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Zhou EFM, Wong AYL, Zheng YP, Lam KHS, Fu SN. Reliability of Ultrasound Shear Wave Elastography for Evaluating Psoas Major and Quadratus Lumborum Stiffness: Gender and Physical Activity Effects. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:564-570. [PMID: 38272743 DOI: 10.1016/j.ultrasmedbio.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE We aimed to assess the reliability of quantifying psoas major (PM) and quadratus lumborum (QL) stiffness with ultrasound shear wave elastography (SWE), and to explore the effects of gender and physical activity on muscle stiffness. METHODS Fifty-two healthy participants (18-32 y) were recruited. To determine reliability, 29 of them underwent repeated SWE measurements of PM and QL stiffness by an operator on the same day. The intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence interval (MDC95) were calculated. The rest participants underwent a single measurement. Two-way MANCOVA was conducted for the effects of gender and physical activity on muscle stiffness. RESULTS The observed reliability for PM (ICC3,1 = 0.89-0.92) and QL (ICC3,1 = 0.79-0.82) were good-to-excellent and good, respectively. The SEM (kPa) was 0.79-1.03 and 1.23-1.28, and the MDC95 (kPa) was 2.20-2.85 and 3.41-3.56 for PM and QL, respectively. After BMI adjustment, both gender (PM: F = 10.15, p = 0.003; QL: F = 18.07, p < 0.001) and activity level (PM: F = 5.90, p = 0.005; QL: F = 6.33, p = 0.004) influenced muscle stiffness. The female and inactive groups exhibited higher stiffness in both muscles. CONCLUSION SWE is reliable for quantifying the stiffness of PM and QL. Female and physical inactivity may elevate PM and QL stiffness, underscoring the importance of accounting for these factors in muscle stiffness investigations. Larger prospective studies are needed to further elucidate their effects.
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Affiliation(s)
- Emma Feng Ming Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yong Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, Hong Kong, China; Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong, China; Department of Family Medicine, The University of Hong Kong, Hong Kong, China.
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Bates K, Zeppieri G, Young C, Bruner M, Moser M, Farmer KW, Pozzi F. Preseason lower extremity range of motion, flexibility, and strength in relation to in-season injuries in NCAA division I gymnasts. PHYSICIAN SPORTSMED 2024; 52:200-206. [PMID: 37216208 PMCID: PMC10803174 DOI: 10.1080/00913847.2023.2215775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To determine if preseason lower extremity ROM, flexibility, and strength differ in collegiate gymnasts (NCAA Division 1) who do or do not sustain an injury during the competitive season. METHODS Over four seasons, a total of 15 female gymnasts (age = 20.5 ± 1.0 years) underwent preseason screening (30 gymnast-season). We tested joint ROM (hip: flexion, internal and external rotation; ankle: weightbearing dorsiflexion), muscle flexibility (passive straight leg raise, Thomas,' Ober's, Ely's tests) and strength (hip extensors, abductors, and flexors isometric strength via a handheld dynamometer; knee: quadriceps and hamstring isokinetic strength at 60°/sec). The team athletic trainer tracked overuse lower extremity injuries (restricted gymnasts from full participation, occurred as from participation in organized practice or competition, and required medical attention) during each season. For athletes that tested multiple seasons, each encounter was considered independent, and each preseason assessment was linked to overuse injuries sustained during the same competitive season. Gymnasts were dichotomized into injured and non-injured groups. An independent t-test was used to measure differences in preseason outcomes between injured and non-injured groups. RESULTS During four years, we recorded 23 overuse lower extremity injuries. Gymnasts that sustained an in-season overuse injury demonstrated significantly lower hip flexion ROM (mean difference: -10.6°; 95% confidence interval: -16.5, -4.6; p < 0.01) and lower hip abduction strength (mean difference: -4.7% of body weight; 95% confidence interval: -9.2, -0.3; p = 0.04). CONCLUSION Gymnasts who sustain an in-season overuse lower extremity injury have significant preseason deficit of hip flexion ROM and weakness in the hip abductors. These findings indicate potential impairments in the kinematic & kinetic chains responsible for skill performance and energy absorption during landing.
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Affiliation(s)
- Kaysha Bates
- Victory lab PT and performance, Jackson, Wyoming, USA
- Sport Physical Therapy Residency Program, University of Florida Health, Gainesville, FL, USA
| | - Giorgio Zeppieri
- Department of Rehabilitation, University of Florida Health, Gainesville, FL, USA
| | - Candace Young
- Sport Physical Therapy Residency Program, University of Florida Health, Gainesville, FL, USA
- Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Michelle Bruner
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Moser
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin W. Farmer
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Federico Pozzi
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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Valadão P, Cenni F, Piitulainen H, Avela J, Finni T. Effects of the EXECP Intervention on Motor Function, Muscle Strength, and Joint Flexibility in Individuals with Cerebral Palsy. Med Sci Sports Exerc 2024; 56:1-12. [PMID: 37565430 DOI: 10.1249/mss.0000000000003273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
PURPOSE Numerous exercise interventions to enhance motor function in cerebral palsy (CP) have been proposed, with varying degrees of effectiveness. Because motor function requires a combination of muscle strength, joint flexibility, and motor coordination, we designed a supervised multicomponent exercise intervention (EXErcise for Cerebral Palsy, or EXECP) for individuals with CP. Our aim was to evaluate the effects of the EXECP intervention and its retention after it ceased. METHODS The EXECP intervention combined strength training for the lower limbs and trunk muscles, passive stretching for the lower limb muscles, and inclined treadmill gait training. Eighteen participants with CP (mean age, 14 yr; 13 were male) were tested twice before the 3-month intervention and twice after the intervention, each test separated by 3 months. Seventeen typically developing age- and sex-matched controls were tested twice. Motor function was assessed with the 6-min walking test (6MWT) and the gross motor function measure dimensions D and E. Passive joint flexibility was measured with goniometry. Isometric and concentric muscle strength were assessed at the knee, ankle, and trunk joints. RESULTS The EXECP intervention successfully increased 6MWT ( P < 0.001), gross motor function measure ( P = 0.004), and muscle strength for knee and trunk muscles ( P < 0.05), although no changes were observed for ankle joint muscles. Hip and knee joint flexibility also increased ( P < 0.05). After the retention period, all tested variables except the 6MWT and knee joint flexibility regressed and were not different from the pretests. CONCLUSIONS The improvements in strength, flexibility, and possibly motor coordination brought by the EXECP intervention were transferred to significant functional gains. The regression toward baseline after the intervention highlights that training must be a lifelong decision for individuals with CP.
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Francesco Cenni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | | | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
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Nonnenmacher CH, de Estéfani D, Benincá IL, da Silveira MP, Nunes GS, Haupenthal A. Intra and interrater reliability for lower limb flexibility assessment using photogrammetry. J Bodyw Mov Ther 2023; 35:364-370. [PMID: 37330794 DOI: 10.1016/j.jbmt.2023.04.078] [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: 01/12/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Photogrammetry represents an advancement in the flexibility evaluation, and although it was highly explored for postural assessment, there is a scarcity of studies analyzing lower limb angular measurements using it. The purpose of this study is to verify the reliability of intrarater and interrarater photogrammetry in assessing lower limb flexibility. METHODS This was a randomized cross-sectional observational study with test-retest design and a two-day interval. Thirty healthy, physically active adults were included. Three novice raters assessed the participants through flexibility tests of iliopsoas, hamstring, quadriceps and gastrocnemius on two occasions, and independently analyzed the captured images to establish reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. RESULTS Intrarater reliability was excellent for iliopsoas (ICC = 0.96; SEM = 1.4; MDC = 3.8), hamstring (ICC = 0.99; SEM = 1.1; MDC = 3.1), quadriceps (ICC = 0.99; SEM = 0.8; MDC = 2.3) and gastrocnemius (ICC = 0.98; SEM = 0.9; MDC = 2.5). Interrater reliability was excellent for iliopsoas (ICC = 0.94; SEM = 1.7; MDC = 4.6) and gastrocnemius (ICC = 0.91; SEM = 2.1; MDC = 5.8), but good for hamstring (ICC = 0.90; SEM = 2.8; MDC = 7.9) and quadriceps (ICC = 0.85; SEM = 3.0; MDC = 8.3). CONCLUSIONS The excellent intrarater and good to excellent interrater reliability suggest that photogrammetry assessment of lower limb flexibility by novice raters is reliable. However, clinicians should consider the higher threshold of range of motion change necessary to outweigh measurement error due to interrater variability.
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Affiliation(s)
- Carolina Holz Nonnenmacher
- Department of Health Sciences, Federal University of Santa Catarina, Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Brazil.
| | - Daniela de Estéfani
- Department of Health Sciences, Federal University of Santa Catarina, Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Brazil
| | - Inaihá Laureano Benincá
- Department of Health Sciences, Federal University of Santa Catarina, Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Brazil
| | - Maiara Petri da Silveira
- Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Camobi, Santa Maria, Brazil
| | - Guilherme S Nunes
- Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Camobi, Santa Maria, Brazil
| | - Alessandro Haupenthal
- Department of Health Sciences, Federal University of Santa Catarina, Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Brazil
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Perkins S, Canavan P. Isokinetic Assessment of Knee Flexor and Extensor Strength and Lower Extremity Flexibility Assessment of an NCAA Division III Men's Soccer Team. Int J Sports Phys Ther 2023; V18:626-635. [PMID: 37425103 PMCID: PMC10324297 DOI: 10.26603/001c.74971] [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: 11/04/2022] [Accepted: 03/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Strength imbalances and flexibility deficits of the hamstrings and hip flexors have been identified as potential risk factors for hamstring injuries, but research on athletes at the Division III level are limited, potentially due to a lack of resources and technology. Purpose The purpose of this study was to conduct isokinetic and flexibility assessments to screen male soccer athletes at risk of sustaining a hamstring injury. Study Design Observational cohort. Methods Standardized isokinetic testing of concentric muscle performance, measured by peak torque of the quadriceps and hamstrings and hamstring-to-quadriceps ratios, was conducted using a Biodex isokinetic dynamometer at speeds of 60 and 180°/sec. Additionally, the Active Knee Extension (AKE) test and the Thomas test were performed bilaterally to objectively measure flexibility. Paired sample t-tests were used to compare left and right lower extremities for all outcomes, with the level of significance set at p<0.05. Participants were ranked for risk and given a set of exercises sourced from the FIFA 11 Injury Prevention Program. Results At 60°/sec, the mean PT/BW bilateral deficit was 14.1% for extension and 12.9% for flexion. At 180°/sec, the mean deficit was 9.9% for extension and 11.4% for flexion. The team's average for left and right H:Q ratios for each speed were 54.4 and 51.4 at 60°/sec and 61.6 and 63.1 at 180°/sec, respectively. The team's average AKE range of motion was 158° for the left leg and 160° for the right leg. The mean Thomas test measurements were 3.6° away from the neutral position on the right and 1.6° on the left, with nine positive tests. There were no statistically significant differences between left and right knee extension or flexion PT/BW or H:Q ratios at either speed. There was no significant difference between left and right AKE measurements (p=0.182). Conclusion The results of this screening suggest that isokinetic testing and flexibility testing may be useful to identify non-optimal strength ratios and flexibility deficits in male collegiate soccer players. The benefits of this research have direct implications, as participants received both their screening data and a set of exercises aimed to help decrease their injury risk, in addition to the offering data that is useful for determining what normative values for flexibility and strength profiles might look like for Division III male soccer players. Level of Evidence Level 3.
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Affiliation(s)
- Savanna Perkins
- Department of Health Sciences Eastern Connecticut State University
| | - Paul Canavan
- Department of Health Sciences Eastern Connecticut State University
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Vomer RP, York E, DeMatas K, Shah NP, Larick RS, Punj M, Rosario-Concepcion RA, Pujalte GGA. Telemedicine Evaluation of Hip Ailments. Cureus 2023; 15:e38900. [PMID: 37303331 PMCID: PMC10257509 DOI: 10.7759/cureus.38900] [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] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has provided new means of patient care while still allowing for physical examination and history to be obtained. Hip ailments are a common musculoskeletal problem leading to limited function. Today, we lack a standardized telemedicine hip evaluation protocol. Aim The aim of this manuscript is to provide an efficient means of extracting relevant information while performing telemedicine examinations of the hip. Methods The authors have created a step-by-step evaluation guide for physicians to evaluate hip complaints, including inspection, palpation, range of motion, strength testing, functional assessment, gait analysis, and special testing, with images of each maneuver. Results We have developed a table of evaluation questions and instructions and a glossary of images of each maneuver to facilitate hip examination via telemedicine. Conclusions This manuscript provides a structured template for performing a telehealth examination of hip ailments.
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Affiliation(s)
- Rock P Vomer
- Family Medicine/Research, Mayo Clinic Jacksonville Campus, Jacksonville, USA
- Department of Family and Community Health/Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, USA
| | - Emma York
- Family Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Kristina DeMatas
- Family Medicine/Sports Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | - Neil P Shah
- Family and Community Medicine, Mayo Clinic Jacksonville Campus, Jacksonville , USA
| | - Rayghan S Larick
- Family and Community Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Mantavya Punj
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | | | - George G A Pujalte
- Family Medicine/Orthopedics/Sports Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
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7
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Cibulka MT, Wunderlich P, Klockenga H, Reed A, Sandman J. The Falcon Test: An Observer Agreement Study in Subjects With and Without Anterior Knee Pain. Int J Sports Phys Ther 2023; 18:368-374. [PMID: 37020445 PMCID: PMC10069384 DOI: 10.26603/001c.73190] [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: 04/19/2022] [Accepted: 01/15/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction A shortened rectus femoris muscle has been associated with many different musculoskeletal problems. Assessing rectus femoris muscle length is commonly performed using the Modified Thomas Test. However, this test position is often difficult to assume and there are difficulties with reliably measuring rectus femoris length. A method that that uses an easier position to assume and could be more reliable would be beneficial to therapists. The purpose of this study was to determine observer agreement using a new test for assessment of rectus femoris length. A second purpose was to determine if those with anterior knee pain have different rectus femoris muscle length than those without anterior knee pain. Method Fifty-three participants with and without anterior knee pain were enrolled. Rectus femoris muscle length was measured lying prone with the leg measured on the table while the non-measured leg was off the table in a position of 90° hip flexion. Rectus femoris muscle was lengthened by passively bending the knee until a firm end-feel. The angle of knee flexion was then measured. The process was then repeated after a brief rest period. Results Observer agreement assessing rectus femoris length using this method showed "almost perfect" reliability for both intra- and inter-rater testing: intra-rater: ICC = .99, [CI95: .98-.99], inter-rater: ICC = .96, [CI95: .92- .98]. Agreement for the sub-sample of those with anterior knee pain (N=16) showed "almost perfect" reliability for intra-rater (ICC 1,1 = .98); [CI95: 0.94-.99] and inter-rater reliability (ICC 2,1 = 0.88); [CI95: 0.70 -.95]. No differences were noted in rectus femoris length between those without and those with anterior knee pain (t= 0.82, p> 0.01); [CI95: -7.8 -3.33]; (SEM = 1.3°; MDC=3.6°). Conclusion This new method of assessing rectus femoris length is reliable between and within raters. No differences were noted in rectus femoris length between those with anterior knee pain and those without.
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Paton BM, Read P, van Dyk N, Wilson MG, Pollock N, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Stirling B, Tulloch L, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med 2023; 57:278-291. [PMID: 36650032 DOI: 10.1136/bjsports-2021-105384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,British Athletics, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers Football Club, Blackburn, UK
| | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Murphy
- Medical Services, Arsenal Football Club, London, UK
| | - Ricci Plastow
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK.,Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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Konrad A, Tilp M, Mehmeti L, Mahnič N, Seiberl W, Paternoster FK. The Relationship Between Lower Limb Passive Muscle and Tendon Compression Stiffness and Oxygen Cost During Running. J Sports Sci Med 2023; 22:28-35. [PMID: 36876188 PMCID: PMC9982528 DOI: 10.52082/jssm.2023.28] [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: 10/14/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
Studies have reported that a stiff triceps surae muscle and tendon-aponeurosis and also a more compliant quadriceps muscle and tendon-aponeurosis, are related to lower oxygen cost during running. However, to date, no study has investigated in a single experiment how oxygen cost during running is related to the stiffness of the free tendons (Achilles tendon, patellar tendon) and all the superficial muscles of two major muscle groups for running (i.e., quadriceps, triceps surae). Thus, 17 male trained runners/triathletes participated in this study and visited the laboratory on three occasions. On the first day, the participants were familiarized with the tests. On the second day, the passive compression stiffness of the triceps surae muscle (i.e., gastrocnemii), Achilles tendon, quadriceps muscle (i.e., vastii, rectus femoris), and patellar tendon was non-invasively measured using a digital palpation device (MyotonPRO). In addition, an incremental test was applied to test the VO2max of the participants. Thereafter, in the third visit, after at least 48-h of rest, participants performed a 15-min run on the treadmill with a speed reflecting a velocity of 70% VO2max, to assess oxygen costs during running. The Spearman correlation showed a significant negative correlation between passive Achilles tendon compression stiffness and running oxygen consumption, with a large effect size (rρ = -0.52; CI (95%) -0.81 to -0.33; P = 0.03). Moreover, no further significant relationship between oxygen cost during running and the passive compression stiffness of the quadriceps muscle and patellar tendon, as well as the triceps surae muscle, was detected. The significant correlation indicates that a stiffer passive Achilles tendon can lead to a lower oxygen cost during running. Future studies will have to test the causality of this relationship with training methods such as strength training that are able to increase the Achilles tendon stiffness.
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Affiliation(s)
- Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
- Associate Professorship of Biomechanics in Sports, Technical University of Munich, Munich, Germany
| | - Markus Tilp
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
| | - Leutrim Mehmeti
- Associate Professorship of Biomechanics in Sports, Technical University of Munich, Munich, Germany
| | - Nik Mahnič
- Associate Professorship of Biomechanics in Sports, Technical University of Munich, Munich, Germany
| | - Wolfgang Seiberl
- Department of Human Sciences, Institute of Sport Science, Universität der Bundeswehr München, Neubiberg, Germany
| | - Florian K Paternoster
- Associate Professorship of Biomechanics in Sports, Technical University of Munich, Munich, Germany
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Association Between Nondominant Leg-Side Hip Internal Rotation Restriction and Low Back Pain in Male Elite High School Soft Tennis Players. J Sport Rehabil 2023; 32:158-164. [PMID: 35961645 DOI: 10.1123/jsr.2022-0114] [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: 03/24/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT The incidence of low back pain (LBP) is high among high school male soft tennis players. In some sports for which the rotational component of the body is important, an association between restricted hip internal rotation of the nondominant leg and LBP has been reported; however, whether this association holds in soft tennis is unknown. Therefore, this study aimed to evaluate the association between hip internal rotation, hip external rotation, hamstring flexibility, iliopsoas flexibility, and LBP incidence. DESIGN This study was designed as a cross-sectional study, conducted at a sports training center. METHODS Participants comprised 113 male elite high school soft tennis players (age: 16.1 [0.7] y) from 9 elite-level teams. The main outcome measures were the hip internal and external rotation range of motion, hamstring flexibility on the straight leg raise test, and iliopsoas flexibility on the Thomas test. Multiple logistic regression analysis was performed to examine the influence of main outcomes on LBP incidence in the past 1 year. RESULTS A total of 35 participants had LBP (LBP group); 78 participants did not have LBP (non-LBP group). Multiple logistic regression analysis revealed that the odds ratio for height was 1.08 (95% confidence interval, 1.00-1.16; P = .043) and for the hip internal rotation range of motion in the nondominant leg was 0.90 (95% confidence interval, 0.85-0.95; P < .001), indicating significant associations with LBP. CONCLUSION Hip internal rotation range of motion in the nondominant leg and height were crucial factors related to LBP in male elite high school soft tennis players.
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Acute and Prolonged Effects of Dermal Suction on Joint Range of Motion and Passive Muscle Stiffness: A Preliminary Study. Healthcare (Basel) 2022; 10:healthcare10112241. [PMID: 36360582 PMCID: PMC9690743 DOI: 10.3390/healthcare10112241] [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: 07/23/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
This study aimed to investigate the acute and prolonged effects of dermal suction on joint range of motion (ROM) and passive muscle stiffness. Eight-minute dermal suction was prescribed for the quadriceps femoris in 15 participants. Hip extension ROM, knee flexion ROM, and passive muscle stiffness of the rectus femoris (RF) and vastus lateralis (VL) were measured before and immediately, 30 min, 60 min, 120 min, 24 h, and 48 h after dermal suction. Passive muscle stiffness was measured using shear wave elastography. Hip extension ROM significantly increased immediately (p = 0.032), 60 min (p = 0.029), and 120 min (p = 0.031) after dermal suction compared with before dermal suction; however, it was not significantly different at 30 min, 24 h, and 48 h after dermal suction (p > 0.05). Passive muscle stiffness of the RF and VL and knee flexion ROM did not significantly change at any measurement time compared with before dermal suction (p > 0.05). Our preliminary results suggest that dermal suction improves hip extension ROM immediately after dermal suction of the quadriceps femoris, followed by a return to the pre-prescription level 30 min after. However, the effect was prolonged for 120 min and disappeared before 24 h.
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Neves RP, Oliveira D, Fanasca MA, Vechin FC. Shortening of hip flexor muscles and chronic low-back pain among resistance training practitioners: applications of the modified Thomas test. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Janyathitipath T, Sakulsriprasert P, Wattananon P, Kantha P. The effects of hip flexor stretching with and without abdominal exercises in asymptomatic individuals with hyperlordosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Hyperlordosis is associated with shortened hip flexor muscles, causing low back pain. The aim of this study was to investigate the effects of hip flexor stretching with and without abdominal exercises in individuals with hyperlordosis. Methods A total of 30 participants with hyperlordosis, aged between 20 and 30 years, were divided into three groups. Participants in the hold-relax group performed hold-relax stretching for 10 seconds, five repetitions, on both legs. Participants in the abdominal hollowing group performed hold-relax stretching and added an abdominal hollowing exercise for 10 seconds a repetition, 10 repetitions a set for three sets. Participants in the curl-up group performed hold-relax stretching and then performed curl-up exercises for 10 repetitions a set for three sets. The angle of lumbar lordosis, hip muscle length (degrees), percentage of maximum voluntary contraction of transversus abdominis and internal abdominal oblique, external abdominal oblique, rectus abdominis, lumbar erector spinae and multifidus muscles were investigated at pre-test, post-test and followed up 3 days after the end of the intervention. Results Significant within-group differences were found in the angle of lumbar lordosis for all groups (P<0.05), muscle length of hip flexor, and percentage of maximum voluntary contraction of the lumbar erector spinae and multifidus muscles in the curl-up group (P<0.05). The significant difference between pre-test and follow up in the hold-relax group and curl-up group reflects the retention of at least 3 days. Conclusions Hold-relax stretching can reduce the angle of lumbar lordosis and increase hip muscle length. In the curl-up group, the lumbar erector spinae and multifidus muscles decreased. Therefore, performing curl-up exercises after hold-relax stretching is recommended to decrease the angle of lumbar lordosis and percentage of maximum voluntary contraction of lumbar erector spinae and multifidus muscles.
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Affiliation(s)
- Thanachaporn Janyathitipath
- Musculoskeletal Physical Therapy Research Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Prasert Sakulsriprasert
- Musculoskeletal Physical Therapy Research Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Peemongkon Wattananon
- Motor Control and Neural Plasticity Lab, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Phunsuk Kantha
- Musculoskeletal Physical Therapy Research Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
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Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls. J Clin Med 2022; 11:jcm11133605. [PMID: 35806887 PMCID: PMC9267262 DOI: 10.3390/jcm11133605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be found and the multifactorial etiology is under discussion. The purpose was to evaluate stiffness of ITB, gluteus maximus (GM) and tensor fasciae latae (TFL) muscles using shear wave elastography (SWE). Methods: In 14 patients with clinically verified ITBS and 14 healthy controls, three SWE measurements each of ITB, GM and TFL in both legs was performed to determine measurement reliability and between-group and -leg differences. Results: The mean value of ITB was 12.8 m/s with ICC of 0.76, whereas the values measured in the GM were 3.02 m/s with an ICC of 0.87. No statistically significant difference in controls compared to patients were found (p = 0.62). The mean value of TFL was 5.42 m/s in healthy participants, compared to 3.89 m/s patients with an ICC of 0.98 (p = 0.002). Conclusion: Although SWE showed no difference in ITB stiffness, significant differences for TFL muscle stiffness in runner’s knee was found, suggesting that the hip abductor muscles might play a bigger role in the pathophysiology of ITBS. We aimed to implement baseline values for stiffness assessments and prove reliability for further prospective studies of SWE in runner’s knee.
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Farley JB, Keogh JWL, Woods CT, Milne N. Physical fitness profiles of female Australian football players across five competition levels. SCI MED FOOTBALL 2022; 6:105-126. [PMID: 35236230 DOI: 10.1080/24733938.2021.1877335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine physical fitness profiles of female Australian football players and investigate differences according to competition level. METHODS A testing battery of 28 physical fitness assessments was undertaken with 240 players across five competition levels: elite senior (≥18 years), non-elite senior (≥18 years), high-level junior (<18 years), non-elite junior (14-17 years), and non-elite junior (10-13 years). Physical fitness profiles were examined and competition level differences were investigated using multivariate analyses of variance. RESULTS Significant differences (p<0.001) were observed between competition levels in body composition (η2p=0.225), flexibility (η2p=0.071), muscular strength and endurance (η2p=0.238), balance (η2p=0.093), reaction time (η2p=0.103), and whole-body locomotor performance (η2p=0.200). Elite seniors and high-level juniors were stronger (p<0.001-0.043), faster (p=0.001-0.022), more responsive (p<0.001-0.048), and had better cardiorespiratory fitness (p<0.001) compared to the non-elite groups. Additionally, body composition and muscular strength and endurance differences were common between the senior and non-elite junior groups. CONCLUSIONS This is the first study to comprehensively profile physical characteristics of female Australian footballers across a broader development pathway. These preliminary findings may assist sport practitioners to better understand athlete development, provide insight on talent identification and development programs, and injury management in this population.
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Affiliation(s)
- Jessica B Farley
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Justin W L Keogh
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia.,Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Sunshine Coast, Australia.,Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Carl T Woods
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
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Rebecca JW, Alison MB, Ryan JW, Claudia RS, Donovan JL, Ann TH, Kirsten LZ, Sean CF, William DR, Dah-Jyuu W, Erika LF, Gihan IT, Michael JD, William TT, Glenn AW, Krista V. Development of Contractures in DMD in Relation to MRI-Determined Muscle Quality and Ambulatory Function. J Neuromuscul Dis 2022; 9:289-302. [PMID: 35124659 DOI: 10.3233/jnd-210731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Joint contractures are common in boys and men with Duchenne muscular dystrophy (DMD), and management of contractures is an important part of care. The optimal methods to prevent and treat contractures are controversial, and the natural history of contracture development is understudied in glucocorticoid treated individuals at joints beyond the ankle. OBJECTIVE To describe the development of contractures over time in a large cohort of individuals with DMD in relation to ambulatory ability, functional performance, and muscle quality measured using magnetic resonance imaging (MRI) and spectroscopy (MRS). METHODS In this longitudinal study, range of motion (ROM) was measured annually at the hip, knee, and ankle, and at the elbow, forearm, and wrist at a subset of visits. Ambulatory function (10 meter walk/run and 6 minute walk test) and MR-determined muscle quality (transverse relaxation time (T2) and fat fraction) were measured at each visit. RESULTS In 178 boys with DMD, contracture prevalence and severity increased with age. Among ambulatory participants, more severe contractures (defined as greater loss of ROM) were significantly associated with worse ambulatory function, and across all participants, more severe contractures significantly associated with higher MRI T2 or MRS FF (ρ: 0.40-0.61 in the lower extremity; 0.20-0.47 in the upper extremity). Agonist/antagonist differences in MRI T2 were not strong predictors of ROM. CONCLUSIONS Contracture severity increases with disease progression (increasing age and muscle involvement and decreasing functional ability), but is only moderately predicted by muscle fatty infiltration and MRI T2, suggesting that other changes in the muscle, tendon, or joint contribute meaningfully to contracture formation in DMD.
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Affiliation(s)
| | | | - J Wortman Ryan
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - T Harrington Ann
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Arcadia University, Glennside, PA, USA
| | - L Zilke Kirsten
- Shriners Hospitals for Children -Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | | | | | - Wang Dah-Jyuu
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Cady K, Powis M, Hopgood K. Intrarater and interrater reliability of the modified Thomas Test. J Bodyw Mov Ther 2022; 29:86-91. [DOI: 10.1016/j.jbmt.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/16/2021] [Accepted: 09/19/2021] [Indexed: 01/16/2023]
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Álvarez-Zafra M, Yanci J, García-Tabar I, Bikandi E, Etxaleku S, Izquierdo M, Krosshaug T, Fernandez-Lasa U, Setuain I. Functional and Anthropometrical Screening Test among High Performance Female Football Players: A Descriptive Study with Injury Incidence Analysis, the Basque Female Football Cohort (BFFC) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10658. [PMID: 34682404 PMCID: PMC8535649 DOI: 10.3390/ijerph182010658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
The main objectives of the present study were to describe the injury incidence and to analyze the anthropometric and physical characteristics of players from three high-level women's football teams. The present study involved 54 female football players (21.9 ± 4.9 years old) from three different teams competing in the Spanish Reto Iberdrola-Segunda División PRO league. A battery of tests was carried out to determine the anthropometric and physical performance characteristics of the players along with an injury incidence record during a full competitive season. The obtained results showed that there was a high incidence of injury, as 38% of the players suffered some type of injury during the season (range 1-5; 1.75 ± 1.02 injuries per player). Injuries occurred in both matches and during training at a similar percentage (48.6 vs. 51.4%), and the majority of the registered episodes were graded as moderate or severe injury types (60%). Players suffering from an injury accumulated a total of 1587 chronological days off work due to injury during the season, with a recurrence rate of 55%. Considering the high incidence of injury, and the injury burden and the reinjure rate observed in this research, it seems necessary to apply the most efficient prevention and recovery measures possible in these female football teams. These descriptive data could serve athletic trainers and medical staff of female football teams to better understand their own screening procedure-derived data.
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Affiliation(s)
- Marta Álvarez-Zafra
- Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain;
| | - Javier Yanci
- Society, Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain; (I.G.-T.); (U.F.-L.)
| | - Ibai García-Tabar
- Society, Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain; (I.G.-T.); (U.F.-L.)
| | - Eder Bikandi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Public University of Navarra (UPNA), Navarra Institute for Health Research (IdiSNA), 31006 Pamplona, Spain; (E.B.); (M.I.); (I.S.)
| | - Saioa Etxaleku
- Clinical Research Department, TDN, Advanced Rehabilitation Center, 31006 Pamplona, Spain;
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Public University of Navarra (UPNA), Navarra Institute for Health Research (IdiSNA), 31006 Pamplona, Spain; (E.B.); (M.I.); (I.S.)
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, 0806 Oslo, Norway;
| | - Uxue Fernandez-Lasa
- Society, Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain; (I.G.-T.); (U.F.-L.)
| | - Igor Setuain
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Public University of Navarra (UPNA), Navarra Institute for Health Research (IdiSNA), 31006 Pamplona, Spain; (E.B.); (M.I.); (I.S.)
- Clinical Research Department, TDN, Advanced Rehabilitation Center, 31006 Pamplona, Spain;
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Lee SH, Ju HS, Lee SH, Kim SW, Park HY, Kang SW, Song YE, Lim K, Jung H. Estimation of Health-Related Physical Fitness (HRPF) Levels of the General Public Using Artificial Neural Network with the National Fitness Award (NFA) Datasets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910391. [PMID: 34639690 PMCID: PMC8507740 DOI: 10.3390/ijerph181910391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 01/02/2023]
Abstract
Estimation of health-related physical fitness (HRPF) levels of individuals is indispensable for providing personalized training programs in smart fitness services. In this study, we propose an artificial neural network (ANN)-based estimation model to predict HRPF levels of the general public using simple affordable physical information. The model is designed to use seven inputs of personal physical information, including age, gender, height, weight, percent body fat, waist circumference, and body mass index (BMI), to estimate levels of muscle strength, flexibility, maximum rate of oxygen consumption (VO2max), and muscular endurance. HRPF data (197,719 sets) gathered from the National Fitness Award dataset are used for training (70%) and validation (30%) of the model. In-depth analysis of the model’s estimation accuracy is conducted to derive optimal estimation accuracy. This included input/output correlation, hidden layer structures, data standardization, and outlier removals. The performance of the model is evaluated by comparing the estimation accuracy with that of a multiple linear regression (MLR) model. The results demonstrate that the proposed model achieved up to 10.06% and 30.53% improvement in terms of R2 and SEE, respectively, compared to the MLR model and provides reliable estimation of HRPF levels acceptable to smart fitness applications.
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Affiliation(s)
- Seung-Hun Lee
- Division of Mechanical and Aerospace Engineering, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-H.L.); (H.-S.J.); (S.-H.L.); (S.-W.K.)
| | - Hyeon-Seong Ju
- Division of Mechanical and Aerospace Engineering, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-H.L.); (H.-S.J.); (S.-H.L.); (S.-W.K.)
| | - Sang-Hun Lee
- Division of Mechanical and Aerospace Engineering, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-H.L.); (H.-S.J.); (S.-H.L.); (S.-W.K.)
| | - Sung-Woo Kim
- Physical Activity and Performance Institute, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-W.K.); (H.-Y.P.); (K.L.)
| | - Hun-Young Park
- Physical Activity and Performance Institute, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-W.K.); (H.-Y.P.); (K.L.)
- Department of Sports Medicine and Science, Graduate School, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
| | - Seung-Wan Kang
- Division of Mechanical and Aerospace Engineering, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-H.L.); (H.-S.J.); (S.-H.L.); (S.-W.K.)
| | - Young-Eun Song
- Department of Electrical Engineering, Hoseo University, 20 Hoseo-ro 79 beon-gil, Baebang-eup, Asan-si 31499, Korea;
| | - Kiwon Lim
- Physical Activity and Performance Institute, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-W.K.); (H.-Y.P.); (K.L.)
- Department of Sports Medicine and Science, Graduate School, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
- Department of Physical Education, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
| | - Hoeryong Jung
- Division of Mechanical and Aerospace Engineering, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea; (S.-H.L.); (H.-S.J.); (S.-H.L.); (S.-W.K.)
- Department of Sports Medicine and Science, Graduate School, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea
- Correspondence: ; Tel.: +82-2-450-3903
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20
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Nagai T, Bates N, McPherson A, Hale R, Hewett T, Schilaty ND. Effects of Sex and Age on Quadriceps and Hamstring Strength and Flexibility in High School Basketball Athletes. Int J Sports Phys Ther 2021; 16:1302-1312. [PMID: 34631251 PMCID: PMC8486399 DOI: 10.26603/001c.27986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Eccentric hamstring strength and hamstring/quadriceps strength ratios have been identified as modifiable risk factors of hamstring strains. Additionally, those strength and flexibility characteristics are commonly used as clinical tests to monitor progress of athletes with acute or chronic hamstring strains. Although hamstring strains are common among basketball athletes, normative values of knee strength and flexibility characteristics are scarce. Normative values for these athletes would be important in prevention and management of hamstring strains. PURPOSE To establish quadriceps and hamstring isokinetic strength and flexibility values among high school basketball athletes and examine the effects of sex and age. STUDY DESIGN Cross-sectional research. METHODS Isokinetic knee muscular strength (concentric quadriceps [QuadC], concentric hamstring [HamC], eccentric hamstring [HamE], and strength ratios ([HamC/QuadC and HamE/Quad]), flexibility of hip flexors and quadriceps during a Modified Thomas test, and flexibility of hip extensors and hamstring during passive straight leg raise (SLR) and passive knee extension (PKE) tests were measured. Effects of sex and age were analyzed using t-tests and analysis of variance, respectively with Bonferroni corrected post hoc tests (p≤0.01). RESULTS A total of 172 high school basketball athletes (64 males/108 females; mean age (range): 15.7 (14-18) years old) participated in the study. Male athletes were significantly stronger than female athletes (QuadC: p<0.001; HamC: p<0.001) while no differences were observed in strength ratio (HamC/QuadC: p=0.759-0.816; HamE/QuadC: p=0.022-0.061). Among male athletes, a significant effect of age on quadriceps and hamstring strength was observed: older male athletes were stronger than younger male athletes. Contrarily, there were no effects of age on strength among female athletes. There were significant sex differences in quadriceps flexibility, SLR, and PKE (female athletes were more flexible; p=0.001-0.005) while no sex differences were found in hip flexor flexibility (p=0.105-0.164). There were no effects of age for any flexibility variables within male and female athletes (p=0.151-0.984). CONCLUSION The current results provide normative values for hamstring strength and flexibility in high school basketball athletes. These normative values may further assist sports medicine specialists to develop screening tests, interventions, and return-to-sport criteria in this population. LEVEL OF EVIDENCE 3B.
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Affiliation(s)
- Takashi Nagai
- United States Army Research Institute of Environmental Medicine; Mayo Clinic
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21
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Valadão P, Piitulainen H, Haapala EA, Parviainen T, Avela J, Finni T. Exercise intervention protocol in children and young adults with cerebral palsy: the effects of strength, flexibility and gait training on physical performance, neuromuscular mechanisms and cardiometabolic risk factors (EXECP). BMC Sports Sci Med Rehabil 2021; 13:17. [PMID: 33637124 PMCID: PMC7908003 DOI: 10.1186/s13102-021-00242-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Background Individuals with cerebral palsy (CP) have problems in everyday tasks such as walking and climbing stairs due to a combination of neuromuscular impairments such as spasticity, muscle weakness, reduced joint flexibility and poor coordination. Development of evidence-based interventions are in pivotal role in the development of better targeted rehabilitation of CP, and thus in maintaining their motor function and wellbeing. Our aim is to investigate the efficacy of an individually tailored, multifaceted exercise intervention (EXECP) in children and young adults with CP. EXECP is composed of strength, flexibility and gait training. Furthermore, this study aims to verify the short-term retention of the adaptations three months after the end of the EXECP intervention. Methods Twenty-four children and young adults with spastic CP will be recruited to participate in a 9-month research project with a 3-month training intervention, consisting of two to three 90-min sessions per week. In each session, strength training for the lower limbs and trunk muscles, flexibility training for the lower limbs and inclined treadmill gait training will be performed. We will evaluate muscle strength, joint flexibility, neuromuscular and cardiometabolic parameters. A nonconcurrent multiple baseline design with two pre-tests and two post-tests all interspaced by three months is used. In addition to the CP participants, 24 typically developing age and sex-matched participants will perform the two pre-tests (i.e. no intervention) to provide normative data. Discussion This study has a comprehensive approach examining longitudinal effects of wide variety of variables ranging from physical activity and gross motor function to sensorimotor functions of the brain and neuromuscular and cardiometabolic parameters, providing novel information about the adaptation mechanisms in cerebral palsy. To the best of our knowledge, this is the first intervention study providing supervised combined strength, flexibility and gait training for young individuals with CP. Trial registration number ISRCTN69044459, prospectively registered (21/04/2017).
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Harri Piitulainen
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Eero A Haapala
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Parviainen
- Centre for Interdisciplinary Brain Research, University of Jyväskylä, Jyväskylä, Finland
| | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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22
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Holzgreve F, Maurer-Grubinger C, Isaak J, Kokott P, Mörl-Kreitschmann M, Polte L, Solimann A, Wessler L, Filmann N, van Mark A, Maltry L, Groneberg DA, Ohlendorf D. The acute effect in performing common range of motion tests in healthy young adults: a prospective study. Sci Rep 2020; 10:21722. [PMID: 33303934 PMCID: PMC7728808 DOI: 10.1038/s41598-020-78846-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
In the application of range of motion (ROM) tests there is little agreement on the number of repetitions to be measured and the number of preceding warm-up protocols. In stretch training a plateau in ROM gains can be seen after four to five repetitions. With increasing number of repetitions, the gain in ROM is reduced. This study examines the question of whether such an effect occurs in common ROM tests. Twenty-two healthy sport students (10 m/12 f.) with an average age of 25.3 ± 1.94 years (average height 174.1 ± 9.8 cm; weight 66.6 ± 11.3 kg and BMI 21.9 ± 2.0 kg/cm2) volunteered in this study. Each subject performed five ROM tests in a randomized order—measured either via a tape measure or a digital inclinometer: Tape measure was used to evaluate the Fingertip-to-Floor test (FtF) and the Lateral Inclination test (LI). Retroflexion of the trunk modified after Janda (RF), Thomas test (TT) and a Shoulder test modified after Janda (ST) were evaluated with a digital inclinometer. In order to show general acute effects within 20 repetitions we performed ANOVA/Friedman-test with multiple comparisons. A non-linear regression was then performed to identify a plateau formation. Significance level was set at 5%. In seven out of eight ROM tests (five tests in total with three tests measured both left and right sides) significant flexibility gains were observed (FtF: p < 0.001; LI-left/right: p < 0.001/0.001; RF: p = 0.009; ST-left/right: p < 0.001/p = 0.003; TT-left: p < 0.001). A non-linear regression with random effects was successfully applied on FtF, RF, LI-left/right, ST-left and TT-left and thus, indicate a gradual decline in the amount of gained ROM. An acute effect was observed in most ROM tests, which is characterized by a gradual decline of ROM gain. For those tests, we can state that the acute effect described in the stretching literature also applies to the performance of typical ROM tests. Since a non-linear behavior was shown, it is the decision of the practitioner to weigh up between measurement accuracy and expenditure. Researchers and practitioners should consider this when applying ROM assessments to healthy young adults.
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Affiliation(s)
- F Holzgreve
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany.
| | - C Maurer-Grubinger
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - J Isaak
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - P Kokott
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - M Mörl-Kreitschmann
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - L Polte
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - A Solimann
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - L Wessler
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - N Filmann
- Institute of Biostatistics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - A van Mark
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - L Maltry
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - D A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - D Ohlendorf
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
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23
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Michaeli A. Treating low back pain - Bridging the gap between manual therapy and exercise. J Bodyw Mov Ther 2020; 24:452-461. [PMID: 33218547 DOI: 10.1016/j.jbmt.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/22/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022]
Abstract
As therapists, we often recommend exercise to reduce patients' low-back pain, as well as increase their active range of motion and muscle strength. However, physical therapists face a challenge when recommending exercise to reduce low-back pain because the pain itself often inhibits the patient's ability to exercise or perform activities of daily living. This situation becomes even more challenging if the prescribed exercise program aggravates the individual's low-back pain. This article discusses a method which provides for the effective treatment of low back pain by allowing patients to exercise pain free earlier in the rehabilitation process. The method comprises a unique approach utilizing the following four components simultaneously from the onset of treatment: isometric muscle contraction (IMC); assisted active oscillatory mobilization; end-of-range passive stretch; and mindfulness.
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Affiliation(s)
- Arie Michaeli
- Clinical Solutions, Johannesburg, Gauteng, South Africa.
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24
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Jairakdee Y, Chansirinukor W, Sitti T. Effect of releasing quadratus lumborum muscle on hip and knee muscle length in asymptomatic individuals. J Bodyw Mov Ther 2020; 26:542-547. [PMID: 33992295 DOI: 10.1016/j.jbmt.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 10/14/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Quadratus lumborum muscle (QL) is one of several muscles subject to tightness and relevant to symptoms in the back and hip. Although releasing the tight QL seems to resolve these symptoms in clinic, no study has investigated the effects of such releasing on the length of the hip and knee muscles. OBJECTIVE To compare muscle length of the hip and knee joints between pre- and post-releasing the QL. METHODS A quasi-experimental design (one-group pretest-posttest design) was conducted. Thirty asymptomatic participants with mean age of 20.40 years took part in the study. An examiner assessed the participants' pelvic transverse gliding movement in standing and rotation of the upper trunk in supine to perceive the end feel of tissue resistance. The side with perceived more muscle tension was selected for receiving muscle release. Before manually releasing the QL, the participant was in the modified Thomas test position and pre-test range of motion (ROM) of hip flexion, hip abduction, and knee flexion angles was measured using a standard goniometer. After releasing the QL, the aforementioned angles were measured for post-test ROM. RESULTS The hip flexion angle was significantly reduced after releasing the QL (p < 0.05), whereas no statistically significant differences were found for the other 2 angles (p > 0.05). CONCLUSION The length of iliopsoas muscle was increased after releasing the QL. The findings may be due to continuous fascial connection and similar attachment of the origins of these 2 muscles. CLINICAL TRIAL REGISTRATION NUMBER NCT03016559.
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Affiliation(s)
- Yaowapa Jairakdee
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Thailand.
| | - Wunpen Chansirinukor
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
| | - Tippawan Sitti
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Thailand.
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Kim D, Jang S, Park J. Electroacupuncture and Manual Acupuncture Increase Joint Flexibility but Reduce Muscle Strength. Healthcare (Basel) 2020; 8:healthcare8040414. [PMID: 33092241 PMCID: PMC7712489 DOI: 10.3390/healthcare8040414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to investigate the immediate effects of electroacupuncture and manual acupuncture on hip flexion range of motion (ROM), knee joint (flexion replication at 15° and 45°) and quadriceps (strength and activation) function. Forty-five neurologically healthy adults participated in this randomized controlled laboratory study. Straight leg raise test, modified Thomas test, and hip abductors strength test were performed to determine acupoints. Afterwards, one of three 15-min treatments (control—no treatment, electroacupuncture, or manual acupuncture) was randomly applied using determined acupoints. Measurements (hip flexion ROM, and knee joint and quadriceps function) were recorded at baseline, and at 0, 20, and 40 min post treatment. Both electroacupuncture (4.0°, ES = 0.41) and manual acupuncture (5.4°, ES = 0.95) treatment immediately increased hip flexion ROM, and the increased values persisted for 40-min (p = 0.01). Knee flexion replication (at 15°: p = 0.17; 45°: p = 0.19) and quadriceps activation (p = 0.71) did not change at any of the time points. Post-treatment, both electroacupuncture and manual acupuncture decreased quadriceps strength at 0-min (electroacupuncture: 9.2%, p < 0.0001, ES = 0.60) and 40-min (electroacupuncture: 7.3%, p = 0.005, ES = 0.55; manual acupuncture: 8.7%, p = 0.01, ES = 0.54). A single session of either electroacupuncture or manual acupuncture treatment (selected acupoints based on physical examination) may immediately improve joint flexibility but reduce muscle strength.
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Affiliation(s)
- Daeho Kim
- Department of Sports Science and Rehabilitation, Woosong University, Daejeon 34606, Korea;
| | - Sein Jang
- Bareun Korean Medicine Clinic, Seoul 05616, Korea;
| | - Jihong Park
- Department of Sports Medicine, Athletic Training Laboratory, Kyung Hee University, Yongin 17104, Korea
- Correspondence:
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26
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Stiffness of the iliotibial band and associated muscles in runner’s knee: Assessing the effects of physiotherapy through ultrasound shear wave elastography. Phys Ther Sport 2020; 45:126-134. [DOI: 10.1016/j.ptsp.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
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Maselli F, Storari L, Barbari V, Colombi A, Turolla A, Gianola S, Rossettini G, Testa M. Prevalence and incidence of low back pain among runners: a systematic review. BMC Musculoskelet Disord 2020; 21:343. [PMID: 32493481 PMCID: PMC7271446 DOI: 10.1186/s12891-020-03357-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background Running is one of the most popular sports worldwide. Despite low back pain (LBP) represents the most common musculoskeletal disorder in population and in sports, there is currently sparse evidence about prevalence, incidence and risk factors for LBP among runners. The aims of this systematic review were to investigate among runners: prevalence and incidence of LBP and specific risk factors for the onset of LBP. Methods A systematic review has been conducted according to the guidelines of the PRISMA statement. The research was conducted in the following databases from their inception to 31st of July 2019: PubMed; CINAHL; Google Scholar; Ovid; PsycINFO; PSYNDEX; Embase; SPORTDiscus; Scientific Electronic Library Online; Cochrane Library and Web of Science. The checklists of The Joanna Briggs Institute Critical Appraisal tools were used to investigate the risk of bias of the included studies. Results Nineteen studies were included and the interrater agreement for full-text selection was good (K = 0.78; 0.61–0.80 IC 95%). Overall, low values of prevalence (0.7–20.2%) and incidence (0.3–22%) of LBP among runners were reported. Most reported risk factors were: running for more than 6 years; body mass index > 24; higher physical height; not performing traditional aerobics activity weekly; restricted range of motion of hip flexion; difference between leg-length; poor hamstrings and back flexibility. Conclusions: Prevalence and incidence of LBP among runners are low compared to the others running related injuries and to general, or specific population of athletes. View the low level of incidence and prevalence of LBP, running could be interpreted as a protective factor against the onset of LBP. Systematic review registration PROSPERO CRD42018102001.
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Affiliation(s)
- Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy. .,Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy.
| | - Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Andrea Colombi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Andrea Turolla
- IRCCS, San Camillo, Laboratory of Rehabilitation Technologies, Rehabilitation Research Unit, Venice, Italy
| | - Silvia Gianola
- IRCCS, Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milano, Italy
| | - Giacomo Rossettini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
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Araújo LMD, Dell’Antonio E, Hubert M, Ruschel C, Roesler H, Pereira SM. Trunk muscular endurance, lumbar spine mobility and hip flexibility in sailors with and without low back pain. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Low back pain is one of the most common injuries in sailors. Findings in the literature indicate that poor trunk endurance, flexibility and muscle strength are common in individuals with low back pain (LBP). Objective: Analyze trunk muscle endurance, lumbar spine mobility and hip flexibility in windsurfers with and without low back pain. Method: Sailors of both sexes with at least three years’ experience in the sport answered the Nordic Musculoskeletal Questionnaire and were submitted to Schober’s test, the passive straight leg raise (PSLR), the modified Thomas test, and isometric endurance assessment of the flexor, extensor and lateral flexor muscles of the torso. The sailors were divided into two groups (with and without LBP) and compared using the Student’s t-test or Mann Whitney U test. Results: Participants were 22 national-level sailors, 11 with low back pain (LBP) and 11 without (NLBP). The LBP group obtained longer holding times for the trunk extensors (p=0.028) and a greater difference in endurance between the right and left sides for lateral trunk muscles (p=0.030). Both groups obtained results below normative values in most of the tests performed. Conclusion: Sailors with low back pain exhibited greater trunk extensor endurance and a larger imbalance between lateral trunk muscles when compared to those with no LBP. Spinal mobility and hip flexibility were similar between groups.
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29
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Harris JD, Mather RC, Nho SJ, Salvo JP, Stubbs AJ, Van Thiel GS, Wolff AB, Christoforetti JJ, Ellis TJ, Matsuda DK, Kivlan BR, Carreira DS. Reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons. J Hip Preserv Surg 2019; 7:77-84. [PMID: 32382433 PMCID: PMC7195937 DOI: 10.1093/jhps/hnz062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/10/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine (i) the reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons and (ii) the magnitude of hip flexion change with posterior pelvic tilt. Five experienced arthroscopic hip preservation surgeons (5–18 years of hip surgery experience) performed passive hip range of motion (internal and external rotation), flexion (contralateral hip extended) and flexion with posterior pelvic tilt (contralateral hip maximally flexed) on five young healthy asymptomatic volunteers (three males, two females; 34.4 ± 10.7 years of age). Motion was measured via digital photography and goniometry. Inter-observer reliability was calculated via two-way mixed, single measures, intra-class correlation coefficient. Paired t-test was utilized to compare hip flexion (with contralateral hip extended) to hip flexion with posterior pelvic tilt (with contralateral hip in forced flexion). The reliabilities of measurements of hip flexion with posterior pelvic tilt and external rotation were excellent, that of hip flexion was fair, and that of hip internal rotation was poor. The magnitude of hip flexion increase with posterior pelvic tilt was 17.0° ± 3.0° (P < 0.001). The reliability of hip range of motion measurement by five experienced arthroscopic hip preservation surgeons was excellent for measures of hip flexion with posterior pelvic tilt and external rotation. Contralateral maximal hip flexion significantly increased ipsilateral hip flexion (approximately 17°). Level of Evidence: Diagnostic, level III (without consistently applied reference standard)
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Affiliation(s)
- Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center Suite 2500, Houston, TX 77030, USA
| | - Richard C Mather
- Duke University, DukeHealth, James R. Urbaniak, MD Sports Sciences Institute, 3475 Erwin Rd, Durham, NC 27705, USA
| | - Shane J Nho
- Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
| | - John P Salvo
- Rothman Orthopaedic Institute, 999 Route 73 North, Marlton, NJ 08053, USA
| | - Allston J Stubbs
- Wake Forest University, 1901 Mooney Street, Winston-Salem, NC 27103, USA
| | | | - Andrew B Wolff
- Washington Orthopaedics & Sports Medicine, 2021 K Street, NW, Suite 516, Washington, DC 20006, USA
| | - John J Christoforetti
- Allen Orthopedics & Sports Medicine, 1120 Raintree Circle, Suite 280, Allen, TX 75013, USA
| | - Thomas J Ellis
- Orthopedic ONE, 4605 Sawmill Road, Columbus, OH 43220, USA
| | - Dean K Matsuda
- Premier Hip Arthroscopy, 13160 Mindanao Way, Suite 300, Marina Del Ray, CA 90292, USA
| | | | - Dominic S Carreira
- Peachtree Orthopedics, 11800 Amber Park Drive Parkway, 400 Building One Suite 200, Alpharetta, GA 30009, USA
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30
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Myers NL, Kibler WB, Axtell AH, Herde BJ, Westgate PM, Uhl TL. Musculoskeletal capacity and serve mechanics in professional women’s tennis players. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2019. [DOI: 10.1007/s12662-019-00574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Alam F, Raza S, Moiz JA, Bhati P, Anwer S, Alghadir A. Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial. PHYSICIAN SPORTSMED 2019; 47:301-311. [PMID: 30517043 DOI: 10.1080/00913847.2018.1553466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Flexibility and strength are compromised in pronated feet, which could in turn lead to alteration of the dynamic balance and muscle activity in the lower extremities. This study aimed to analyze the effects of selective tibialis posterior strengthening and iliopsoas stretching on navicular drop, dynamic balance, and lower limb muscle activity in young adults with pronated feet. Methods: Twenty-eight participants with pronated feet were randomly assigned to either the stretching and strengthening group (n = 14) or the conventional exercise group (n = 14). The stretching and strengthening group performed tibialis posterior strengthening exercises and iliopsoas stretching three times a week for 6 weeks in addition to the conventional towel curl exercises. The conventional exercise group performed towel curl exercises only. Navicular drop, dynamic balance, and lower limb muscle activity were assessed at baseline and post-intervention. A mixed model analysis of variance was performed to test the study hypothesis. Results: Significant group effects for the activity of tibialis anterior (p = 0.003) and abductor hallucis muscle (p = 0.010), as well as for the posterolateral (p = 0.036) and composite reach scores (p = 0.018), were detected. Significant group × time interactions were observed for naviculardrop (p < 0.001), all dynamic balance components (p < 0.001), and the activity of tibialis anterior (p < 0.001) and abductor hallucis (p < 0.001). Conclusions: This study demonstrated that inclusion of selective tibialis posterior strengthening and iliopsoas stretching in addition to the conventional towel curl exercise program could improve important clinical outcomes, such as navicular drop, muscle activity, and dynamic balance in flatfeet.
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Affiliation(s)
- Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Shahid Raza
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Pooja Bhati
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia
| | - Ahmad Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia
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Gruskay JA, Strickland SM, Casey E, Chiaia TA, Green DW, Gomoll AH. Team Approach: Patellofemoral Instability in the Skeletally Immature. JBJS Rev 2019; 7:e10. [PMID: 31365447 DOI: 10.2106/jbjs.rvw.18.00159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jordan A Gruskay
- Departments of Orthopedics (J.A.G., S.M.S., D.W.G., and A.H.G.), Physiatry (E.C.), and Sports Rehabilitation (T.A.C.), Hospital for Special Surgery, New York, NY
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Avman MA, Osmotherly PG, Snodgrass S, Rivett DA. Is there an association between hip range of motion and nonspecific low back pain? A systematic review. Musculoskelet Sci Pract 2019; 42:38-51. [PMID: 31030110 DOI: 10.1016/j.msksp.2019.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/04/2019] [Accepted: 03/14/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To systematically review whether there is an association between hip range of motion (ROM) and nonspecific low back pain (NSLBP). DATA SOURCES MEDLINE, EMBASE, Cochrane library, PsychINFO, CINAHL and AMED databases were searched from year of inception until October 31st, 2018, using a combination of LBP and hip joint search terms. Commonly cited journals were also hand searched within the previous two years. STUDY SELECTION Two reviewers independently screened identified articles, by title and abstract and then by full-text. After first round screening of 2908 identified records, 248 progressed to full-text screening. Due to the heterogeneity of studies identified, post hoc inclusion criteria of English language, studies comparing subjects with NSLBP and healthy controls, cross-sectional design, and clinical measures of hip ROM were applied. Twenty-four records were finally included. DATA EXTRACTION Extracted data included population characteristics, duration and severity of NSLBP, hip movement direction, testing position, measurement tool and between-group difference. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess for study bias. DATA SYNTHESIS Hip flexion ROM was measured in seven studies, extension in 13, internal rotation (IR) in 14, external rotation (ER) in 13, abduction in six, and adduction in only two studies. Among all directions tested, IR ROM was reported in more studies as significantly reduced in NSLBP subjects compared to healthy individuals. Overall the quality of evidence was very low. Common sources of study bias included lack of sample size justification, blinding of outcome assessors, adjusting for key confounders, and poor reporting. CONCLUSION There is very low-quality evidence to support an association between limited hip ROM and NSLBP. Limited hip IR ROM was the only movement impairment found to be significantly associated with NSLBP, however this should be viewed with caution due to the low-quality supportive evidence. Further studies are needed.
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Affiliation(s)
- Maya Abady Avman
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.
| | - Peter G Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Suzanne Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Darren A Rivett
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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Nojiri S, Yagi M, Mizukami Y, Ichihashi N. Static stretching time required to reduce iliacus muscle stiffness. Sports Biomech 2019; 20:901-910. [PMID: 31232167 DOI: 10.1080/14763141.2019.1620321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Static stretching (SS) is an effective intervention to reduce muscle stiffness and is also performed for the iliopsoas muscle. The iliopsoas muscle consists of the iliacus and psoas major muscles, among which the former has a greater physiological cross-sectional area and hip flexion moment arm. Static stretching time required to reduce muscle stiffness can differ among muscles, and the required time for the iliacus muscle remains unclear. The purpose of this study was to investigate the time required to reduce iliacus muscle stiffness. Twenty-six healthy men participated in this study. A 1-min hip extension SS was performed five times. Shear elastic modulus, an index of muscle stiffness, of the iliacus muscle was measured using ultrasonic shear wave elastography before SS and immediately after each SS. One-way repeated analysis of variance showed a statistical effect of time on the shear elastic modulus. A paired t-test with Holm adjustment revealed that the shear elastic moduli after 1-5 SS were statistically lower than that before SS. In addition, the shear elastic modulus after 5 SS was statistically lower than that after 1 SS. The results suggested that the stiffness of the iliacus muscle decreased with 1-min SS and further decreased with 5-min SS.
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Affiliation(s)
- Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yu Mizukami
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Guillot A, Kerautret Y, Queyrel F, Schobb W, Di Rienzo F. Foam Rolling and Joint Distraction with Elastic Band Training Performed for 5-7 Weeks Respectively Improve Lower Limb Flexibility. J Sports Sci Med 2019; 18:160-171. [PMID: 30787664 PMCID: PMC6370967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
Both foam rolling and joint distraction training with elastic bands are very popular interventions designed to improve muscular function, motor performance, and joint range of motion, as well as to reduce feeling of fatigue and delayed onset of muscle soreness. The heterogeneity of methods used among studies however prevents from drawing firm conclusions about the optimal content of pre/post interventions. The present study aims at answering the following questions: i) Do foam rolling and joint distraction with elastic band training improve joint range of motion in national rugby players? ii) Do short and long rolling durations have similar effects on range of motion? In a first experiment, we compared ankle, knee, and hip flexibility scores in 30 national rugby players after a 7-week foam rolling training program involving either a short (20s) or long (40s) rolling duration. Data revealed that foam rolling substantially improved all range of motion scores, regardless the rolling duration (performance gains ranged from 9 to 18° in the foam rolling groups, i.e. 8 to 20% increase, but remained under 2° in the control group). In a second experiment, we investigated the effect of a 5-week joint distraction with elastic band training program on hamstring and adductor range of motion in 23 national rugby players. Data showed that elastic band training significantly improved sit-and-reach (29.16% increase, p = 0.01) as well as side split (2.31% increase, p < 0.001) stretching performances. Taken together, present findings confirm that both foam rolling and joint distraction exercises with elastic bands are likely to enhance joint range of motion and specific mobility patterns during sport performance, and further serve prophylaxis. Such effects therefore constitute a promising avenue for clinical, home therapy, and personal flexibility training.
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Affiliation(s)
- Aymeric Guillot
- Institut Universitaire de France, F-75000, Paris
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Villeurbanne, France
| | - Yann Kerautret
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Villeurbanne, France
- CAPSIX, 69450, Saint-Cyr au Mont d'Or, France
| | - Florian Queyrel
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Villeurbanne, France
| | - William Schobb
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Villeurbanne, France
| | - Franck Di Rienzo
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Villeurbanne, France
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Martínez TC, Lluch E, Torres-Cueco R, Pecos-Martín D, McConnell J. Concurrent Criterion-related Validity, Reliability, and Responsiveness to Treatment of the Figure-of-Four Position for Measurement of Anterior Hip Joint Structures Tightness. J Manipulative Physiol Ther 2019; 41:780-788. [PMID: 30791995 DOI: 10.1016/j.jmpt.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to examine the intra- and intertester reliability, concurrent criterion-related validity, and responsiveness to treatment of the "figure-of-four" position. METHODS A total of 52 asymptomatic male soccer players participated in this study. The intraclass correlation coefficient (2, 1) was used to determine intra- and intertester reliability of the figure-of-four position. Pearson product moment correlation coefficients examining the association between the figure-of-four position and goniometric measurements of hip extension and external rotation were used to establish concurrent validity. To evaluate responsiveness to treatment, the figure-of-four position was assessed by a blinded examiner before and immediately after the application of a stretching technique or control intervention. RESULTS Excellent reliability (intraclass correlation coefficient > 0.75) was obtained for both intra- and intertester reliability of the figure-of-four position. Overall, the figure-of-four position and goniometric measurements of both hip extension and external rotation were significantly correlated. However, no significant treatment effects were observed for the figure-of-four position. CONCLUSION The results of this study demonstrated that the figure-of-four position is a reliable and valid way to obtain information on tightness of anterior hip joint structures in male soccer players. However, responsiveness to treatment of the figure-of-four position should be questioned.
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Affiliation(s)
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | | | - Daniel Pecos-Martín
- Department of Physical Therapy, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Jenny McConnell
- Centre for Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Young JD, Spence AJ, Power G, Behm DG. The Addition of Transcutaneous Electrical Nerve Stimulation with Roller Massage Alone or in Combination Did Not Increase Pain Tolerance or Range of Motion. J Sports Sci Med 2018; 17:525-532. [PMID: 30479519 PMCID: PMC6243624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/13/2018] [Indexed: 06/09/2023]
Abstract
Roller massage (RM) can be painful and induce muscle activity during application. Acute increases in pain pressure threshold (PPT) and range of motion (ROM) have been previously reported following RM. It is unclear whether the RM-induced increases in PPT and ROM can be attributed to changes in neural or muscle responses. To help determine if neural pain pathways are affected by roller massage, transcutaneous electrical nerve stimulation (TENS) was utilized as a form of electroanalgesia during RM with PPT and ROM tested on the affected and contralateral quadriceps. The purpose of this study was to evaluate in both quadriceps, the effect of brief intense TENS on PPT and ROM following unilateral RM of the quadriceps. A randomized within subjects' design was used to examine local and non-local effects of TENS and roller massage versus a control condition (rolling without TENS application). Four 30s bouts of roller massage of the dominant quadriceps were implemented with 30s of rest. The researcher applied the RM using a constant pressure device with approximately 70% of the maximum tolerable load. Perceived pain was monitored using a visual analog scale (VAS) during RM. Ipsilateral and contralateral quadriceps ROM and PPT were measured immediately following RM. Significant main effects for time showed increased PPT and ROM in both the treated and contralateral quadriceps, with no significant main effects for intervention or interactions for intervention and time. Moderate to large effect sizes and minimal clinically important differences (MCID) were detected when comparing baseline to pre- and post-tests respectively. VAS scores were significantly (main effect for intervention) and near significantly (interactions) reduced with MCID when TENS was applied during rolling. The addition of TENS to rolling did not increase PPT or ROM in the affected or contralateral quadriceps, likely due to a repeated testing effect.
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Affiliation(s)
- James D Young
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's Newfoundland, Canada
| | - Alyssa-Joy Spence
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's Newfoundland, Canada
| | - Gerard Power
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's Newfoundland, Canada
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's Newfoundland, Canada
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Song MH, Lee TJ, Song JH, Song HR. Sustained hip flexion contracture after femoral lengthening in patients with achondroplasia. BMC Musculoskelet Disord 2018; 19:417. [PMID: 30497473 PMCID: PMC6267876 DOI: 10.1186/s12891-018-2344-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hip flexion contracture often occurs after femoral lengthening in patients with achondroplasia, but few studies have investigated its development in these patients. The purpose of this study was to analyze sustained hip flexion contracture in achondroplasia patients who underwent femoral lengthening and to identify contributing factors. Methods This study included 34 patients with achondroplasia who underwent femoral lengthening (mean age at operation, 11.1 years). Sustained hip flexion was defined as flexion contracture lasting > 6 months postoperatively despite physiotherapy. Demographic data, spinopelvic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, and sagittal vertical axis), and quantitative assessments of femoral lengthening were investigated. The associations among these factors and the development of sustained hip flexion contracture were assessed. Results Sustained hip flexion contracture developed in 13 (38%) of 34 achondroplasia patients after femoral lengthening. Eight (62%) of these 13 patients concomitantly exhibited limitation of knee flexion. Excessive femoral lengthening (odds ratio [OR], 1.450; 95% confidence interval [CI], 1.064 to 1.975; p = 0.019) and forward sagittal vertical axis tilt (OR, 1.062; 95% CI, 1.001 to 1.127; p = 0.047) contributed to sustained hip flexion contracture. Conclusions Sustained hip flexion contracture frequently occurs after femoral lengthening in achondroplasia patients. Both excessive femoral lengthening and preoperative forward SVA tilt may contribute to the development of sustained hip flexion contracture in these patients.
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Affiliation(s)
- Mi Hyun Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Tae-Jin Lee
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Jong Hyeop Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Hae-Ryong Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea.
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Successful conservative treatment for a subtotal proximal avulsion of the rectus femoris in an elite soccer player. Phys Ther Sport 2018; 33:62-69. [DOI: 10.1016/j.ptsp.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022]
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40
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Toivo K, Kannus P, Kokko S, Alanko L, Heinonen OJ, Korpelainen R, Savonen K, Selänne H, Vasankari T, Kannas L, Kujala UM, Villberg J, Parkkari J. Musculoskeletal examination in young athletes and non-athletes: the Finnish Health Promoting Sports Club (FHPSC) study. BMJ Open Sport Exerc Med 2018; 4:e000376. [PMID: 29955377 PMCID: PMC6018865 DOI: 10.1136/bmjsem-2018-000376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives To determine the inter-rater repeatability of a musculoskeletal examination and to compare findings between adolescent athletes and non-athletes in Finland. Methods In this cross-sectional study, a musculoskeletal examination assessing posture, mobility and movement control was carried out by a sports and exercise medicine physician on 399 athletes aged 14–17 years and 177 non-athletes. Within 2 weeks another sports and exercise medicine physician repeated the examination for 41 adolescents to test the inter-rater repeatability. Results In total, 10 of the 11 tests performed had at least moderate inter-rater reliability (κ ≥0.4 or percentage agreement >80%). Athletes more often than non-athletes had one shoulder protruded (8.0% vs 4.0%, OR 2.81, 95% CI 1.16 to 6.81). Forty-six per cent of athletes had good knee control in the two-legged vertical drop jump test compared with 32% of non-athletes (OR 1.99, 95% CI 1.29 to 3.06). Athletes had better core muscle control with 86.3% being able to remain in the correct plank position for 30 s compared with 68.6% of non-athletes (OR 2.70, 95% CI 1.67 to 4.36). In the deep squat test, good lumbar spine control was maintained only by 35.8% of athletes and 38.4% of non-athletes. Conclusion A basic musculoskeletal examination is sufficiently reliable to be performed by trained physicians as a part of a periodic health evaluation. Shortfalls in mobility, posture and movement control are common in both athletes and non-athletes. These deficits could have been caused by sedentary behaviour, monotonous training, or both.
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Affiliation(s)
- Kerttu Toivo
- Tampere Research Center of Sports Medicine, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Kannus
- Tampere Research Center of Sports Medicine, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | - Sami Kokko
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Lauri Alanko
- Clinic for Sports and Exercise Medicine, Helsinki, Finland
| | - Olli J Heinonen
- Paavo Nurmi Centre & Unit of Health and Physical Activity, University of Turku, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Clinic, Oulu Deaconess Institute, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and University Hospital of Oulu, Oulu, Finland
| | - Kai Savonen
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Harri Selänne
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Lasse Kannas
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Villberg
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
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Light N, Smith N, Delahunt E, Thorborg K. Hip and groin injury management in English youth football: a survey of 64 professional academies. SCI MED FOOTBALL 2018. [DOI: 10.1080/24733938.2018.1441536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Neil Light
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
| | - Neal Smith
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
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Beneck GJ, Selkowitz DM, Janzen DS, Malecha E, Tiemeyer BR. The influence of pelvic rotation on clinical measurements of hip flexion and extension range of motion across sex and age. Phys Ther Sport 2017; 30:1-7. [PMID: 29253799 DOI: 10.1016/j.ptsp.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/15/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the amount of pelvic rotation associated with hip motion during passive hip flexion and extension goniometric measurements. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS One hundred healthy adults (males = 45, females = 55) aged 18-66 years participated. OUTCOME MEASURES Clinical range of motion measurements of hip flexion, and extension during the modified Thomas test, and pelvic sagittal position measured using a device, attached from the PSIS to ASIS, and a fluid-filled inclinometer. RESULTS When pelvic rotation was subtracted from the clinical measurements, hip flexion measurements were significantly reduced in both sexes (males: 110.8 ± 7.4 to 93.8 ± 7.8°, P < 0.001; females: 121.3 ± 7.2 to 107.3 ± 8.6°, P < 0.001). However, subtracting pelvic rotation from hip extension measurements only significantly reduced the measurements in females (15.5 ± 6.0 to 6.2 ± 6.8°, P < 0.001). No significant differences were found across age groups. CONCLUSIONS Clinical measurements of hip flexion exaggerated the range of motion in both sexes. The modified Thomas test appeared to control for rotation of the pelvis during hip extension in men. However, in women, hip extension measurements were exaggerated.
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Affiliation(s)
- George J Beneck
- Department of Physical Therapy, California State University at Long Beach, CA, USA.
| | - David M Selkowitz
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions Charlestown Navy Yard, Boston, MA, USA.
| | - Dani Skeie Janzen
- Department of Physical Therapy, California State University at Long Beach, CA, USA.
| | - Erin Malecha
- Department of Physical Therapy, California State University at Long Beach, CA, USA.
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Halabchi F, Abolhasani M, Mirshahi M, Alizadeh Z. Patellofemoral pain in athletes: clinical perspectives. Open Access J Sports Med 2017; 8:189-203. [PMID: 29070955 PMCID: PMC5640415 DOI: 10.2147/oajsm.s127359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Patellofemoral pain (PFP) is a very common problem in athletes who participate in jumping, cutting and pivoting sports. Several risk factors may play a part in the pathogenesis of PFP. Overuse, trauma and intrinsic risk factors are particularly important among athletes. Physical examination has a key role in PFP diagnosis. Furthermore, common risk factors should be investigated, such as hip muscle dysfunction, poor core muscle endurance, muscular tightness, excessive foot pronation and patellar malalignment. Imaging is seldom needed in special cases. Many possible interventions are recommended for PFP management. Due to the multifactorial nature of PFP, the clinical approach should be individualized, and the contribution of different factors should be considered and managed accordingly. In most cases, activity modification and rehabilitation should be tried before any surgical interventions.
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Affiliation(s)
- Farzin Halabchi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirshahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
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MENDIGUCHIA JURDAN, MARTINEZ-RUIZ ENRIQUE, EDOUARD PASCAL, MORIN JEANBENOÎT, MARTINEZ-MARTINEZ FRANCISCO, IDOATE FERNANDO, MENDEZ-VILLANUEVA ALBERTO. A Multifactorial, Criteria-based Progressive Algorithm for Hamstring Injury Treatment. Med Sci Sports Exerc 2017; 49:1482-1492. [DOI: 10.1249/mss.0000000000001241] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Individuals With Patellofemoral Pain Have Less Hip Flexibility Than Controls Regardless of Treatment Outcome. Clin J Sport Med 2017; 27:97-103. [PMID: 27347862 DOI: 10.1097/jsm.0000000000000307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine differences in hip flexibility before and after a 6-week muscle strengthening program between those with patellofemoral pain (PFP) and healthy controls. DESIGN Single-blind, multicentered, randomized controlled trial. SETTING Four clinical research laboratories. SUBJECTS Physically active individuals (199 PFP and 38 controls). INTERVENTIONS Patellofemoral pain and control subjects were randomized into either a hip-focused or a knee-focused muscle strengthening treatment program. MAIN OUTCOME MEASURES Pain-visual analog scale (centimeter), function-Anterior Knee Pain Scale (points), flexibility-passive goniometry (degrees): hip adduction (HADD), hip external rotation (HER), hip internal rotation (HIR), total hip rotation (HROT), hip extension (HEXT) were measured before and after the muscle strengthening treatment program. RESULTS Subjects with patellofemoral pain who successfully completed the treatment program (n = 153) had 65%, 25%, 18%, and 12% less HADD, HER, HROT, and HIR ranges of motion (ROMs), respectively, than controls (P < 0.05). Patellofemoral pain subjects who did not successfully complete the program (n = 41) had 134%, 31%, 22%, and 13% less HADD, HER, HROT, and HIR ROMs, respectively, than controls (P < 0.05). All subjects increased their HIR, HROT, and HEXT ROMs pretest to posttest (P < 0.05), but by less than 2 degree. CONCLUSIONS Individuals with PFP had less hip flexibility than controls regardless of treatment outcome or time. After the 6-week muscle strengthening program, and regardless of treatment success, PFP and control subjects experienced a small but clinically insignificant improvement in hip flexibility. CLINICAL RELEVANCE Hip ROM should be considered as a targeted area of focus in a rehabilitation program for physically active individuals with PFP.
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Mullaney MJ, Fukunaga T. CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES. Int J Sports Phys Ther 2016; 11:891-902. [PMID: 27904792 PMCID: PMC5095942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues.
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Schultz AB, Taaffe DR, Blackburn M, Logan P, White D, Drew M, Lockie RG. Musculoskeletal screening as a predictor of seasonal injury in elite Olympic class sailors. J Sci Med Sport 2016; 19:903-909. [DOI: 10.1016/j.jsams.2016.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Peñailillo L, Guzmán N, Cangas J, Reyes A, Zbinden-Foncea H. Metabolic demand and muscle damage induced by eccentric cycling of knee extensor and flexor muscles. Eur J Sport Sci 2016; 17:179-187. [DOI: 10.1080/17461391.2016.1217278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Vigotsky AD, Lehman GJ, Beardsley C, Contreras B, Chung B, Feser EH. The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ 2016; 4:e2325. [PMID: 27602291 PMCID: PMC4991856 DOI: 10.7717/peerj.2325] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/14/2016] [Indexed: 02/02/2023] Open
Abstract
The modified Thomas test was developed to assess the presence of hip flexion contracture and to measure hip extensibility. Despite its widespread use, to the authors’ knowledge, its criterion reference validity has not yet been investigated. The purpose of this study was to assess the criterion reference validity of the modified Thomas test for measuring peak hip extension angle and hip extension deficits, as defined by the hip not being able to extend to 0º, or neutral. Twenty-nine healthy college students (age = 22.00 ± 3.80 years; height = 1.71 ± 0.09 m; body mass = 70.00 ± 15.60 kg) were recruited for this study. Bland–Altman plots revealed poor validity for the modified Thomas test’s ability to measure hip extension, which could not be explained by differences in hip flexion ability alone. The modified Thomas test displayed a sensitivity of 31.82% (95% CI [13.86–54.87]) and a specificity of 57.14% (95% CI [18.41–90.10]) for testing hip extension deficits. It appears, however, that by controlling pelvic tilt, much of this variance can be accounted for (r = 0.98). When pelvic tilt is not controlled, the modified Thomas test displays poor criterion reference validity and, as per previous studies, poor reliability. However, when pelvic tilt is controlled, the modified Thomas test appears to be a valid test for evaluating peak hip extension angle.
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Affiliation(s)
- Andrew D Vigotsky
- Kinesiology Program, Arizona State University , Phoenix , AZ , United States
| | | | - Chris Beardsley
- Strength and Conditioning Research Limited , London , United Kingdom
| | - Bret Contreras
- School of Sport and Recreation, Auckland University of Technology , Auckland , New Zealand
| | - Bryan Chung
- Department of Plastic Surgery, Island Health Authority , Victoria , British Columbia , Canada
| | - Erin H Feser
- Kinesiology Program, Arizona State University , Phoenix , AZ , United States
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Three-Year Outcome After a 1-Month Physiotherapy Program of Local and Individualized Global Treatment for Patellofemoral Pain Followed by Self-Management. Clin J Sport Med 2016; 26:190-8. [PMID: 26327289 DOI: 10.1097/jsm.0000000000000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The main aim of this study was to assess whether improvements after a 1-month patellofemoral pain (PFP) program addressing local and global deficits were maintained for 3 years. DESIGN This prospective cohort study comprised 4 treatment phases including a randomized trial during week 1. SETTING The study was conducted in a private physiotherapy practice. PATIENTS Thirty-seven patients (55 knees) from an original cohort of 41 patients (60 knees) with PFP were followed for 3 years after referral by doctors to participate in this study. INTERVENTIONS Patients received 4 treatments: local treatment focusing on quadriceps strengthening, quadriceps stretching, and taping for fortnight 1, supplemented with individualized global treatment focusing on lower limb posture and movement patterns for fortnight 2, followed by ongoing self-management. MAIN OUTCOME MEASURES Seven outcome measures, assessed at 4 time points, were quadriceps strength, quadriceps length, eccentric knee control, and 4 pain measures. Long-term measures included return to sporting activity, pain recurrence, exercise compliance, and Kujala score. RESULTS Improvements after fortnight 1 (P < 0.001) and fortnight 2 (P < 0.05) were maintained over 3 years for 6 of 7 measures. On testing, 73% were pain free and the remaining 27% had less pain than pretreatment. Kujala scores improved 27%. Eighty-two percent resumed any sport stopped and 54% of patients started new sports/activities. Patellofemoral pain recurred in 7% and 89% of patients was still exercising 3 years posttreatment. CONCLUSIONS Significant improvements after physiotherapy, incorporating local and individually targeted treatment, were maintained for 3 years in a compliant cohort.
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