, and mass to determine isokinetic strength and jump characteristic differences between groups Jump tests consisted of single leg vertical, double leg vertical, and a 4-jump single leg vertical jump assessed using an electronic jump mat system Independent t-tests were used to determine differences between groups and multiple regression analyses were used to identify any relationships between jump performance and knee strength (p Results The ACL-R group had lower vertical jump capabilities and some bilateral knee strength deficiencies compared to the matched control group The ACL-R group also showed several moderate-to-strong positive relationships for both knee extension and flexion strength with several jump performance characteristics, such as single and double leg vertical jump height Conclusion The current results indicate that ACL-R patients present with several knee strength and vertical jump differences compared to a matched control group at the time of return-to-play Also, ACL-R patient's performance on an electronic jump mat system is strongly related to isokinetic knee strength measures Level of evidence 2b

Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls.

Abstract: Background: Non-specific low back pain is a common condition often without a clear mechanism for its presentation. Recently more attention has been placed on the hip and its potential contributions to non-specific chronic low back pain (NSCLBP). Emphasis in research has mainly been placed on motor control, strength and endurance factors in relation to NSCLBP. Limited focus has been placed on hip mobility and its potential contribution in subjects with NSCLBP. Purpose/Aim: The aim of this study was to compare passive ROM in hip extension, hip internal rotation, hip external rotation and total hip rotation in active subjects with NSCLBP to healthy control subjects. The hypothesis was that active subjects with NSCLBP would present with decreased total hip ROM and greater asymmetry when compared to controls. Design: Two group case controlled Setting: Clinical research laboratory Participants: 30 healthy subjects without NSCLBP and 30 active subjects with NSCLBP. Subjects categorized as NSCLBP were experiencing pain in the low back area with or without radicular symptoms of greater than three months duration.

Considerations for late stage acl rehabilitation and return to sport to limit re-injury risk and maximize athletic performance.

Abstract: Purpose/Background: Despite recent advances in anterior cruciate ligament reconstruction (ACL) surgical techniques, an improved understanding of the ACL’s biomechanical role, and expanding research on optimal rehabilitation practices in ACL‐reconstructed (ACLR) patients, the re‐tear rate remains alarmingly high and athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients. Significant deficits may persist in strength, muscular activation, power, postural stability, lower extremity mechanics, and psychological preparedness. Many patients may continue to demonstrate altered movement mechanics associated with increased injury risk. The purpose of this clinical commentary and literature review is to provide a summary of current evidence to assist the rehabilitation professional in recognizing, assessing, and addressing factors which may have been previously underappreciated or unrecognized as having significant influence on ACLR rehabilitation outcomes.

Dry Needling for Myofascial Trigger Point Pain: A Clinical Commentary

Abstract: Sports and orthopaedic physical therapists have long used a multitude of techniques in order to address pain and dysfunction associated with myofascial trigger points. One technique in particular has recently received overwhelming attention: trigger point dry needling (DN). Despite its efficacy and low risk, questions remain as to its effectiveness, safety, and whether the technique is within the scope of practice of physical therapists. Therefore, the purpose of this clinical commentary is to summarize the current literature related to the associated mechanisms of action of DN, the safety of DN, as well as to discuss relevant scope of practice concerns. Level of Evidence 5

Physical therapy intervention strategies for patients with prolonged mild traumatic brain injury symptoms: a case series

Abstract: Although most patients recover from a mild traumatic brain injury (mTBI) within 7-14 days, 10-30% of people will experience prolonged mTBI symptoms. Currently, there are no standardized treatment protocols to guide physical therapy interventions for this population. The purpose of this case series was to describe the unique, multimodal evaluation and treatment approaches for each of the patients with post-concussion syndrome (PCS).Six pediatric athletes with PCS who had participated in physical therapy and fit the inclusion criteria for review were retrospectively chosen for analysis. Patients received a cervical evaluation, an aerobic activity assessment, an oculomotor screen, and postural control assessment. Each patient participated in an individualized physical therapy treatment plan-of-care based on their presentation during the evaluation.Patients were treated for a mean of 6.8 treatment sessions over 9.8 weeks. Four of six patients returned to their pre-injury level of activity while two returned to modified activity upon completion of physical therapy. Improvements were observed in symptom scores, gaze stability, balance and postural control measures, and patient self-management of symptoms. All patients demonstrated adequate self-management of symptoms upon discharge from physical therapy.Physical therapy interventions for pediatric athletes with PCS may facilitate recovery and improve function. Further research is needed to validate effective tools for assessment of patients who experience prolonged concussion symptoms as well as to establish support for specific post-mTBI physical therapy interventions.Level 4.

Association of isometric strength of hip and knee muscles with injury risk in high school cross country runners.

Abstract: High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries.To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners.Sixty-eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury.During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi-square = 6.140; p=0.046), knee extensor (chi-square = 6.562; p=0.038), and knee flexor (chi-square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury.High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners.2b.

An examination of the gluteal muscle activity associated with dynamic hip abduction and hip external rotation exercise: a systematic review.

Abstract: A wide variety of hip abduction and hip external rotation exercises are used for training, both in athletic performance and in rehabilitation programming. Though several different exercises exist, a comprehensive understanding of which exercises best target the gluteus maximus (Gmax) and gluteus medius (Gmed) and the magnitude of muscular activation associated with each exercise is yet to be established.The purpose of this systematic review was to quantify the electromyographic (EMG) activity of exercises that utilize the Gmax and Gmed muscles during hip abduction and hip external rotation.Pubmed, Sports Discuss, Web of Science and Science Direct were searched using the Boolean phrases (gluteus medius OR gluteus maximus) AND (activity OR activation) AND (electromyography OR EMG) AND (hip abduction OR hip external rotation). A systematic approach was used to evaluate 575 articles. Articles that examined injury-free participants of any age, gender or activity level were included. No restrictions were imposed on publication date or publication status. Articles were excluded when not available in English, where studies did not normalize EMG activity to maximum voluntary isometric contraction (MVIC), where no hip abduction or external rotation motion occurred or where the motion was performed with high acceleration.Twenty-three studies met the inclusion criteria and were retained for analysis. The highest Gmax activity was elicited during the lateral step up, cross over step up and rotational single leg squat (ranging from 79 to 113 % MVIC). Gmed activity was highest during the side bridge with hip abduction, standing hip abduction with elastic resistance at the ankle and side lying hip abduction (ranging from 81 to 103 % MVIC).The methodological approaches varied between studies, notably in the different positions used for obtaining MVIC, which could have dramatically impacted normalized levels of gluteal activation, while variation also occurred in exercise technique and/or equipment.The findings from this review provide an indication for the amount of muscle activity generated by basic strengthening and rehabilitation exercises, which may assist practitioners in making decisions for Gmax and Gmed strengthening and injury rehabilitation programs.

The influence of hip strength on knee kinematics during a single-legged medial drop landing among competitive collegiate basketball players.

Abstract: Background A smaller knee flexion angle and larger knee valgus angle during weight-bearing activities have been identified as risk factors for non-contact anterior cruciate ligament (ACL) injuries. To prevent such injuries, attention has been focused on the role of hip strength in knee motion control. However, gender differences in the relationship between hip strength and knee kinematics during weight-bearing activities in the frontal plane have not been evaluated. Hypothesis/purpose The purpose of this study was to determine the influence of hip strength on knee kinematics in both genders during a single-legged landing task in the frontal plane. The hypotheses were that 1) subjects with a greater hip strength would demonstrate larger knee flexion and smaller knee valgus and internal rotation angles and 2) no gender differences would exist during the single-legged landing task. Methods Forty-three Japanese collegiate basketball players (20 males, 23 females) participated in this study. Three-dimensional motion analysis was used to evaluate knee kinematics during a single-legged medial drop landing (SML). A hand-held dynamometer was used to assess hip extensor (HEXT), abductor (HAB), and external rotator (in two positions: seated position [SHER] and prone [PHER]) isometric strength. Spearman rank correlation coefficients (ρ) were determined for correlations between hip strength and knee kinematics at initial contact (IC) and peak (PK) during SML (p Results Negative correlations were observed between the knee valgus angle at IC and HEXT (ρ = -0.48, p = 0.02), HAB (ρ = -0.46, p = 0.03) and PHER (ρ = -0.44, p = 0.04) strength in females. In addition, a significant positive correlation was observed between the knee flexion angle at PK and HEXT strength (ρ = 0.61, p = 0.004) in males. Conclusions Significant correlations between hip strength and knee kinematics during SML were observed in both genders. Hip strength may, therefore, play an important role in knee motion control during sports activities, suggesting that increased hip strength may help to prevent non-contact ACL injuries in athletes of both genders. Moreover, gender-specific programs may be needed to control abnormal knee motion, as the influence of hip strength on knee kinematics may differ based on gender. Level of evidence 3.

Neuromuscular control during performance of a dynamic balance task in subjects with and without ankle instability.

Abstract: Cross-sectional, controlled laboratory study.Lateral ankle sprains are common injuries and often lead to chronic ankle instability (CAI). Individuals who previously sustained a lateral ankle sprain, but did not develop CAI, termed copers, may have altered postural control strategies compared to individuals who have developed CAI. These altered postural control strategies may allow for more appropriate dynamic stabilization of the ankle joint after injury compared to those seen in patients who have developed CAI.To compare lower leg biomechanics, as well as electromyographic (EMG) activation of the tibilias anterior and peroneus longus muscles, during the posteromedial reach of the Star Excursion Balance Test (SEBT) in individuals with healthy ankles, copers, and those with CAI.30 participants (12 control, 9 copers, 9 CAI) divided into three groups based on ankle sprain history and Cumberland Ankle Instability Tool score. Kinematic, kinetic, and EMG data were collected during three posteromedial reach trials on the SEBT.Primary outcome measures include SEBT normalized reach distance in the posteromedial direction and average integrated EMG activation of the tibialis anterior and peroneus longus muscles during the reach. Secondary outcome measures included sagittal and frontal plane ankle complex angles and moments and sagittal plane knee angles and moments. Data were analyzed between groups using a one-way ANOVA model.No significant differences in reach distance or kinematic and kinetic outcomes were found between groups. The activation of the tibialis anterior and peroneus longus muscles was significantly different between groups (p=0.033 and p=0.014, respectively). The post-hoc analysis revealed that the coper group had significantly higher muscle activation compared to the control group, but not to the CAI group.CAI did not alter kinematic, kinetic, or reach performance during the SEBT. When compared to controls, copers appeared to have greater activation of the ankle musculature, which may increase stability of the ankle complex during a dynamic balance task.Prospective Cohort level II.