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Donegan T, Sanchez-Vives MV. Perception and control of a virtual body in immersive virtual reality for rehabilitation. Curr Opin Neurol 2024:00019052-990000000-00195. [PMID: 39253749 DOI: 10.1097/wco.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PURPOSE OF REVIEW This review explores recent advances in using immersive virtual reality to improve bodily perception and motor control in rehabilitation across musculoskeletal and neurological conditions, examining how virtual reality's unique capabilities can address the challenges of traditional approaches. The potential in this area of the emerging metaverse and the integration of artificial intelligence in virtual reality are discussed. RECENT FINDINGS In musculoskeletal rehabilitation, virtual reality shows promise in enhancing motivation, adherence, improving range of motion, and reducing kinesiophobia, particularly postsurgery. For neurological conditions like stroke and spinal cord injury, virtual reality's ability to manipulate bodily perceptions offers significant therapeutic potential, with reported improvements in upper limb function and gait performance. Balance and gait rehabilitation, especially in older adults, have also seen positive outcomes. The integration of virtual reality with brain-computer interfaces presents exciting possibilities for severe speech and motor impairments. SUMMARY Current research is limited by small sample sizes, short intervention durations, and variability in virtual reality systems. Future studies should focus on larger, long-term trials to confirm findings and explore underlying mechanisms. As virtual reality technology advances, its integration into rehabilitation programs could revolutionize treatment approaches, personalizing treatments, facilitating home training, and potentially improving patient outcomes across a wide variety of conditions.
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Affiliation(s)
- Tony Donegan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
| | - Maria V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Institució Catalana de Investigación y Estudios Avanzados (ICREA), Passeig de Lluís Companys, Barcelona, Spain
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Hamoongard M, Letafatkar A, Thomas AC. The Effect of Neurocognitive Training on Biomechanical Risk Factors Related to Anterior Cruciate Ligament Injury in Athletes: A Narrative Review. J Sport Rehabil 2024; 33:485-494. [PMID: 39117316 DOI: 10.1123/jsr.2023-0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/18/2024] [Accepted: 05/31/2024] [Indexed: 08/10/2024]
Abstract
CONTEXT The best current evidence supports the effectiveness of neuromuscular training in reducing the risk of injury; however, the rate of anterior cruciate ligament (ACL) injuries is still high. Neurocognitive training (NT) has successfully improved biomechanical risk factors, but they have been considered in only a few studies. OBJECTIVE To review the literature to determine the effect of NT on biomechanical risk factors related to ACL injury in athletes. EVIDENCE ACQUISITION We searched PubMed, Google Scholar, Scopus, Science Direct, and the Physiotherapy Evidence Database from inception to August 2011. We included randomized controlled trials that used motor learning approaches and injury prevention programs to investigate kinematic and kinetic risk factors related to ACL injury. The quality of each clinical trial study was evaluated by the Physiotherapy Evidence Database scale. The eligibility criteria were checked based on the PICOS (population, intervention, comparison, outcome, and study type) framework. EVIDENCE SYNTHESIS A total of 9 studies were included in the final analysis. Motor learning approaches include internal and external focus of attention, dual tasks, visual motor training, self-control feedback, differential learning, and linear and nonlinear pedagogy, combined with exercise programs. In most of the studies that used NT, a significant decrease in knee valgus; tibial abduction and external rotation; ground reaction force; and an increase in knee-, trunk-, hip-, and knee-flexion moment was observed. CONCLUSION In classical NT, deviation from the ideal movement pattern especially emphasizing variability and self-discovery processes is functional in injury prevention and may mitigate biomechanical risk factors of ACL injuries in athletes. Practitioners are advised to use sport-specific cognitive tasks in combination with neuromuscular training to simulate loads of the competitive environment. This may improve ACL injury risk reduction and rehabilitation programs.
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Affiliation(s)
- Majid Hamoongard
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Abbey C Thomas
- Department of Applied Physiology, Health, and Clinical Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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Mohammadi Orangi B, Dehghani M, Jones PA. Manipulation of task constraints is the most effective motor learning method for reducing risk factors for ACL injury during side-step cutting in both male and female athletes. Res Sports Med 2024; 32:631-647. [PMID: 37158705 DOI: 10.1080/15438627.2023.2209248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
This study compared the efficacy of linear, non-linear and differential methods on variables related to ACL injury risk of a side-step cutting task in male and female basketball players. Thirty males and thirty females practiced basketball skills in sixty 90-minute sessions across 5 months. Ten players trained in each of the LP, NLP and DL female/male groups separately. Before and after the intervention, each player was tested on a side-step cutting task. A repeated 3 × 2 × 2 factorial ANOVA with repeated measures was performed for each biomechanical variable. Variables (trunk, hip, and knee flexion angle, knee valgus angle, ankle dorsiflexion angle, hip, knee, and ankle ROM, peak VGRF and knee extension/flexion, knee moment and ankle dorsiflexion moment) all revealed significant test by group interactions (P < 0.05) but no significant group by sex interactions (P > 0.05). In both sex, biomechanical changes were better in the NLP, followed by the DL and LP. It is argued that the advantage of the NLP method results from increased exploration of movement solutions induced by the manipulation of task constraints. Therefore, according to the NLP, it is possible to manipulate the constraints without feedback and the model/pattern can keep the athlete away from possible risks.
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Affiliation(s)
| | - Mahrokh Dehghani
- Faculty of Physical Education and Sport Sciences, University of Mohaghegh Ardabili, Iran
| | - Paul A Jones
- Centre for Health Sciences Research, School of Health & Society, University of Salford, UK
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Welling W. Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review. Phys Ther Sport 2024; 67:141-148. [PMID: 38749349 DOI: 10.1016/j.ptsp.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024]
Abstract
A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective".
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Affiliation(s)
- Wouter Welling
- Pro-F Fysiotherapie, Kotkampweg 65, 7531 AS, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Science, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
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Mohr M, Federolf P, Heinrich D, Nitschke M, Raschner C, Scharbert J, Koelewijn AD. An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk. Sci Rep 2024; 14:3115. [PMID: 38326644 PMCID: PMC10850483 DOI: 10.1038/s41598-024-53640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/03/2024] [Indexed: 02/09/2024] Open
Abstract
Knee ligament sprains are common during change-of-direction (COD) maneuvers in multidirectional team sports. This study aimed to compare the effects of an 8-week injury prevention exercise program containing COD-specific exercises and a similar program containing linear sprint exercises on injury- and performance-related variables during a 135° COD task. We hypothesized that the COD-specific training would lead to (H1) stronger reductions in biomechanical variables associated with anterior cruciate ligament (ACL) injury risk during COD, i.e. knee abduction moment and angle, hip internal rotation angle and lateral trunk lean, and (H2) more effective improvements in COD performance according to the COD completion time, executed angle, ground contact time, and approach speed. Twenty-two sports science students (40% female) completed biomechanical assessments of COD movement strategies before and after participating in two supervised 25-min training sessions per week over 8 weeks. We observed significant 'training x group' interaction effects in support of H1: the COD-specific training but not the linear sprint training led to reduced peak knee abduction moments (interaction, p = 0.027), initial knee abduction (interaction, p < 0.001), and initial lateral trunk lean angles (interaction, p < 0.001) compared to baseline. Although the COD-specific training resulted in sharper executed angles (interaction, p < 0.001), the sprint-specific training group showed reduced COD completion (interaction, p = 0.037) and ground contact times (interaction, p < 0.001). In conclusion, a combination of generic and COD-specific injury prevention training resulted in COD technique adaptations that can help to avoid ACL injury-prone COD movements but may negatively affect COD speed.
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Affiliation(s)
- M Mohr
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - P Federolf
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - D Heinrich
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - M Nitschke
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - C Raschner
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - J Scharbert
- Department of Sport Science, Universität Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - A D Koelewijn
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Bilateral neuromuscular control in patients one year after unilateral ACL rupture or reconstruction. A cross-sectional study. Heliyon 2024; 10:e24364. [PMID: 38268828 PMCID: PMC10803901 DOI: 10.1016/j.heliyon.2024.e24364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Objectives To compare bilateral neuromuscular control in patients one year after anterior cruciate ligament reconstruction (ACL-R) or conservative treatment (ACL-C) to healthy controls (ACL-I). Design Cross-sectional study. Setting Electromyography of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded during stair descent and anterior tibial translation. Each step of stair descent was divided into pre-activity, weight-acceptance and push-off phase. Pre-activation, short, medium (MLR) and long latency responses (LLR) were defined for reflex activity. Participants N = 38 patients one year after ACL reconstruction (ACL-R), N = 26 participants with conservative treatment one year after ACL rupture (ACL-C), N = 38 healthy controls with an intact ACL (ACL-I). Main outcome measures Normalized root mean squares per muscle and phase (α = 0.05). Results During stair descent, within-group leg differences were found for the quadriceps in ACL-R during all phases and for the BF in ACL-C during weight-acceptance. Between-group leg differences were found for BF in both patient groups compared to ACL-I during push-off.Between-group differences in pre-activation for VM between ACL-R and ACL-C, and between ACL-C and ACL-I were found, and as LLR between patients and ACL-R versus ACL-I. Pre-activation of BF and MLR of ST differed for each patient group compared to ACL-I. Conclusions Bilateral neuromuscular alterations are still present one year after ACL rupture or reconstruction.
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, 2610, Wilrijk, Belgium
| | - Aglaja Busch
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
- University of Potsdam, University Outpatient Clinic, Sports Medicine & Sports Orthopedics, 14469, Potsdam, Germany
| | - Philipp Henle
- Lindenhof Group AG, Sonnenhof Orthopaedic Center, 3006, Bern, Switzerland
- University of Bern, Bern University Hospital, Inselspital, Department of Orthopaedic Surgery and Traumatology, 3010, Bern, Switzerland
| | - Sven Bruhn
- University of Rostock, Institute of Sports Science, 18051, Rostock, Germany
| | - Dirk Vissers
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, 2610, Wilrijk, Belgium
| | - Heiner Baur
- Bern University of Applied Sciences, School of Health Professions, Division of Physiotherapy, 3008, Bern, Switzerland
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Maenhout A, Heijenk W, Glashouwer P, Quatacker L, Praet L, Borms D. Effect of a Novel Training Program in Patients With Chronic Shoulder Pain Based on Implicit Motor Learning: Pilot and Feasibility Study. Int J Sports Phys Ther 2024; 19:1503-1515. [PMID: 38179585 PMCID: PMC10761605 DOI: 10.26603/001c.90284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024] Open
Abstract
Background Implicit motor learning has been shown to be effective for learning sports-related motor skills. It facilitates automaticity of movements and thereby improves performance in multitasking and high-pressure environments. Motor learning to develop motor skills and neuroplastic capacities is not sufficiently incorporated in musculoskeletal rehabilitation. Especially in patients with chronic pain conditions like shoulder pain this approach might benefit over traditional exercise programs. Purpose/hypothesis The aim of this study was to investigate the feasibility and clinical outcome of a new implicit motor learning exercise program in a group of patients with chronic shoulder pain. Study design Pilot and feasibility cohort study. Methods Twenty-six patients with chronic shoulder pain performed a 6-week home exercise program with weekly remote follow up by a physiotherapist. The program comprised five exercises designed to challenge overall body balance, simultaneously engaging the upper limbs in a range of reaching tasks. The tasks included reaching above the head, at and below waist level, in various directions. No instructions on correct performance were provided to foster external focus. Feasibility was assessed by (1) recruitment rate, (2) follow up rate, (3) subjective experience, (4) self-reported adverse events and (5) self-reported adherence of subjects. Clinical effects of the program were assessed with (1) the Shoulder Pain and Disability Index (SPADI), (2) the Auto-Constant score, (3) the numeric rating scale (NRS) at rest and at night, (4) the patient specific functional scale (PSFS), (5) the avoidance endurance questionnaire (AEQ), (6) patient acceptable symptom state (PASS) and (7) a global rating of change (GROC). Results The study protocol was feasible in terms of follow up rate (16w for 28 patients), exercise adherence (77.1%± 29.41), and adverse events (no serious, 5 light adverse events). Statistically significant improvements were observed for SPADI (p<0.001), NRS at rest (p=0.033), at night (p=0.29), PSFS (p<0.001) and PASS (p<0.001) after only six weeks training. Conclusion This study reveals promising results of another way of looking at exercise for patients with chronic shoulder pain. Both feasibility and clinical effects of the program on pain and function was acceptable. Future studies should incorporate a control group, provide longer follow up and include objective measurements. Level of evidence 2b.
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Combalia A, Sanchez-Vives MV, Donegan T. Immersive virtual reality in orthopaedics-a narrative review. INTERNATIONAL ORTHOPAEDICS 2024; 48:21-30. [PMID: 37566225 PMCID: PMC10766717 DOI: 10.1007/s00264-023-05911-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE This narrative review explores the applications and benefits of immersive virtual reality (VR) in orthopaedics, with a focus on surgical training, patient functional recovery, and pain management. METHODS The review examines existing literature and research studies on immersive VR in orthopaedics, analyzing both experimental and clinical studies. RESULTS Immersive VR provides a realistic simulation environment for orthopaedic surgery training, enhancing surgical skills, reducing errors, and improving overall performance. In post-surgical recovery and rehabilitation, immersive VR environments can facilitate motor learning and functional recovery through virtual embodiment, motor imagery during action observation, and virtual training. Additionally VR-based functional recovery programs can improve patient adherence and outcomes. Moreover, VR has the potential to revolutionize pain management, offering a non-invasive, drug-free alternative. Virtual reality analgesia acts by a variety of means including engagement and diverting patients' attention, anxiety reduction, and specific virtual-body transformations. CONCLUSION Immersive virtual reality holds significant promise in orthopaedics, demonstrating potential for improved surgical training, patient functional recovery, and pain management but further research is needed to fully exploit the benefits of VR technology in these areas.
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Affiliation(s)
- A Combalia
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), c. Villarroel, 170, 08036, Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain.
| | - M V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain.
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Passeig de Lluís Companys, 23, 08010, Barcelona, Spain.
| | - T Donegan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036, Barcelona, Spain
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Kim KM, Needle AR, Kim JS, An YW, Cruz-Díaz D, Taube W. What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis. Disabil Rehabil 2024; 46:241-256. [PMID: 36650898 DOI: 10.1080/09638288.2022.2161643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI). MATERIALS AND METHODS Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus. RESULTS Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles (g = 0.55, 95% CI = 0.03-1.08, p = 0.040 for the soleus and g = 0.54, 95% CI = 0.01-1.07, p = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention (g = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and g = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior). CONCLUSIONS FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.
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Affiliation(s)
- Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si, Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
| | - Joo-Sung Kim
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA
| | - Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USA
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
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Reiche E, Collins K, Genoese F, Walaszek M, Triplett A, Kuenze C, Harkey M, Baez S. Lower Extremity Reaction Time in Individuals With Contact Versus Noncontact Anterior Cruciate Ligament Injuries After Reconstruction. J Athl Train 2024; 59:66-72. [PMID: 37248503 PMCID: PMC10783466 DOI: 10.4085/1062-6050-0428.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Deficits in perceptual-motor function, like visuomotor reaction time (VMRT), are risk factors for primary and secondary anterior cruciate ligament (ACL) injury. Noncontact ACL injuries have been associated with slower reaction time, but whether this association exists for patients with contact ACL injuries is unknown. Exploring differences in VMRT among individuals with contact versus noncontact ACL injuries may provide a more comprehensive understanding of modifiable risk factors. OBJECTIVE To compare lower extremity VMRT (LEVMRT) in individuals with contact or noncontact ACL injuries after ACL reconstruction (ACLR). DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 36 participants with primary, unilateral ACLR completed an LEVMRT assessment (contact ACL injury = 20 [56%], noncontact ACL injury = 16 [44%]). MAIN OUTCOME MEASURE(S) The LEVMRT was assessed bilaterally and collected using a series of wireless light discs deactivated by individuals with their feet. The ACLR-active LEVMRT (ie, ACLR limb is deactivating lights) and ACLR-stable LEVMRT were compared using separate analyses of covariance to determine the association with contact or noncontact injury using time since surgery as a covariate. RESULTS After controlling for time since surgery, a difference and large effect size between groups was found for the ACLR-stable LEVMRT (P = .010; η2 = 0.250) but not for the ACLR-active (P = .340; η2 = 0.065) condition. The contact group exhibited slower ACLR-stable LEVMRT (521.7 ± 59.3 milliseconds) than the noncontact group (483.4 ± 83.9 milliseconds). CONCLUSIONS Individuals with contact ACL injury demonstrated a slower LEVMRT while their ACLR limb was stabilizing. The group differences during the ACLR-stable LEVMRT task might indicate deficits in perceptual-motor function when the surgical limb maintains postural control during a reaction time task. After ACLR, individuals with contact injuries may need additional motor learning interventions to enhance perceptual-motor functioning.
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Affiliation(s)
- Elaine Reiche
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | | | | | - Ashley Triplett
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Adhitya IPGS, Kurniawati I, Sawa R, Wijaya TF, Dewi NPAC. The Risk Factors and Preventive Strategies of Poor Knee Functions and Osteoarthritis after Anterior Cruciate Ligament Reconstruction: A Narrative Review. Phys Ther Res 2023; 26:78-88. [PMID: 38125289 PMCID: PMC10730125 DOI: 10.1298/ptr.r0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.
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Affiliation(s)
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia
| | - Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Tabita Febyola Wijaya
- Bachelor and Professional Program of Physical Therapy, College of Medicine, Universitas Udayana, Indonesia
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13
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Pauw AHJ, Buck TMF, Gokeler A, Tak IJR. Reconsideration of Return-to-Sport Decision-Making After Pediatric ACL Injury: A Scoping Review. Sports Health 2023; 15:898-907. [PMID: 36715226 PMCID: PMC10606966 DOI: 10.1177/19417381221146538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
CONTEXT Up to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%. OBJECTIVES (1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes. DATA SOURCES PubMed, CINAHL, Embrase, and Cochrane library databases and gray literature. STUDY SELECTION Data on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies. STUDY DESIGN Scoping review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Details on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart. RESULTS Studies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported. CONCLUSION RTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.
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Affiliation(s)
| | - Tristan Marcel Frank Buck
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
| | - Alli Gokeler
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
- Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands
| | - Igor Joeri Ramon Tak
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
- Fysiotherapie Utrecht Oost, Utrecht, the Netherlands
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14
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Jochimsen KN, Kim JS, Jayabalan P, Lawrence C, Lewis CL, Prather H, Bostrom MP. Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 3: Rehabilitation and Exercise. HSS J 2023; 19:447-452. [PMID: 37937088 PMCID: PMC10626932 DOI: 10.1177/15563316231192098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from 5 presentations given on hip-related rehabilitation at the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City.
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Affiliation(s)
- Kate N Jochimsen
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Prakash Jayabalan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cecelia Lawrence
- Acute Care Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Cara L Lewis
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
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15
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Neuromuscular control in males and females 1 year after an anterior cruciate ligament rupture or reconstruction during stair descent and artificial tibial translation. Sci Rep 2023; 13:15316. [PMID: 37714980 PMCID: PMC10504317 DOI: 10.1038/s41598-023-42491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
Neuromuscular alterations are reported in patients with anterior cruciate ligament reconstruction (ACL-R) and conservative treatment (copers with ACL deficiency, ACL-C). However, it is unclear whether sex influences neuromuscular control. The objective was to investigate differences in neuromuscular control regarding sex and treatment type one year after ACL rupture in comparison to a group with an intact ACL (ACL-I). Electromyography of vastus medialis (VM) and lateralis, biceps femoris (BF) and semitendinosus (ST) was recorded in ACL-R (N = 38), ACL-C (N = 26), and ACL-I (N = 38) during stair descent and reflex activity by anterior tibial translation while standing. The movements of stair descent were divided into pre-activity, weight-acceptance and push-off phases, reflex activity in pre-activation, short, medium (MLR), and long latency responses (LLR). Normalized root mean squares for each muscle of involved and matched control limb per phase were calculated and analyzed with two-way ANOVA (α = 0.05). During stair descent, neuromuscular differences of BF were significant during push-off only (p = 0.001). Males of ACL-R and ACL-C had higher BF activity compared to ACL-I (p = 0.009, 0.007 respectively). During reflex activity, VM and BF were significantly different between treatment groups for pre-activation (p = 0.013, 0.035 respectively). VM pre-activation of females was higher in ACL-R compared to ACL-C (p = 0.018), and lower in ACL-C compared to ACL-I (p = 0.034). Males of ACL-R showed higher VM and less BF pre-activation (p = 0.025, p = 0.003 respectively) compared to ACL-I. Males of ACL-C had less BF pre-activation compared to ACL-I (p = 0.019). During MLR, intra-group differences in ST were found for treatment (p = 0.011) and females of ACL-R compared to ACL-I (p = 0.015). During LLR, overall intra-group differences in VM were present for treatment (p = 0.034) and in females (ACL-R versus ACL-C (p = 0.015), ACL-I (p = 0.049), respectively). One year after an ACL rupture, neuromuscular alterations persist regardless of treatment and sex. Standard rehabilitation protocols may not be able to restore neuromuscular control. Future research should include long-term follow up and focus on exercises targeting neuromuscular function.
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Affiliation(s)
- Angela Blasimann
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Aglaja Busch
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Lindenhof Group AG, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Bruhn
- Institute of Sports Science, University of Rostock, Rostock, Germany
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Heiner Baur
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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16
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Mahmoudkhani M, Norouzi M, Fathi Z, Charehjoo B, Oftadehgan M, Alizadeh F, Miri M. Epidemiology of injuries during Iran wheelchair basketball professional league: predictive risk factors and prevention strategies. J Inj Violence Res 2023; 15:171-178. [PMID: 37551417 PMCID: PMC10915874 DOI: 10.5249/jivr.v15i2.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Very few studies have investigated athletes with disabilities during a long period of competitions, such as a professional league. Also, there are limited findings related to specific mechanisms and risk factors of injury, and prevention strategies in Wheelchair Basketball. Therefore, the objective of this study was to investigate the rate and characteristics of injuries in the 2021-2022 Iran Wheelchair Basketball League and present prevention strategies. METHODS This retrospective study was conducted after the 2021-2022 (Mar 2021-Sep 2022) competition season. The sample size consists of 36 players, who were randomly selected among 129 players. All the data was processed using SPSS (version 21). RESULTS 111 injuries were registered, equivalent to 132 per 100 players (95% CI: 100-180) and 8.16 Injuries per 1000 hours of athlete exposure (6.2-9.8). Also, 77.8% occurred during training and 22.2% in competitions. Most injuries affected the fingers and hands (35.13%), and shoulders (22.57%). The most common types of injuries were contusions (30.63%), laceration and skin lesion (23.42%), and muscle spasms (13.51%), in which, half of the injuries were slight (0-1 days), 27.8% (mild 4-7 days), and 22.2% moderate (8-28 days). Also, 66.9% of injuries were new, and 33.1% were recurrent. Most situations and actions leading to injury include quick wheelchair pushing (29.72%), the intense ball hitting (17.14%), and sudden stops or changes of direction of the wheelchair (12.63%). A multiple linear regression analysis (Enter method) demonstrated (R2 Adjusted=0.530) Wheelchair inappropriateness (P=0.015), lack of protective equipment (P=0.028), and previous injury (P=0.003) explained close to 55% of the injury rate. CONCLUSIONS The injury rate during the league period was higher than the amounts reported from Paralympic games. Prevention strategies should be focused on rethinking athletes' pre-season readiness evaluation, return to play assessments and protection equipment technologies.
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Affiliation(s)
- Mohammadreza Mahmoudkhani
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
| | - Mehdi Norouzi
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Zahra Fathi
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Behnaz Charehjoo
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Mona Oftadehgan
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Fatemeh Alizadeh
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Mahsa Miri
- Sport Medicine and Health Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
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17
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Maricot A, Dick E, Walravens A, Pluym B, Lathouwers E, De Pauw K, Verschueren J, Roelands B, Meeusen R, Tassignon B. Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review. Sports Med 2023; 53:1423-1443. [PMID: 37155129 DOI: 10.1007/s40279-023-01834-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking. OBJECTIVE The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability. METHODS PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956. RESULTS Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability. DISCUSSION The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.
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Affiliation(s)
- Alexandre Maricot
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Emilie Dick
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Annemiek Walravens
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bert Pluym
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Elke Lathouwers
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Kevin De Pauw
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Jo Verschueren
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bart Roelands
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Romain Meeusen
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bruno Tassignon
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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18
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Bruce Leicht AS, Thompson XD, Kaur M, Hopper HM, Stolzenfeld RL, Wahl AJ, Sroufe MD, Werner BC, Diduch DR, Gwathmey FW, Brockmeier SF, Miller MD, Hart JM. Hip Strength Recovery After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231169196. [PMID: 37435425 PMCID: PMC10331192 DOI: 10.1177/23259671231169196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
Background Return-to-play (RTP) assessment after anterior cruciate ligament reconstruction (ACLR) rarely includes hip strength. Hypothesis It was hypothesized that (1) patients after ACLR will have weaker hip abduction (AB) and adduction (AD) strength compared with the contralateral limb, with larger deficits in women, (2) there will be a correlation between hip and thigh strength ratios and patient-reported outcomes (PROs), and (3) hip AB and AD strength will improve over time. Study Design Descriptive laboratory study. Methods Included were 140 patients (74 male, 66 female; mean age, 24.16 ± 10.82 years) who underwent RTP assessment at 6.1 ± 1.6 months after ACLR; 86 patients underwent a second assessment at 8.2 ± 2.2 months. Hip AB/AD and knee extension/flexion isometric strength were measured and normalized to body mass, and PRO scores were collected. Strength ratios (hip vs thigh), limb differences (injured vs uninjured), sex-based differences, and relationships between strength ratios and PROs were determined. Results Hip AB strength was weaker on the ACLR limb (ACLR vs contralateral: 1.85 ± 0.49 vs 1.89 ± 0.48 N·m/kg; P < .001) and hip AD torque was stronger (ACLR vs contralateral: 1.80 ± 0.51 vs 1.76 ± 0.52 N·m/kg; P = .004), with no sex-by-limb interaction found. Lower hip-to-thigh strength ratios of the ACLR limb were correlated with higher PRO scores (r = -0.17 to -0.25). Over time, hip AB strength increased in the ACLR limb more than in the contralateral limb (P = .01); however, the ACLR limb remained weaker in hip AB at visit 2 (ACLR vs contralateral: 1.88 ± 0.46 vs 1.91 ± 0.45 N·m/kg; P = .04). In both limbs, hip AD strength was greater at visit 2 than visit 1 (ACLR: 1.82 ± 0.48 vs 1.70 ± 0.48 N·m/kg; contralateral: 1.76 ± 0.47 vs 1.67 ± 0.47 N·m/kg; P < .01 for both). Conclusion The ACLR limb had weaker hip AB and stronger AD compared with the contralateral limb at initial assessment. Hip muscle strength recovery was not influenced by sex. Hip strength and symmetry improved over the course of rehabilitation. Although strength differences across limbs were minor, the clinical importance of these differences is still unknown. Clinical Relevance The evidence provided highlights the need to integrate hip strength into RTP assessments to identify hip strength deficits that may increase reinjury or lead to poor long-term outcomes.
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Affiliation(s)
| | - Xavier D. Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Mandeep Kaur
- Department of Physical Therapy, Northern Arizona University, Phoenix, Arizona, USA
| | - Haleigh M. Hopper
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Alexander J. Wahl
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Madison D. Sroufe
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F. Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F. Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joe M. Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Solie BS, Eggleston GG, Schwery NA, Doney CP, Kiely MT, Larson CM. Clinic and Home-Based Exercise with Blood Flow Restriction Resolves Thigh Muscle Atrophy after Anterior Cruciate Ligament Reconstruction with the Bone-Patellar Tendon-Bone Autograft: A Case Report. Healthcare (Basel) 2023; 11:1885. [PMID: 37444719 DOI: 10.3390/healthcare11131885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) results in thigh muscle atrophy. Of the various interventions proposed to mitigate thigh muscle atrophy, exercise with blood flow restriction (BFR) appears safe and effective. Some literature suggests daily exposure to exercise with BFR may be indicated during the early phase of ACLR rehabilitation; this case report outlines the methodology utilized to prescribe clinic- and home-based BFR within an outpatient rehabilitation program. A 15-year-old male soccer player suffered a left knee injury involving the anterior cruciate ligament and both menisci. He underwent ACLR and completed exercise with BFR as part of his clinic- and home-based rehabilitation program, which included practical blood flow restriction during home-based rehabilitation. After 16 weeks of rehabilitation, surgical limb thigh girth values were objectively larger than the non-surgical limb (surgical, 52.25 cm; non-surgical 50 cm), as well as the multi-frequency bioelectrical impedance analysis of his lower-extremity lean body mass (surgical limb, 10.37 kg; non-surgical limb, 10.02 kg). The findings of this case report suggest that the inclusion of clinic- and home-based BFR within an outpatient rehabilitation program may be indicated to resolve thigh muscle atrophy early after ACLR.
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Affiliation(s)
- Braidy S Solie
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Nicole A Schwery
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Michael T Kiely
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
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An YW, Kim KM, DiTrani Lobacz A, Baumeister J, Higginson JS, Rosen J, Swanik CB. Cognitive Training Improves Joint Stiffness Regulation and Function in ACLR Patients Compared to Healthy Controls. Healthcare (Basel) 2023; 11:1875. [PMID: 37444709 DOI: 10.3390/healthcare11131875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
As cognitive function is critical for muscle coordination, cognitive training may also improve neuromuscular control strategy and knee function following an anterior cruciate ligament reconstruction (ACLR). The purpose of this case-control study was to examine the effects of cognitive training on joint stiffness regulation in response to negative visual stimuli and knee function following ACLR. A total of 20 ACLR patients and 20 healthy controls received four weeks of online cognitive training. Executive function, joint stiffness in response to emotionally evocative visual stimuli (neutral, fearful, knee injury related), and knee function outcomes before and after the intervention were compared. Both groups improved executive function following the intervention (p = 0.005). The ACLR group had greater mid-range stiffness in response to fearful (p = 0.024) and injury-related pictures (p = 0.017) than neutral contents before the intervention, while no post-intervention stiffness differences were observed among picture types. The ACLR group showed better single-legged hop for distance after cognitive training (p = 0.047), while the healthy group demonstrated no improvement. Cognitive training enhanced executive function, which may reduce joint stiffness dysregulation in response to emotionally arousing images and improve knee function in ACLR patients, presumably by facilitating neural processing necessary for neuromuscular control.
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Affiliation(s)
- Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA 90621, USA
| | - Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si 16419, Republic of Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | | | - Jochen Baumeister
- Department of Exercise & Health, Paderborn University, 33098 Paderborn, Germany
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, USA
| | - Jeffrey Rosen
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Charles Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
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Alyami AH, Darraj H, Hamdi S, Saber A, Bakri N, Maghrabi R, Hakami KM, Darraj A. Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs among Saudi Athletes. Clin Pract 2023; 13:656-665. [PMID: 37366929 DOI: 10.3390/clinpract13030060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is a common medical condition that entails a stretch or sprain of the ACL, which is present in the knee joint. The incidence of ACL injury in the Kingdom of Saudi Arabia is estimated to be 31.4%. Prevention training programs (PTPs) can be used to reduce ACL injuries sustained during physical activity, as they primarily focus on improving strength, balance, and lower limb biomechanics and reducing landing impact. This study aimed to assess Saudi athletes' awareness of ACL injury PTPs. METHODS A cross-sectional survey in the form of a self-administered questionnaire in the Arabic language was carried out from 22 December 2022 to 7 March 2023 and included 1169 Saudi athletes. Statistical analyses were performed on the collected data using frequency and percentages. Binary logistic regression was used for the adjusted analysis and determining associations between athletes playing high- and low-risk sports. RESULTS Overall, 52% of participants were female athletes, and 48% were male athletes. The western region of the country had the highest response rate (28.9%). The most common sport played was football at 36.6%. Most participants (70.97%) reported that their information on ACL injury was taken by their coaches. When assessing whether participants were familiar with the concept of an ACL injury PTP, the majority of the participants answered no, representing 971 (662 high-risk, 309 low-risk), compared to those who answered yes, representing only 198 (167 high-risk, 31 low-risk), with a statistically significant difference (adjusted OR: 2.106; 95% confidence interval: 1.544-2.873; p-value < 0.001). CONCLUSION In general, the level of awareness of ACL injury PTPs among Saudi athletes was poor.
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Affiliation(s)
- Ali H Alyami
- Department of Surgery, Ministry of the National Guard Health Affairs, Jeddah 21423, Saudi Arabia
- Department of Surgery, King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
- Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
| | - Hussam Darraj
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sulaiman Hamdi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Abdulaziz Saber
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
| | - Nawaf Bakri
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Rawan Maghrabi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Khalid M Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Anwar Darraj
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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22
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Bæktoft van Weert M, Skovdal Rathleff M, Eppinga P, Møller Mølgaard C, Welling W. Using a target as external focus of attention results in a better jump-landing technique in patients after anterior cruciate ligament reconstruction - A cross-over study. Knee 2023; 42:390-399. [PMID: 37230002 DOI: 10.1016/j.knee.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Improving jump-landing technique during rehabilitation is important and may be achieved through different feedback techniques, i.e., internal focus of attention (IF) or external focus of attention using a target (EF). However, there is a lack of evidence on the most effective feedback technique after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to investigate the potential difference in jump-landing techniques between IF and EF instructions in patients after ACLR. METHODS Thirty patients (12 females, mean age 23.26 ± 4.91 years) participated after ACLR. Patients were randomly assigned into two groups that each followed a different testing sequence. Patients performed a drop vertical jump-landing test after receiving instructions with varying types of focus of attention. The Landing Error Scoring System (LESS) assessed the jump-landing technique. RESULTS EF was associated with a significantly better LESS score (P < 0.001) compared with IF. Only EF instructions led to improvements in jump-landing technique. CONCLUSION Using a target as EF resulted in a significantly better jump-landing technique than IF in patients after ACLR. This indicates that increased use of EF could or might result in a better treatment outcome during ACLR rehabilitation.
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Affiliation(s)
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Centre for General Practice at Aalborg University, Aalborg, Denmark; Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Peter Eppinga
- Medisch Centrum Zuid (MCZ), Groningen, The Netherlands
| | - Carsten Møller Mølgaard
- Department of Orthopedic Surgery, Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
| | - Wouter Welling
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Groningen, The Netherlands; Pro-F Fysiotherapie, Enschede, The Netherlands.
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23
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Criss CR, Lepley AS, Onate JA, Clark BC, Simon JE, France CR, Grooms DR. Brain activity associated with quadriceps strength deficits after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:8043. [PMID: 37198275 PMCID: PMC10192374 DOI: 10.1038/s41598-023-34260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI < 90%, n = 12; Q-LSI ≥ 90%, n = 10; controls, all n = 22 Q-LSI ≥ 90%). Lower Q-LSI was related to increased activity in the contralateral premotor cortex and lingual gyrus (p < .05). Those who did not meet clinical recommendations for strength demonstrated greater lingual gyrus activity compared to those who met clinical recommendations Q-LSI ≥ 90 and healthy controls (p < 0.05). Asymmetrically weak ACL-R patients displayed greater cortical activity than patients with no underlying asymmetry and healthy controls.
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Affiliation(s)
- Cody R Criss
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
| | - Adam S Lepley
- School of Kinesiology; Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA.
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
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24
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Gholami F, Letafatkar A, Moghadas Tabrizi Y, Gokeler A, Rossettini G, Ghanati HA, Schöllhorn WI. Comparing the Effects of Differential and Visuo-Motor Training on Functional Performance, Biomechanical, and Psychological Factors in Athletes after ACL Reconstruction: A Randomized Controlled Trial. J Clin Med 2023; 12:2845. [PMID: 37109182 PMCID: PMC10142379 DOI: 10.3390/jcm12082845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Variation during practice is widely accepted to be advantageous for motor learning and is, therefore, a valuable strategy to effectively reduce high-risk landing mechanics and prevent primary anterior cruciate ligament (ACL) injury. Few attempts have examined the specific effects of variable training in athletes who have undergone ACL reconstruction. Thereby, it is still unclear to what extent the variations in different sensor areas lead to different effects. Accordingly, we compared the effects of versatile movement variations (DL) with variations of movements with emphasis on disrupting visual information (VMT) in athletes who had undergone ACL reconstruction. Forty-five interceptive sports athletes after ACL reconstruction were randomly allocated to a DL group (n = 15), VT group (n = 15), or control group (n = 15). The primary outcome was functional performance (Triple Hop Test). The secondary outcomes included dynamic balance (Star Excursion Balance Test (SEBT)), biomechanics during single-leg drop-landing task hip flexion (HF), knee flexion (KF), ankle dorsiflexion (AD), knee valgus (KV), and vertical ground reaction force (VGRF), and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)) assessed before and after the 8 weeks of interventions. Data were analyzed by means of 3 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. Significant group × time interaction effects, main effect of time, and main effect of group were found for the triple hop test and all eight directions, SEBT, HF, KF, AD, KV, VGRF, and TSK. There was no significant main effect of group in the HF and triple hop test. Additionally, significant differences in the triple hop test and the seven directions of SEBT, HF, KF, KV, VGRF, and TSK were found between the control group and the DL and VMT groups. Between group differences in AD and the medial direction of SEBT were not significant. Additionally, there were no significant differences between VMT and the control group in the triple hop test and HF variables. Both motor learning (DL and VMT) programs improved outcomes in patients after ACL reconstruction. The findings suggest that DL and VMT training programs lead to comparable improvements in rehabilitation.
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Affiliation(s)
- Fatemeh Gholami
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran; (F.G.); (H.A.G.)
| | - Amir Letafatkar
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran; (F.G.); (H.A.G.)
| | - Yousef Moghadas Tabrizi
- Department of health and sport medicine, Faculty of Sport Sciences and health, University of Tehran, Tehran 1439813141, Iran;
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, 33098 Paderborn, Germany
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, 1105 Amsterdam, The Netherlands
| | | | - Hadi Abbaszadeh Ghanati
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran; (F.G.); (H.A.G.)
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25
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ÖZALTIN GE, TALU B, ÖKTEM U. Functional Outcomes of Motor Learning Interventions in Anterior Cruciate Ligament Injuries. ARŞIV KAYNAK TARAMA DERGISI 2023. [DOI: 10.17827/aktd.1169499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Anterior cruciate ligament injury is one of the pathologies that affect the daily and professional life of the majority of athletes. When the treatment options are examined, there are two options surgical treatment and conservative treatment. Rehabilitation is essential in both cases, with or without surgery. Especially for returning to sports, long-term rehabilitation after surgery has become essential. While many different exercise methods have been tried in the prevention of anterior cruciate ligament injury and rehabilitation after reconstructive surgery, many have focused on strength training. The abnormal movement pattern that occurs with the somatosensory loss seen after anterior cruciate ligament injury results in a functional loss in the injured extremity and the contralateral extremity in the long term. Considering the incidence of injury, studies to establish the normal movement pattern and restore motor control are very important. For this reason, motor learning-based interventions that support neuroplasticity are of great interest today. This review aims to examine the functional results of current motor learning-based interventions in anterior cruciate ligament rehabilitation in line with the literature.
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26
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Yañez-Diaz R, Roby M, Silvestre R, Zamorano H, Vergara F, Sandoval C, Neira A, Yañez-Rojo C, De la Fuente C. Multiclass Support Vector Machine improves the Pivot-shift grading from Gerdy's acceleration resultant prior to the acute Anterior Cruciate Ligament surgery. Injury 2023:S0020-1383(23)00271-1. [PMID: 37003872 DOI: 10.1016/j.injury.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Rotatory laxity acceleration still lacks objective classification due to interval grading superposition, resulting in a biased pivot shift grading prior to the Anterior Cruciate Ligament (ACL) reconstruction. However, data analysis might help improve data grading in the operative room. Therefore, we described the improvement of the pivot-shift categorization in Gerdy's acceleration under anesthesia prior to ACL surgery using a support vector machine (SVM) classification, surgeon, and literature reference. METHODS Seventy-five patients (aged 30.3 ± 10.2 years, and IKDC 52.0 ± 16.5 points) with acute ACL rupture under anesthesia prior to ACL surgery were analyzed. Patients were graded with pivot-shift sign glide (+), clunk (++), and (+++) gross by senior orthopedic surgeons. At the same time, the tri-axial tibial plateau acceleration was measured. Categorical data were statistically described, and the accelerometry and categorical data were associated (α = 5%). A multiclass SVM kernel with the best accuracy trained by orthopedic surgeons and assisted from literature for missing data was compared with experienced surgeons and literature interval grading. The cubic SVM classifier achieved the best grading. RESULTS The intra-group proportions were different for each grading in the three compared strategies (p < 0.001). The inter-group proportions were different for all comparisons (p < 0.001). There were significant (p < 0.001) associations (Tau: 0.69, -0.28, and -0.50) between the surgeon and SVM, the surgeon and interval grading, and the interval and SVM, respectively. CONCLUSION The multiclass SVM classifier improves the acceleration categorization of the (+), (++), and (+++) pivot shift sign prior to the ACL surgery in agreement with surgeon criteria.
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Affiliation(s)
- Roberto Yañez-Diaz
- Traumatologia, Clinica MEDS, Santiago, Chile; Centro de Innovación, Clinica MEDS, Santiago Chile
| | - Matías Roby
- Traumatologia, Clinica MEDS, Santiago, Chile; Centro de Innovación, Clinica MEDS, Santiago Chile
| | - Rony Silvestre
- Centro de Innovación, Clinica MEDS, Santiago Chile; Carrera de Kinesiologia, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | | | - Alejandro Neira
- Escuela de Kinesiologia, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | | | - Carlos De la Fuente
- Centro de Innovación, Clinica MEDS, Santiago Chile; Carrera de Kinesiologia, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Applied Neuromechanics Research Group, Universidade Federal do Pampa, Uruguaiana, RS, Brazil.
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27
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Muccio M, Atun-Einy O, Kafri M, Kaplan SL. Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article. Phys Occup Ther Pediatr 2023; 43:741-758. [PMID: 36922700 DOI: 10.1080/01942638.2023.2186198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/13/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
AIM This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. METHODS Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. CONCLUSIONS AND IMPLICATIONS As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.
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Affiliation(s)
- Marissa Muccio
- Division of PRNY PC, Scoliosis Specialty Center, Totowa, NJ, USA
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
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28
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Tayebi A, Kouhzad Mohammadi H, Nassadj G, Mehravar M. Protocol for double-blinded randomized trial to enhance postural control after anterior cruciate ligament reconstruction by balance training and concurrent cognitive demands or external focus of attention. Eur J Transl Myol 2023; 33. [PMID: 36919557 PMCID: PMC10141750 DOI: 10.4081/ejtm.2023.11085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/10/2023] [Indexed: 03/12/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury is one of the most common injuries among athletes that lead to postural control disorders. The aim of this study is to compare the effects of balance training with and without cognitive task and external focus of attention on postural control in individuals with ACL reconstruction. Sixty participants with ACL reconstruction, between the ages of 18 and 47 will be randomly allocated to three group's including routine balance training, balance training with external focus of attention. Patients will be assessed at the baseline, after receiving eight weeks of intervention, and four weeks later. A double-blinded design will be used. Center of pressure data acquired from a forceplate will be used to assess amount and velocity of sway, local dynamical stability, and global stability of upright balance. Also, dynamic balance will be assessed using Star Excursion balance test. The results of this research will be used to establish effectiveness of treatment strategies for postural control in individuals with anterior cruciate ligament reconstruction. The suggested interventions would be clinically applicable in the athlete with ACL injury.
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Affiliation(s)
- Abdollah Tayebi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
| | - Hossein Kouhzad Mohammadi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
| | - Gholamhossein Nassadj
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz.
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Protocol for a Randomized Crossover Trial to Evaluate the Effect of Soft Brace and Rigid Orthosis on Performance and Readiness to Return to Sport Six Months Post-ACL-Reconstruction. Healthcare (Basel) 2023; 11:healthcare11040513. [PMID: 36833047 PMCID: PMC9957425 DOI: 10.3390/healthcare11040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
A randomized crossover trial was designed to investigate the influence of muscle activation and strength on functional stability/control of the knee joint, to determine whether bilateral imbalances still occur six months after successful anterior cruciate ligament reconstruction (ACLR), and to analyze whether the use of orthotic devices changes the activity onset of these muscles. Furthermore, conclusions on the feedforward and feedback mechanisms are highlighted. Therefore, twenty-eight patients will take part in a modified Back in Action (BIA) test battery at an average of six months after a primary unilateral ACLR, which used an autologous ipsilateral semitendinosus tendon graft. This includes double-leg and single-leg stability tests, double-leg and single-leg countermovement jumps, double-leg and single-leg drop jumps, a speedy jump test, and a quick feet test. During the tests, gluteus medius and semitendinosus muscle activity are analyzed using surface electromyography (sEMG). Motion analysis is conducted using Microsoft Azure DK and 3D force plates. The tests are performed while wearing knee rigid orthosis, soft brace, and with no aid, in random order. Additionally, the range of hip and knee motion and hip abductor muscle strength under isometric conditions are measured. Furthermore, patient-rated outcomes will be assessed.
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30
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Culiver A, Grooms D, Edwards N, Schmitt L, Oñate J. A Preliminary Investigation into the Neural Correlates of Knee Loading during a Change of Direction Task in Individuals after Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2023; 18:70-80. [PMID: 36793571 PMCID: PMC9897027 DOI: 10.26603/001c.57782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/03/2022] [Indexed: 02/04/2023] Open
Abstract
Background Central nervous system (CNS) function after ACLR, quantified by the blood oxygen level dependent (BOLD) response, is altered in regions of sensory function during knee movement after ACLR. However, it is unknown how this altered neural response may manifest in knee loading and response to sensory perturbations during sport specific movements. Purpose To investigate the relationship among CNS function and lower extremity kinetics, under multiple visual conditions, during 180° change of direction task in individuals with a history of ACLR. Methods Eight participants, 39.3 ± 37.1 months after primary, left ACLR performed repetitive active knee flexion and extension of their involved knee during fMRI scanning. Participants separately performed 3D motion capture analysis of a 180° change of direction task under full vision (FV) and stroboscopic vision (SV) conditions. A neural correlate analysis was performed to associate BOLD signal to knee loading of the left lower extremity. Results Involved limb peak internal knee extension moment (pKEM) was significantly lower in the SV condition (1.89 ± 0.37 N*m/Kg) compared to the FV condition (2.0 ± 0.34 N*m/Kg) (p = .018). Involved limb pKEM during the SV condition was positively correlated with BOLD signal in the contralateral precuneus and superior parietal lobe (Voxels: 53; p = .017; z-stat max: 6.47; MNI peak: 6, -50, 66). Conclusion There is a positive association between involved limb pKEM in the SV condition and BOLD response in areas of visual-sensory integration. Activation of contralateral precuneus and superior parietal lobe brain regions may be a strategy to maintain joint loading when vision is perturbed. Level of Evidence Level 3.
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Affiliation(s)
- Adam Culiver
- School of Health and Rehabilitation Sciences Ohio State University
- Jameson Crane Sports Medicine Research Institute Ohio State University
| | - Dustin Grooms
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions Ohio University
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions Ohio University
- 5. Ohio Musculoskeletal and Neurological Institute Ohio University
| | - Nathan Edwards
- School of Health and Rehabilitation Sciences Ohio State University
- Jameson Crane Sports Medicine Research Institute Ohio State University
| | - Laura Schmitt
- Jameson Crane Sports Medicine Research Institute Ohio State University
- Division of Physical Therapy, School of Health and Rehabilitation Sciences Ohio State University
| | - James Oñate
- Jameson Crane Sports Medicine Research Institute Ohio State University
- Division of Athletic Training, School of Health and Rehabilitation Sciences Ohio State University
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Criss CR, Lepley AS, Onate JA, Simon JE, France CR, Clark BC, Grooms DR. Neural Correlates of Self-Reported Knee Function in Individuals After Anterior Cruciate Ligament Reconstruction. Sports Health 2023; 15:52-60. [PMID: 35321615 PMCID: PMC9808834 DOI: 10.1177/19417381221079339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a common knee injury among athletes and physically active adults. Despite surgical reconstruction and extensive rehabilitation, reinjuries are common and disability levels are high, even years after therapy and return to activity. Prolonged knee dysfunction may result in part from unresolved neuromuscular deficits of the surrounding joint musculature in response to injury. Indeed, "upstream" neurological adaptations occurring after injury may explain these persistent functional deficits. Despite evidence for injury consequences extending beyond the joint to the nervous system, the link between neurophysiological impairments and patient-reported measures of knee function remains unclear. HYPOTHESIS Patterns of brain activation for knee control are related to measures of patient-reported knee function in individuals after ACL reconstruction (ACL-R). STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS In this multicenter, cross-sectional study, participants with unilateral ACL-R (n = 25; 10 men, 15 women) underwent task-based functional magnetic resonance imaging testing. Participants performed repeated cycles of open-chain knee flexion/extension. Neural activation patterns during the movement task were quantified using blood oxygen level-dependent (BOLD) signals. Regions of interest were generated using the Juelich Histological Brain Atlas. Pearson product-moment correlations were used to determine the relationship between mean BOLD signal within each brain region and self-reported knee function level, as measured by the International Knee Documentation Committee index. Partial correlations were also calculated after controlling for time from surgery and sex. RESULTS Patient-reported knee function was positively and moderately correlated with the ipsilateral secondary somatosensory cortex (r = 0.57, P = 0.005) and the ipsilateral supplementary motor area (r = 0.51, P = 0.01). CONCLUSION Increased ipsilateral secondary sensorimotor cortical activity is related to higher perceived knee function. CLINICAL RELEVANCE Central nervous system mechanisms for knee control are related to subjective levels of knee function after ACL-R. Increased neural activity may reflect central neuroplastic strategies to preserve knee functionality after traumatic injury.
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Affiliation(s)
- Cody R. Criss
- Translational Biomedical Sciences,
Graduate College, Ohio University, Athens, Ohio
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Cody R Criss, W283 Grover
Center, 1 Ohio University, Athens, OH 45701 (
) (Twitter: @criss_cody)
| | - Adam S. Lepley
- Exercise and Sport Science Initiative,
School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - James A. Onate
- School of Health and Rehabilitation
Sciences, The Ohio State University, Columbus, Ohio
| | - Janet E. Simon
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Division of Athletic Training, School
of Applied Health Sciences and Wellness, College of Health Sciences and Professions,
Ohio University, Athens, Ohio
| | - Christopher R. France
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Department of Psychology, College of
Arts and Sciences, Ohio University, Athens, Ohio
| | - Brian C. Clark
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Department of Biomedical Sciences,
Ohio University, Athens, Ohio
- Department of Geriatric Medicine, Ohio
University, Athens, Ohio
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological
Institute (OMNI), Ohio University, Athens, Ohio
- Division of Athletic Training, School
of Applied Health Sciences and Wellness, College of Health Sciences and Professions,
Ohio University, Athens, Ohio
- Division of Physical Therapy, School
of Rehabilitation and Communication Sciences, College of Health Sciences and
Professions, Ohio University, Athens, Ohio
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32
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Castillo-Vejar L, Lizama-Fuentes M, Bascour-Sandoval C, Cuyul-Vásquez I. [Attentional focus instructions for therapeutic exercise in people with musculoskeletal disorders. A scoping review]. Rehabilitacion (Madr) 2022; 56:344-352. [PMID: 35469643 DOI: 10.1016/j.rh.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/28/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.
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Affiliation(s)
- L Castillo-Vejar
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - M Lizama-Fuentes
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - C Bascour-Sandoval
- Departamento de Medicina Interna, Universidad de La Frontera, Temuco, Chile; Carrera de Kinesiología, Universidad Autónoma de Chile, Temuco, Chile
| | - I Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile.
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Werner I, Peer-Kratzer M, Mohr M, van-Andel S, Federolf P. Intervention for Better Knee Alignment during Jump Landing: Is There an Effect of Internally vs. Externally Focused Instructions? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10763. [PMID: 36078475 PMCID: PMC9518031 DOI: 10.3390/ijerph191710763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Externally focused attention is known to induce superior results in the movement outcome, whereas focusing attention on the moving body (internal focus) causes conscious control and constrains action. The study investigated effects on knee trajectory and whole-body movement complexity when addressing knee alignment using externally (EF) vs. internally (IF) focused instructions. Young ski racers, n = 24 (12 male), performed landings with subsequent jumps to submaximal height. Movements were tracked and analyzed during the ground contact phase. Sets of jumps were executed without instruction (CON), followed by EF and IF instructions on knee alignment in a random order. Medial-lateral displacement of the knee in landing quantified task achievement, and whole-body principal component analysis was used to compute movement complexity. Knee alignment instructions led to a significantly lower medial knee displacement compared to CON (p = 0.001, ηp2 = 0.35). EF vs. IF did not reach significance. EF, as well as IF instructions increased the prominence of the first movement pattern (p = 0.01, ηp2 = 0.22) with a reduction of higher-order patterns (p = 0.002, W = 0.11), suggesting a strategy of freezing degrees of freedom. Both instructions addressing the movement form positively influenced knee displacement during landing, and both led to a freezing strategy, simplifying whole-body coordination.
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Affiliation(s)
- Inge Werner
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Maurice Mohr
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Steven van-Andel
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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34
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Ghanati HA, Letafatkar A, Shojaedin S, Hadadnezhad M, Schöllhorn WI. Comparing the Effects of Differential Learning, Self-Controlled Feedback, and External Focus of Attention Training on Biomechanical Risk Factors of Anterior Cruciate Ligament (ACL) in Athletes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610052. [PMID: 36011685 PMCID: PMC9408147 DOI: 10.3390/ijerph191610052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 05/13/2023]
Abstract
The current study aimed to compare the possible effects of differential learning strategy, self-controlled feedback, and external focus of attention on kinetic and kinematic risk factors of anterior cruciate ligament (ACL) injury in athletes. Forty-eight male athletes from three sports of handball, volleyball and basketball were selected for this study and were randomly divided into four groups: differential learning (n = 12), self-control feedback (n = 12), external focus (n = 12), and control (n = 12) group. All groups followed the intervention for eight weeks with three sessions per week. Data were analyzed by means of 4 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. A significant group × time interaction and the main effect of time was found for most kinetic and kinematic variables. The main effect of the group was significant only at the knee abduction angle. Differential learning and external focus of attention methods positively reduced the kinetic and kinematic variables that are considered risk factors for ACL injury. However, the effect sizes (Cohen's d) for the changes in most of the variables were larger for the differential learning group. Tailoring the boundary conditions that are based on the manipulations created in the exercise through variability and variety of movements associated with differential learning methods rather than repeating movements could reduce the risk of ACL injury.
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Affiliation(s)
- Hadi Abbaszadeh Ghanati
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
| | - Amir Letafatkar
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
| | - Sadredin Shojaedin
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
| | - Malihe Hadadnezhad
- Department of Biomechanics and Sport Injury, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran 1571914911, Iran
| | - Wolfgang I. Schöllhorn
- Department for Training and Movement Science, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
- Correspondence: (H.A.G.); (A.L.); (W.I.S.)
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35
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Gokeler A, Grassi A, Hoogeslag R, van Houten A, Bolling C, Buckthorpe M, Norte G, Benjaminse A, Heuvelmans P, Di Paolo S, Tak I, Villa FD. Return to sports after ACL injury 5 years from now: 10 things we must do. J Exp Orthop 2022; 9:73. [PMID: 35907095 PMCID: PMC9339063 DOI: 10.1186/s40634-022-00514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current outcomes. The aim of this manuscript is to present an overview of factors that are needed to be incorporated and to personalize the rehabilitation process for an athlete who has undergone an ACLR. Level of evidence 4.
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Affiliation(s)
- Alli Gokeler
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands. .,Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands. .,Department Exercise and Health, Faculty of Science, Exercise Science and Neuroscience, Paderborn University, Paderborn, Germany.
| | | | - Roy Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - Albert van Houten
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - Caroline Bolling
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands
| | - Matthew Buckthorpe
- Allied Health and Performance Science, St Mary's University, Twickenham, London, England
| | - Grant Norte
- Exercise Science Program, School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, USA
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, the Netherlands
| | - Pieter Heuvelmans
- Department Exercise and Health, Faculty of Science, Exercise Science and Neuroscience, Paderborn University, Paderborn, Germany
| | - Stefano Di Paolo
- Dipartimento Di Scienze Biomediche E Neuromotorie DIBINEM, Università Di Bologna, Bologna, BO, Italy
| | - Igor Tak
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands.,Sports Physical, Therapy Clinic Fysiotherapie Utrecht Oost, Utrecht, The Netherlands
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Center of Excellence, Bologna, Italy
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36
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Han S, Lee H, Hopkins JT. Acute effects of external visual feedback using cross-line laser on landing neuromechanics and postural control in chronic ankle instability. Sports Biomech 2022:1-16. [PMID: 35678240 DOI: 10.1080/14763141.2022.2085620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
Although neuromuscular training (NMT) programmes positively enhance clinical deficits in chronic ankle instability (CAI) patients, the effectiveness of NMTs in restoring movement patterns during jump landing is still questionable. Before developing new prolonged motor-learning interventions, it is important to determine the immediate effects of intervention on movement patterns during jump-landing in patients with CAI. Therefore, the purpose of this study was to determine whether real-time external feedback using a crossline laser device changes the movement patterns during jump-landing and balance tasks in patients with CAI. Eighteen patients with CAI completed three successful single-leg jump-landing tasks and single-leg balance tasks under the conditions of with and without external feedback. Lower-extremity joint angles, moments, and EMG activation of six muscles were collected during the single leg jump-landing task and centre of pressure data were collected during the single-leg balance test. Real-time external feedback allowed to change neuromechanical characteristics in the entire lower-extremity (i.e., ankle, knee, and hip joints) during jump-landing. However, there were no differences in static postural control between the two conditions. Clinicians should carefully consider incorporating a cost-effective laser device into an augmented NMT programme of longer duration to improve movement patterns during functional tasks in patients with CAI.
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Affiliation(s)
- Seunguk Han
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Hyunwook Lee
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Jon Tyson Hopkins
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
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37
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Have We Forgotten Our Patient? An Exploration of Patient Experiences After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2022; 31:993-999. [PMID: 35588766 DOI: 10.1123/jsr.2021-0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/08/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limited information is available on the experiences of patients during rehabilitation after anterior cruciate ligament reconstruction (ACLR). AIM The current study aimed to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. METHOD AND DESIGN A survey-based study with an online platform was used to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Seventy-two patients (age 27.8 [8.8] y) after ACLR participated. Data were analyzed and themes were identified by comparing categories and subcategories on similarity. MAIN FINDINGS Positive patient experiences were room for own input, supervision, attention, knowledge, honesty, and professionalism of the physiotherapist. Additionally, a varied and structured rehabilitation program, adequate facilities, and contact with other patients were identified as positive patient experiences. Negative experiences were a lack of attention, lack of professionalism of the physiotherapists, a lack of sport-specific field training, a lack of goal setting, a lack of adequate facilities, and health insurance costs. CONCLUSIONS The current study identified factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. These findings can help physiotherapists in understanding the patient experiences during rehabilitation after ACLR.
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38
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Ghorbani M, Yaali R, Schöllhorn WI, Letafatkar A, Sadeghi H. The effects of learning with various noise on Gait Kinematics in 3-to-5-year-old children: a randomized controlled trial. BMC Sports Sci Med Rehabil 2022; 14:25. [PMID: 35164859 PMCID: PMC8845401 DOI: 10.1186/s13102-022-00416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022]
Abstract
Background Lack of the neuromuscular control during locomotion in the knee joint leads to an increased risk of anterior cruciate ligament (ACL) injury in children. Hence, we aimed to explore the effects of a repetitive, model-oriented, and self-organized approach on lower limb kinematics during gait in children. Methods In randomized controlled trial, 36 children with 4 ± 0.79 years of age from the children gym were randomly (a lottery method) allocated into three groups, including (1) the model-oriented (n = 10), (2) Differential Learning (n = 11), and (3) control (n = 10) groups. Kinematic data of hip, knee, and ankle joints in the sagittal plane were recorded by a GoPro camera at the moments of heel-ground contact and toe-off the ground before and after a 6-week intervention (two sessions per week). Results The results indicate a 35% post-intervention increase of ankle dorsiflexion (95% CI: − 5.63 _ − 0.96) in the moment of heel-ground contact in the model-oriented group; however, knee flexion (95% CI: − 1.05 _ 8.34) and hip flexion (95% CI: 3.01 _ 11.78) were respectively decreased by 20% and 20%. After the intervention, moreover, ankle plantar flexion (95% CI: − 9.18 _ − 2.81) and hip extension (95% CI: − 12.87 _ − 3.72) have respectively increased by 37% and 37%, while knee flexion (95% CI: 3.49 _ 11.30) showed a %16 decrease in the moment of toe off the ground. As for the Differential Learning group, ankle dorsiflexion (95% CI: − 5.19 _ − 1.52) increased by 33%, and knee (95% CI: 0.60 _ 5.76) and hip flexion (95% CI: 2.15 _ 7.85) respectively decreased by 17% and 17% at the moment of the heel-ground contact following the intervention. At toe lifting off the ground, the plantar flexion (95% CI: − 7.77 _ − 2.77) increased by 35%, knee flexion (95% CI: 2.17 _ 7.27) decreased to 14%, and hip extension (95% CI: − 9.98 _ − 4.20) increased by %35 following the intervention for the Differential Learning group subjects. Based on the results obtained from the one-way ANOVA, there was a significant difference between these groups and the control group in all kinematic gait variables (p ≤ 0.05). However, no statistically significant differences were found between the two experimental groups. Conclusions The results implied that the model-oriented repetitive and the self-organized Differential Learning approach were both appropriate to alter the kinematic gait pattern in the 3–5-year-old children. Previous research has almost exclusively recommended a model-oriented approach to change kinematic patterns and preventing non-contact motor injuries. However, the present study showed that the Differential Learning approach can help children to achieve the same goal by continuously changing environments and stimulating challenges. Trial registration: Current Controlled Trials using the IRCT website with ID number of, IRCT20130109012078N5 “Prospectively registered” at 14/5/2021.
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Affiliation(s)
- Maryam Ghorbani
- Faculty of Physical Education and Sports Sciences, Kharazmi University of Tehran, Tehran, Iran
| | - Rasoul Yaali
- Faculty of Physical Education and Sports Sciences, Kharazmi University of Tehran, Tehran, Iran.
| | - Wolfgang I Schöllhorn
- Department for Training and Movement Science, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amir Letafatkar
- Faculty of Physical Education and Sports Sciences, Kharazmi University of Tehran, Tehran, Iran
| | - Hassan Sadeghi
- Faculty of Physical Education and Sports Sciences, Kharazmi University of Tehran, Tehran, Iran
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39
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Brazalovich P, Simon JE, Criss CR, Yom JP, Grooms DR. The effects of virtual reality immersion on drop landing mechanics. Sports Biomech 2022:1-17. [PMID: 35139757 DOI: 10.1080/14763141.2022.2035427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Virtual reality (VR) can be used to alter the environment and challenge sensory calibration which rehabilitation and return-to-sport testing lack. The purpose was to establish how VR manipulation of the environment changes knee landing biomechanics. Twenty-nine healthy active adults (22 males; 20.52 ± 1.21 years; 1.75 ± 0.09 m; 78.34 ± 14.33 kg) were recruited. Three drop landing trials (31 cm height box) were performed for three conditions: eyes-open (EO), eyes-closed (EC), and VR, consisting of a head-mounted display of a 360° photo of a steep man-made edge or drop. Knee kinematics and kinetics were evaluated using 3D motion capture. The VR condition significantly increased Landing Error Score System errors relative to EO (1.28 ± 0.20, p < 0.001) and EC (0.98 ± 0.22, p < 0.001) and increased vertical ground reaction force relative to EO (0.41 ± 0.09 N·bw-1, p < 0.001) and EC (0.34 ± 0.07 N·bw-1, p < 0.001). The VR condition had less knee flexion at initial contact compared to EO (4.39 ± 0.75°, p = 0.001) and EC (1.83 ± 0.63°, p = 0.021). The VR condition had more knee abduction at initial contact compared to EO (0.71 ± 0.24°, p = 0.002) and EC (0.69 ± 0.22°, p = 0.002) and increased knee abduction at maximum flexion compared to EO (2.01 ± 0.58°, p = 0.026). Landing in VR increased injury risk landing biomechanics, indicating that VR may option to incorporate into return-to-play or injury risk assessment.
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Affiliation(s)
- Philip Brazalovich
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Janet E Simon
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Jae P Yom
- Department of Allied Health, University of Illinois Springfield, Springfield, IL, USA
| | - Dustin R Grooms
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
- School of Rehabilitation and Communications Science, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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40
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Monson J, Schoenecker J, Schwery N, Palmer J, Rodriguez A, LaPrade RF. Postoperative Rehabilitation and Return to Sport Following Multiligament Knee Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e29-e40. [PMID: 35141534 PMCID: PMC8811527 DOI: 10.1016/j.asmr.2021.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
Multiligament knee injuries (MLKIs) are debilitating injuries that increasingly occur in young athletes. Return to sport (RTS) has historically been considered unlikely due to the severity of these injuries. Reporting in the literature regarding objective outcomes following MLKI, including RTS, is lacking, as are clear protocols for both rehabilitation progressions and RTS testing. RTS following MLKI is a complex process that requires an extended recovery duration compared to other surgery types. Progressions through postoperative rehabilitation and RTS should be thoughtful, gradual, and criterion based. After effective anatomic reconstruction to restore joint stability, objective measures of recovery including range of motion, strength, movement quality, power, and overall conditioning guide decision-making throughout the recovery process. It is important to frame the recovery process of the athlete in the context of the severity of their injury, as it is typically slower and less linear. Improved reporting on objective outcomes will enhance our understanding of recovery expectations within this population by highlighting persistent deficits that may interfere with a full recovery, including RTS.
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Affiliation(s)
- Jill Monson
- Twin Cities Orthopedics, Eagan, Minnesota, U.S.A
- Training HAUS, Eagan, Minnesota, U.S.A
| | - Jon Schoenecker
- Twin Cities Orthopedics, Eagan, Minnesota, U.S.A
- Training HAUS, Eagan, Minnesota, U.S.A
| | | | - Jamie Palmer
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A
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41
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Civilette MD, Rate WR, Haislup BD, Cohen AS, Camire L, Bodendorfer BM, Gould HP. The top 100 most impactful articles on the anterior cruciate ligament: An altmetric analysis of online media. SAGE Open Med 2022; 10:20503121221111694. [PMID: 35924141 PMCID: PMC9340895 DOI: 10.1177/20503121221111694] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/13/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives: To identify the top 100 most impactful anterior cruciate ligament articles in online media as measured by the Altmetric Attention Score and compare their characteristics to the most-cited anterior cruciate ligament articles in the scientific literature. Methods: The Altmetric database was queried to identify all published articles pertaining to the anterior cruciate ligament. The search yielded 9445 articles, which were stratified by highest to lowest Altmetric Attention Score. The top 100 articles were included. Collected data included article type, article topic, journal name, and online mentions in news, blogs, Twitter, Facebook, Wikipedia, and other sources. The geographic origin of each article was also determined based on the institutional affiliation of the first author. Results: Altmetric Attention Score of the top 100 anterior cruciate ligament articles ranged from 109 to 2193 (median 172.0, interquartile range 137.5–271.5). Of the 100 articles, 65 were published in three journals: American Journal of Sports Medicine, British Journal of Sports Medicine, and Journal of Orthopaedic & Sports Physical Therapy. The most prevalent article type was original research (60%), followed by systematic review/meta-analysis (18%). The most prevalent article topic was rehabilitation and return to play after anterior cruciate ligament reconstruction (22%), followed by epidemiology/risk factors (16%), injury prevention (14%), and biomechanics of anterior cruciate ligament injuries (14%). Of the top 100 articles, 54% were American, 31% were European, and 15% were published in other countries outside of the United States and Europe. Conclusion: This study used Altmetric Attention Score to identify the 100 most engaged anterior cruciate ligament articles in online media. The characteristics of these articles differed substantially from the most-cited anterior cruciate ligament articles in the literature with regard to article type, article topic, geographic origin, and publication journal. These findings suggest that alternative metrics measure distinct components of anterior cruciate ligament article engagement and add an important dimension to understanding the overall impact of published research on the anterior cruciate ligament.
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Affiliation(s)
- Matthew D Civilette
- Georgetown University Medical Center, Washington, DC, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - William R Rate
- Georgetown University Medical Center, Washington, DC, USA
| | - Brett D Haislup
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Andrew S Cohen
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lyn Camire
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Blake M Bodendorfer
- Division of Sports Medicine and Shoulder Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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42
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Gokeler A, Dingenen B, Hewett TE. Rehabilitation and Return to Sport Testing After Anterior Cruciate Ligament Reconstruction: Where Are We in 2022? Arthrosc Sports Med Rehabil 2022; 4:e77-e82. [PMID: 35141539 PMCID: PMC8811523 DOI: 10.1016/j.asmr.2021.10.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/30/2021] [Indexed: 01/02/2023] Open
Abstract
Athletes who sustain an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to return to sports at the preinjury level. The proportion of athletes who successfully return to preinjury-level sport is low and disappointing, whereas the rate of second ACL injury in athletes under the age of 20 has been reported to be as high as 40% after return to sport (RTS). Although in recent years, new insights pertaining to RTS have been published, the lack of validity of RTS criteria after ACLR remain. The purpose of this clinical commentary is to present a critical overview of the current literature on RTS testing after ACLR.
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Affiliation(s)
- Alli Gokeler
- OCON Centre of Orthopaedic Surgery and Sports Medicine, Hengelo, The Netherlands.,Exercise Science and Neuroscience Unit, Department Exercise & Health, Faculty of Science, University of Paderborn, Paderborn, Germany
| | - Bart Dingenen
- Reval Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Timothy E Hewett
- Hewett Global Consultants, Rochester, Minnesota, U.S.A.,Rocky Mountain Consortium for Sports Research, Edwards, Colorado, U.S.A
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2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther 2022; 52:11-28. [PMID: 34972489 DOI: 10.2519/jospt.2022.10952] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.
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Arundale AJH, Silvers-Granelli HJ, Myklebust G. ACL injury prevention: Where have we come from and where are we going? J Orthop Res 2022; 40:43-54. [PMID: 33913532 DOI: 10.1002/jor.25058] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.
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Affiliation(s)
- Amelia J H Arundale
- Department of Rehabilitation, Icahn School of Medicine, Mount Sinai Health System, New York, New York, USA.,Red Bull Athlete Performance Center, Red Bull GmBH, Thalgua, Austria
| | - Holly J Silvers-Granelli
- Velocity Physical Therapy, Santa Monica, California, USA.,Major League Soccer, Medical Research Committee, New York, New York, USA
| | - Grethe Myklebust
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Yantha ZD, McKay B, Ste-Marie DM. The recommendation for learners to be provided with control over their feedback schedule is questioned in a self-controlled learning paradigm. J Sports Sci 2021; 40:769-782. [PMID: 34963413 DOI: 10.1080/02640414.2021.2015945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Evidence that self-controlled feedback schedules are more effective for motor learning than yoked or predetermined schedules has been used to forward the recommendation that practitioners should provide choice to learners over when they would like to receive feedback. This recommendation can be questioned because the typical comparison groups in such experimentation do not well represent the applied setting. Consequently, comparison groups that better map onto the applied setting are needed. To this end, three groups learned a golf putting task: (1) self-controlled, (2) traditional-yoked, and (3) a group who were led to believe their KR schedule was being controlled by a golf coach. Participants (N = 60) completed a pre-test, acquisition phase, and delayed post-tests (retention/transfer). No group differences during the post-tests for mean radial error, F(2, 54) = 2.71, p = .075, or bivariate variable error, F(2, 56) = 0.11, p = .896, were found. Thus, the typical self-controlled learning advantage was not observed. Given the failure to replicate self-controlled benefits, combined with the fact there is little research that has directly compared self-controlled feedback schedules to coach-controlled schedules, we argue more evidence is needed before advocating that learners be provided choice over their feedback schedule.
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Affiliation(s)
- Zachary D Yantha
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Brad McKay
- Department of Kinesiology, McMaster University, Ivor Wynne Centre, Hamilton, Ontario, Canada
| | - Diane M Ste-Marie
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
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Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. J Sport Rehabil 2021; 31:717-735. [PMID: 34883466 DOI: 10.1123/jsr.2021-0139] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. OBJECTIVES To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. EVIDENCE ACQUISITION PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. EVIDENCE SYNTHESIS 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. CONCLUSION AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.
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Sánchez Romero EA, Lim T, Alonso Pérez JL, Castaldo M, Martínez Lozano P, Villafañe JH. Identifying Clinical and MRI Characteristics Associated with Quality of Life in Patients with Anterior Cruciate Ligament Injury: Prognostic Factors for Long-Term. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12845. [PMID: 34886570 PMCID: PMC8657193 DOI: 10.3390/ijerph182312845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Associated lesions in the diagnostic MRI may be related to worse long-term subjective outcomes. There is a lack of conclusive information about the long-term outcomes of associated injuries in anterior cruciate ligament (ACL) tears. The purpose of this study is to assess the long-term effects of associated injuries in ACL tears measured by means of a quality of life (QOL) assessment. METHODS A retrospective cohort study of 225 consecutive patients admitted for physical therapy with ACL injury (42 ± 12 years, 28.2% female) were conducted. All demographic and clinical variables were used to measure a QOL. Univariate and multivariable analyses were completed. RESULTS The mean follow-up period was 8.4 ± 2.6 years. In univariate analysis, male gender, and sports as the cause of the ACL lesion were factors significantly associated with improved International Knee Documentation Committee (IKDC) scores at the end of follow-up (all p < 0.002). In multivariable analysis, the occurrence of bone contusion was positively associated with injury (OR = 2.12) and negatively associated with sports injury (OR = 0.44) and medial collateral ligament (MCL) injury (OR = 0.48). CONCLUSIONS After ACL injury, male gender and sports injury were associated with better clinical outcomes.
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Affiliation(s)
- Eleuterio A. Sánchez Romero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (T.L.); (J.L.A.P.); (P.M.L.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Tenerife, 38300 Canary Islands, Spain
| | - Tifanny Lim
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (T.L.); (J.L.A.P.); (P.M.L.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Tenerife, 38300 Canary Islands, Spain
| | - José Luis Alonso Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (T.L.); (J.L.A.P.); (P.M.L.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Tenerife, 38300 Canary Islands, Spain
- Onelifecenter, Multidisciplinary Pain Treatment Center, 28925 Madrid, Spain
| | - Matteo Castaldo
- Center for Neuroplasticity and Pain (CNAP), Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Sport Physiotherapy, University of Siena, 53100 Siena, Italy
| | - Pedro Martínez Lozano
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (T.L.); (J.L.A.P.); (P.M.L.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Jorge Hugo Villafañe
- Instituto di Ricovero e Cura a Carettere Scientifico (IRCCS) Fondazione Don Carlo Gnocchi, 20141 Milan, Italy
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Larson D, Vu V, Ness BM, Wellsandt E, Morrison S. A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Musculoskeletal System. Int J Sports Phys Ther 2021; 17:27-46. [PMID: 35237463 PMCID: PMC8856762 DOI: 10.26603/001c.29456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Several negative adaptations to the musculoskeletal system occur following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) such as arthrogenic muscle inhibition, decreased lower extremity muscle size, strength, power, as well as alterations to bone and cartilage. These changes have been associated with worse functional outcomes, altered biomechanics, and increased risk for re-injury and post-traumatic osteoarthritis. After ACL injury and subsequent ACLR, examination and evaluation of the musculoskeletal system is paramount to guiding clinical decision making during the rehabilitation and the return to sport process. The lack of access many clinicians have to devices necessary for gold standard assessment of muscle capacities and force profiles is often perceived as a significant barrier to best practices. Fortunately, testing for deficits can be accomplished with methods available to the clinician without access to costly equipment or time-intensive procedures. Interventions to address musculoskeletal system deficits can be implemented with a periodized program. This allows for restoration of physical capacities by adequately developing and emphasizing physical qualities beginning with mobility and movement, and progressing to work capacity and neuromuscular re-education, strength, explosive strength, and elastic or reactive strength. Additional considerations to aid in addressing strength deficits will be discussed such as neuromuscular electrical stimulation, volume and intensity, eccentric training, training to failure, cross-education, and biomechanical considerations. The American Physical Therapy Association adopted a new vision statement in 2013 which supported further development of the profession's identity by promoting the movement system, yet validation of the movement system has remained a challenge. Application of a multi-physiologic systems approach may offer a unique understanding of the musculoskeletal system and its integration with other body systems after ACLR. The purpose of this clinical commentary is to highlight important musculoskeletal system considerations within a multi-physiologic system approach to human movement following ACLR. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Vien Vu
- Samaritan Athletic Medicine; Oregon State University Athletics Department
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Tufts University School of Medicine
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center; Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center
| | - Scot Morrison
- PhysioPraxis PLLC; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona
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Taberner M, Allen T, O'keefe J, Cohen DD. Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning. Phys Ther Sport 2021; 53:67-74. [PMID: 34839202 DOI: 10.1016/j.ptsp.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 12/26/2022]
Abstract
The 'control-chaos continnum' is an adaptable framework developed to guide the on-pitch rehabilitation process in elite football. One of the key objectives of the continuum is to progressively return players to their preinjury chronic running load, while incorporating the qualitative aspects of movement and cognitive stresses integral to competitive match-play. Whilst injury and player-specific considerations are key to an individualised rehabilitation approach, a host of contextual factors also play an important role in return to sport (RTS) planning. In this article, we highlight some key intrinsic and extrinsic contextual factors for the practitioner to consider in the RTS planning process to help mitigate reinjury risk upon a return to team training. While a return to chronic running load is generally a critical component of the framework, we highlight circumstances in elite football where it is a less relevant factor in RTS decision-making.
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Affiliation(s)
- M Taberner
- Performance and Medical Department, Orlando Magic Basketball Club, Orlando, USA; School of Sport and Exercise Sciences, Liverpool John Moore's University, Liverpool, UK.
| | - T Allen
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK; Institute of Coaching and Performance, University of Central Lancashire, Preston, UK. https://twitter.com/tallen_5
| | - J O'keefe
- Academy Sports Science Department, Everton Football Club, Liverpool, UK. https://twitter.com/JasonOkeefe10
| | - D D Cohen
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia; Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia. https://twitter.com/danielcohen1971
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50
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Sonkodi B, Varga E, Hangody L, Poór G, Berkes I. Finishing stationary cycling too early after anterior cruciate ligament reconstruction is likely to lead to higher failure. BMC Sports Sci Med Rehabil 2021; 13:149. [PMID: 34823577 PMCID: PMC8613948 DOI: 10.1186/s13102-021-00377-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 01/12/2023]
Abstract
Background Anterior cruciate ligament injury arises when the knee anterior ligament fibers are stretched, partially torn, or completely torn. Operated patients either end up re-injuring their reconstructed anterior cruciate ligament or majority develop early osteoarthritis regardless of the remarkable improvements of surgical techniques and the widely available rehabilitation best practices. New mechanism theories of non-contact anterior cruciate ligament injury and delayed onset muscle soreness could provide a novel perspective how to respond to this clinical challenge. Main body A tri-phasic injury model is proposed for these non-contact injuries. Mechano-energetic microdamage of the proprioceptive sensory nerve terminals is suggested to be the first-phase injury that is followed by a harsher tissue damage in the second phase. The longitudinal dimension is the third phase and that is the equivalent of the repeated bout effect of delayed onset muscle soreness. Current paper puts this longitudinal injury phase into perspective as the phase when the long-term memory consolidation and reconsolidation of this learning related neuronal injury evolves and the phase when the extent of the neuronal regeneration is determined. Reinstating the mitochondrial energy supply and ‘breathing capacity’ of the injured proprioceptive sensory neurons during this period is emphasized, as avoiding fatigue, overuse, overload and re-injury. Conclusions Extended use, minimum up to a year or even longer, of a current rehabilitation technique, namely moderate intensity low resistance stationary cycling, is recommended preferably at the end of the day. This exercise therapeutic strategy should be a supplementation to the currently used rehabilitation best practices as a knee anti-aging maintenance effort.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary.
| | - Endre Varga
- Department of Traumatology, University of Szeged, Szeged, Hungary
| | - László Hangody
- Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Gyula Poór
- National Institute of Musculoskeletal Diseases, Budapest, Hungary.,Semmelweis University Medical School, Budapest, Hungary
| | - István Berkes
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary
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