Upper extremity weight-training modifications for the injured athlete. A clinical perspective

Effects of bench press technique variations on musculoskeletal shoulder loads and potential injury risk

While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of < 1.5 BAW decreased acromioclavicular compression (p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of < 1.5 BAW (p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines.

Radial Tunnel Syndrome in a Collegiate Baseball Pitcher: A Case Report

A Division I baseball pitcher presented with chronic forearm pain in his throwing arm while pitching. Physical examination was remarkable for point tenderness over the radial tunnel. A postexertion magnetic resonance imaging (MRI) scan revealed edema around the posterior interosseous nerve. The patient underwent decompression of the nerve along with radial tunnel release, which resulted in full resolution of symptoms and return to full baseball activities. Radial tunnel syndrome is a rare phenomenon but can occur in throwing athletes. MRI immediately after a pitching session aided in accurate diagnosis and successful surgical management.

Para Powerlifting Performance: A Systematic Review

This research aimed to conduct a systematic review of para powerlifting strength performance. The searches were conducted in three electronic databases: PubMed, Scopus, and SPORTDiscus. Intervention studies related to para powerlifting performance were included. The main information was extracted systematically, based on criteria established by the authors. The data on study design, sample size, participant's characteristics (e. g. type of disability, sex, age, body weight, and height), training experience, assessment tools, physical performance criteria, and force-related outcomes were extracted and analyzed. The studies (n=9) describe factors related to biomechanics and performance. Outcomes revealed that the one-repetition maximum test is used as load prescription and that para powerlifting should work at high speeds and higher loads. Regarding technique, grip width with 1.5 biacromial distance provides a good lift and partial amplitude training as an alternative to training. There are no differences in total load and movement quality in the lumbar arched technique compared with the flat technique. As a monitoring method, repetitions in reserve scale was used for submaximal loads. Finally, our outcomes and discussion indicated strategies and techniques that can be used by para powerlifting coaches.

A Sports Medicine Clinician's Guide to the Diagnosis and Management of Distal Clavicular Osteolysis

ABSTRACT

Weightlifting associated shoulder injuries have seen a dramatic rise in the last 20 years. Distal clavicular osteolysis, coined weightlifter's shoulder, is one such condition caused by repetitive microtrauma to the distal clavicle with subsequent, painful development of bony erosions and resorption of the distal clavicle. Diagnosis, treatment, and prevention of this condition can be challenging. In this article, we highlight evidence-based clinical recommendations for the diagnosis and management of distal clavicular osteolysis, including specific considerations for atraumatic and posttraumatic etiologies, to help clinicians better care for their patients. Activity modification and rehabilitation are the mainstays of the initial treatment. Adjuvant treatments, such as injections or surgery, may be required in refractory cases or in certain patient populations. Early recognition and treatment of weightlifter's shoulder is essential to prevent progression to acromioclavicular joint pathology or instability and to allow for continued participation in sport-specific activities.

Predicting the Clean Movement Technique in Crossfit® Athletes Using an Optimal Upper-Limb Range of Motion: A Prospective Cohort Study

BACKGROUND

The aim of this study was to determine the optimal upper-limb range of motion (ROM) profile for the catch phase of the clean movement (CPCM) and to identify the key ROMs for performing the CPCM in CrossFit® athletes.

METHODS

A prospective cohort study of twenty CrossFit® athletes aged 20-36 years was conducted. Data were collected regarding age, anthropometrics, CrossFit® training experience and upper-limb ROM. The ROM was measured using the ROM-SPORT method. After 7 months, athletes performed a clean movement with a load of 80% one repetition maximum. A Bayesian Student's t-analysis, binary logistic regression analysis and Receiver Operating Characteristic analysis were performed.

RESULTS

The optimal upper-limb ROM profile that predicted correct CPCM performance was 78° in shoulder extension, 173° in shoulder flexion, 107° in shoulder external rotation, 89° in shoulder internal rotation, 153° in elbow flexion, 99° in elbow pronation and 92° in wrist extension (area under the curve ≥ 651; positive predictive value ≥ 80%). Shoulder external rotation, elbow pronation and wrist extension were found to be the most important ROMs for the efficient and safe performance of CPCM (area under the curve ≥ 854; positive predictive value ≥ 85.7%).

CONCLUSION

The upper-limb ROM profile is associated with proper clean performance. Further studies are warranted to determine whether improving flexibility on upper-limb ROM may improve proper clean movement performance.

Effects of and Response to Mechanical Loading on the Knee

Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.

Reintroduction of running after ACL reconstruction with a hamstring graft: can we predict short-term success?

CONTEXT

Return to running (RTR) after anterior cruciate ligament reconstruction (ACL-R) is a crucial milestone. However, there is uncertainty on how and when to start a running program.

OBJECTIVE

To explore the feasibility of a structured program to reintroduce running after ACL-R and to evaluate the predictive value of potential predictors of short-term success.

DESIGN

Longitudinal cohort study.

SETTING

Local Research Center / participant's home.

PATIENTS

Thirty-five participants were recruited after ACL-R.

INTERVENTION

Program with a progression algorithm to reintroduce running (10 running sessions in 14 days).

MAIN OUTCOME MEASURES

The criterion for short-term success was no exacerbation of symptoms. Potential predictors included: (i) the International Knee Document Committee (IKDC) subjective knee form; (ii) ACL Return to Sport after Injury questionnaire; (iii) quadriceps and hamstring strength; (iv) Step-Down Endurance test; and (v) the modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program and Poisson regression analysis was used to evaluate predictors of success.

RESULTS

Of the 34 participants included, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only one had to stop the RTR program. Initial IKDC score was the only significant predictor of a successful RTR with an Area under the ROC curve of 80.4%. An ICKD cut-off of 63.7/100 differentiated responders and non-responders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). There was a 3-fold greater chance of success with an IKDC score above this threshold.

CONCLUSIONS

Our results confirm the feasibility of our RTR program and progression algorithm after ACL-R. Clinicians should use an IKDC score of >64 as a criterion to reintroduce running after ACL-R to increase the likelihood of short-term success.

The Effect of Grip Width on Muscle Strength and Electromyographic Activity in Bench Press among Novice- and Resistance-Trained Men

BACKGROUND

This study compared the muscle activity and six repetition maximum (6-RM) loads in bench press with narrow, medium, and wide grip widths with sub-group comparisons of resistance-trained (RT) and novice-trained (NT) men.

METHODS

After two familiarization sessions, twenty-eight subjects lifted their 6-RM loads with the different grip widths with measurement of electromyographic activity.

RESULTS

Biceps brachii activity increased with increasing grip width, whereas wide grip displayed lower triceps brachii activation than medium and narrow. In the anterior deltoid, greater activity was observed using a medium compared to narrow grip. Similar muscle activities were observed between the grip widths for the other muscles. For the RT group, greater biceps brachii activity with increasing grip width was observed, but only greater activity was observed in the NT group between narrow and wide. Comparing wide and medium grip width, the RT group showed lower triceps activation using a wide grip, whereas the NT group showed lower anterior deltoid activation using a narrow compared to medium grip. Both groups demonstrated lower 6-RM loads using a narrow grip compared to the other grips.

CONCLUSION

Grip widths affect both 6-RM loads and triceps brachii, biceps brachii, and anterior deltoid activity especially between wide and narrow grip widths.

A Criterion Based Rehabilitation Protocol for ACL Repair with Internal Brace Augmentation

The anterior cruciate ligament (ACL) is one of the main stabilizing structures of the knee and its rupture is a common injury in young active adults. ACL reconstruction has been the preferred operative management of an ACL rupture for several decades; however, success rates are variable. Recently, interest in arthroscopic primary repair of the ligament has increased. The repair is augmented with an Internal Brace (IB), which is an ultra-high strength suture tape that bridges the ligament. This technique protects the ligament during the healing and the ligament is encouraged to heal naturally, whilst not requiring any external braces. It acts as a stabiliser to permit early mobilization and optimise rehabilitation. As understanding of rehabilitation has progressed, there has been an increased focus on early weight-bearing and achieving full range of movement. While detailed criterion-based rehabilitation protocols exist for ACL reconstruction, this is not the case for ACL repair. The purpose of this commentary is to present a novel criterion-based rehabilitation protocol following ACL repair surgery augmented with an IB.

LEVEL OF EVIDENCE

V.

Maximal Strength, Muscle Activation, and Bar Velocity Comparisons Between Squatting With a Traditional or Safety Squat Bar

ABSTRACT

Vantrease, WC, Townsend, JR, Sapp, PA, Henry, RN, and Johnson, KD. Maximal strength, muscle activation, and bar velocity comparisons between squatting with a traditional or safety squat bar. J Strength Cond Res 35(2S): S1-S5, 2021-The purpose of this study was to compare strength, muscle activation, and bar velocity between the traditional (TRAD) and safety squat bar (SSB) back squat. Thirty-two men (21.94 ± 3.1 years, 1.78 ± 0.8 m, 81.7 ± 10.1 kg) volunteered to complete this randomized, crossover-design study. Subjects completed 2 separate 1 repetition maximum (1RM) sessions using either the TRAD or SSB. Subsequently, subjects completed 1 session of 3 repetitions at 65 and 85% of their 1RM for each squat condition (SSB & TRAD). Peak muscle activation of 7 muscles from the lower body and trunk was recorded through surface electromyography (EMG), and mean velocity (MV) was recorded by a linear transducer. Electromyography and MV were analyzed by a 2 × 2 (bar × load) repeated-measures analysis of variance. A Pearson correlation was used to determine the relationship of 1RM load between bars. Squat 1RM was significantly higher (p < 0.001; 11.6%) for TRAD (144.7 kg) compared with SSB (128.8 kg), and a strong correlation (r = 0.94) was observed between 1RM values of each bar. A significant main effect was seen in EMG (p < 0.001) and MV for load (p < 0.001). No significant bar × load interaction was observed between conditions for any EMG or bar velocity measure (p > 0.05). The SSB produces similar muscle activation and bar velocities compared with the TRAD at relative intensities. However, absolute loads should be adjusted when changing squat bars during a training cycle.

A Secondary Injury Prevention Program May Decrease Contralateral Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Injury Rates in the ACL-SPORTS Randomized Controlled Trial

OBJECTIVE

To determine whether the addition of perturbation training to a secondary injury prevention program reduces the rate of second anterior cruciate ligament (ACL) injury compared to the prevention program alone.

DESIGN

Single-blinded randomized controlled trial.

METHODS

Thirty-nine female athletes who intended to return to cutting/pivoting sports were enrolled 3 to 9 months after primary anterior cruciate ligament reconstruction (ACLR). Athletes were randomized to receive a training program of either progressive strengthening, agility, plyometrics, and prevention (SAPP) (n = 20) or SAPP plus perturbation training (n = 19); each had 10 sessions over 5 weeks. Occurrence and side of second ACL injury were recorded for 2 years after primary ACLR.

RESULTS

There were 9 second ACL injuries in the 2 years after ACLR. There was no statistically significant difference in rate or side of second ACL injury between the SAPP-plus-perturbation training and SAPP groups.

CONCLUSION

Adding perturbation training to a secondary ACL injury prevention program did not affect the rate of second ACL injury in female athletes. J Orthop Sports Phys Ther 2020;50(9):523-530. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9407.

Athletes With Bone-Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction Were Slower to Meet Rehabilitation Milestones and Return-to-Sport Criteria Than Athletes With Hamstring Tendon Autograft or Soft Tissue Allograft : Secondary Analysis From the ACL-SPORTS Trial

OBJECTIVE

Graft choices for athletes undergoing anterior cruciate ligament reconstruction (ACLR) include bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts and soft tissue allografts. The objective was to assess time to meet clinical milestones by graft type in athletes who completed a return-to-sport (RTS) program after ACLR.

DESIGN

Retrospective cohort study.

METHODS

Seventy-nine athletes enrolled after ACLR (allograft, n = 18; BPTB, n = 24; HT, n = 37). Time from surgery to meet (1) enrollment criteria (12 or more weeks post surgery, 80% or greater isometric quadriceps strength index, minimal effusion, and full knee range of motion), and (2) RTS criteria (90% or greater quadriceps strength index, hop testing limb symmetry, and patient-reported outcomes) was calculated. Quadriceps strength, hop performance, and patient-reported outcomes were measured before and after training, and at 1 year post surgery. Descriptive statistics, chi-square tests, and 1-way analyses of variance (α = .05) were used to analyze differences among graft types.

RESULTS

On average, the BPTB group (28.5 ± 7.6 weeks) took longer to meet enrollment milestones than the HT (22.5 ± 7.6 weeks, P = .007) and allograft (18.9 ± 5.8 weeks, P<.001) groups. The BPTB group (44.7 ± 15.8 weeks) took longer from surgery to meet RTS criteria than the HT (32.5 ± 9.9 weeks, P = .001) and allograft (29.3 ± 9.0 weeks, P<.001) groups. After training, the quadriceps strength index was lower in the BPTB group (86.1% ± 11.4%) than it was in the HT (96.1% ± 12.9%, P = .004) and allograft (96.9% ± 5.9%, P = .009) groups.

CONCLUSION

Athletes with a BPTB autograft may take longer than athletes with an HT autograft or a soft tissue allograft to complete postoperative rehabilitation, recover quadriceps strength, and meet RTS criteria. J Orthop Sports Phys Ther 2020;50(5):259-266. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9111.

Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift

Pain and injuries are considered a common problem among elite athletes and recreational lifters performing the squat, bench press and deadlift. Since all three lifts engage multiple joints and expose the lifters’ bodies to high physical demands often several times a week, it has been suggested that their injuries might be related to the excessively heavy loads, the large range of motion during the exercises, insufficient resting times between training sessions and/or faulty lifting technique. However, no previous article has summarised what is known about specific injuries and the injury aetiology associated with the three lifts. Thus, the aim of this narrative review was to summarise what is known about the relationships between the powerlifting exercises and the specific injuries or movement impairments that are common among lifters and recreationally active individuals.

The Epidemiology of Injuries Across the Weight-Training Sports

BACKGROUND

Weight-training sports, including weightlifting, powerlifting, bodybuilding, strongman, Highland Games, and CrossFit, are weight-training sports that have separate divisions for males and females of a variety of ages, competitive standards, and bodyweight classes. These sports may be considered dangerous because of the heavy loads commonly used in training and competition.

OBJECTIVES

Our objective was to systematically review the injury epidemiology of these weight-training sports, and, where possible, gain some insight into whether this may be affected by age, sex, competitive standard, and bodyweight class.

METHODS

We performed an electronic search using PubMed, SPORTDiscus, CINAHL, and Embase for injury epidemiology studies involving competitive athletes in these weight-training sports. Eligible studies included peer-reviewed journal articles only, with no limit placed on date or language of publication. We assessed the risk of bias in all studies using an adaption of the musculoskeletal injury review method.

RESULTS

Only five of the 20 eligible studies had a risk of bias score ≥75 %, meaning the risk of bias in these five studies was considered low. While 14 of the studies had sample sizes >100 participants, only four studies utilized a prospective design. Bodybuilding had the lowest injury rates (0.12-0.7 injuries per lifter per year; 0.24-1 injury per 1000 h), with strongman (4.5-6.1 injuries per 1000 h) and Highland Games (7.5 injuries per 1000 h) reporting the highest rates. The shoulder, lower back, knee, elbow, and wrist/hand were generally the most commonly injured anatomical locations; strains, tendinitis, and sprains were the most common injury type. Very few significant differences in any of the injury outcomes were observed as a function of age, sex, competitive standard, or bodyweight class.

CONCLUSION

While the majority of the research we reviewed utilized retrospective designs, the weight-training sports appear to have relatively low rates of injury compared with common team sports. Future weight-training sport injury epidemiology research needs to be improved, particularly in terms of the use of prospective designs, diagnosis of injury, and changes in risk exposure.

The current management of patients with patellofemoral pain from the physical therapist's perspective

Patellofemoral pain (PFP) is a common diagnosis that includes an amalgam of conditions that are typically non-traumatic in origin and result in peripatellar and/or retropatellar knee pain. The purpose of this review is to provide an overview of the physical therapist's management, including the evaluation and treatment, of the patient with PFP. A thorough history is critical for appropriately diagnosing and optimally managing PFP; the history should include the date of symptom onset, mechanism of injury and/or antecedent events, location and quality of pain, exacerbating and alleviating symptoms, relevant past medical history, occupational demands, recreational activities, footwear, and patient goals. Physical examination should identify the patient's specific impairments, assessing range of motion (ROM), muscle length, effusion, resisted isometrics, strength, balance and postural control, special tests, movement quality, palpation, function, and patient reported outcome measures. Objective assessments should guide treatment, progression, and clinical decision-making. The rehabilitation program should be individually tailored, addressing the patient's specific impairments and functional limitations and achieving the patient's goals. Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFP. Other complimentary treatments may include patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining. Appropriate progression of interventions should consider objective evaluations (e.g., effusion, soreness rules), systematic increases in loading, and the chronicity of symptoms. Although short-term changes or reductions in movement often are necessary in a protective capacity, the persistence of altered movement is a key characteristic of chronic pain, which may be managed in part through emphasis on function over symptoms, graded exposure, patient education, and perhaps referral. PFP etiology is largely movement related and a comprehensive conservative treatment using movement can be successful.

Upper extremity weightlifting injuries: Diagnosis and management

Common upper extremity injuries in resistance training athletes include muscle strains, ligament sprains, pectoralis major tendon ruptures, distal biceps tendon ruptures, and chronic shoulder pain and capsulolabral injuries. While each injury is unique in its specific anatomic location and mechanism, each is preventable with proper exercise technique, safety and maintenance of muscle balance. Conservative treatment is the therapeutic modality of choice and these injuries generally resolve with workout modification, appropriate recovery, anti-inflammatory medication, and physical therapy. If conservative treatment fails, surgical intervention is often successful and can return the weightlifter to a level of performance near their pre-injury level.

An Investigation of the Mechanics and Sticking Region of a One-Repetition Maximum Close-Grip Bench Press versus the Traditional Bench Press

The close-grip bench press (CGBP) is a variation of the traditional bench press (TBP) that uses a narrower grip (~95% of biacromial distance (BAD)) and has potential application for athletes performing explosive arm actions from positions where the hands are held close to the torso. Limited research has investigated CGBP mechanics compared to the TBP. Twenty-seven resistance-trained individuals completed a one-repetition maximum TBP and CGBP. The TBP was performed with the preferred grip; the CGBP with a grip width of 95% BAD. A linear position transducer measured lift distance and duration; peak and mean power, velocity, and force; distance and time when peak power occurred; and work. Pre-sticking region (PrSR), sticking region, and post-sticking region distance and duration for each lift was measured. A repeated measures ANOVA was used to derive differences between TBP and CGBP mechanics (p < 0.01); effect sizes (d) were also calculated. A greater load was lifted in the TBP, thus mean force was greater (d = 0.16⁻0.17). Peak power and velocity were higher in the CGBP, which had a longer PrSR distance (d = 0.49⁻1.32). The CGBP could emphasize power for athletes that initiate explosive upper-body actions with the hands positioned close to the torso.

On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction

Synopsis The literature pertaining to the rehabilitation of ice hockey players seeking to return to sport after anterior cruciate ligament reconstruction (ACLR) is currently limited. The purpose of this clinical commentary was to present a criterion-based progression for return to ice hockey for athletes after ACLR. First, we review pertinent literature and provide previously published guidelines on general rehabilitation after ACLR. Then, we present a 4-phase, on-ice skating progression with objective criteria to initiate each phase. During the early on-ice phase, the athlete is reintroduced to specific demands, including graded exposure to forward, backward, and crossover skating. In the intermediate on-ice phase, the emphasis shifts to developing power and introducing anticipated changes of direction within a controlled environment. During the late on-ice phase, the focus progresses to developing anaerobic endurance and introducing unanticipated changes of direction, but still without other players or contact. Finally, once objective return-to-sport criteria are met, noncontact team drills, outnumbered and even-numbered drills, practices, scrimmages, and games are progressively reintroduced during the return-to-sport phase. Recommendations for off-ice strength and conditioning exercises complement the on-ice progression. Additionally, we apply the return-to-hockey progression framework to a case report of a female collegiate defensive ice hockey player who returned to sport successfully after ACLR. This criterion-based return-to-hockey progression may guide rehabilitation specialists managing athletes returning to ice hockey after ACLR. J Orthop Sports Phys Ther 2017;47(5):324-333. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7245.

Distal clavicular osteolysis in adults: association with bench pressing intensity

OBJECTIVES

To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity.

METHODS

From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests.

RESULTS

The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p < 0.001). Low-intensity bench pressing (1RM less than 1.5 times the body weight) was not a risk factor for DCO (OR = 0.6; 95 % CI = 0.4-0.8). High frequency (>1×/week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney).

CONCLUSIONS

High-intensity, but not low-intensity bench pressing is a risk factor for DCO.

Rehabilitation after anatomical ankle ligament repair or reconstruction

The selection, implementation of and adherence to a post-operative regimen are all essential in order to achieve the best outcomes after ankle ligament surgery. The purpose of this paper is to present a best-evidence approach to this, with grounding in basic science and a consensus opinion from the members of the ESSKA-AFAS Ankle Instability Group. Basic science and clinical evidence surrounding tissue healing after surgical repair or reconstruction of the ligaments as well as around the re-establishment of sensorimotor control are reviewed. A consensus opinion based on this evidence as to the recommended rehabilitation protocol after ankle ligament surgery was then obtained from the members of the ESSKA-AFAS Ankle Instability Group. Rehabilitation recommendations are presented for the initial post-operative period, the early recovery phase and a goal-orientated late rehabilitation and return-to-sport phase. This paper presents practical, evidenced-based guidelines for rehabilitation and return to activity after lateral ankle ligament surgery.

Rehabilitation after anatomical ankle ligament repair or reconstruction

The selection, implementation of and adherence to a post-operative regimen are all essential in order to achieve the best outcomes after ankle ligament surgery. The purpose of this paper is to present a best-evidence approach to this, with grounding in basic science and a consensus opinion from the members of the ESSKA-AFAS Ankle Instability Group. Basic science and clinical evidence surrounding tissue healing after surgical repair or reconstruction of the ligaments as well as around the re-establishment of sensorimotor control are reviewed. A consensus opinion based on this evidence as to the recommended rehabilitation protocol after ankle ligament surgery was then obtained from the members of the ESSKA-AFAS Ankle Instability Group. Rehabilitation recommendations are presented for the initial post-operative period, the early recovery phase and a goal-orientated late rehabilitation and return-to-sport phase. This paper presents practical, evidenced-based guidelines for rehabilitation and return to activity after lateral ankle ligament surgery.

Standardised method for reporting exercise programmes: protocol for a modified Delphi study

INTRODUCTION

Exercise is integral to health across the lifespan and important for people with chronic health conditions. A systematic review of exercise trials for chronic conditions reported suboptimal descriptions of the evaluated interventions and concluded that this hinders interpretation and replication. The aim of this project is to develop a standardised method for reporting essential exercise programme details being evaluated in clinical trials.

METHODS AND ANALYSIS

A modified Delphi technique will be used to gain consensus among international exercise experts. We will use three sequential rounds of anonymous online questionnaires to refine a standardised checklist. A draft checklist of potentially relevant items was developed based on the results of a systematic review of exercise systematic reviews. An international panel of experts was identified by exercise systematic review authorship, established international profile in exercise research and practice and by peer referral. In round 1, the international panel of experts will be asked to rate the importance of each draft item and provide additional suggestions for revisions or new items. Consensus will be considered reached if at least 70% of the panel strongly agree/disagree that an item should be included or excluded. Where agreement is not reached or there are suggestions for altered or new items, these will be taken to round 2 together with an aggregated summary of round 1 responses. Following the second round, a ranking of item importance will be made to rationalise the number of items. The final template will be distributed to panel members for approval.

ETHICS AND DISSEMINATION

Ethics approval was received from The Cabrini Institute Ethics Committee, Melbourne, Australia (HREC 02-07-04-14). We plan to use a stepwise process to develop and refine a standardised and internationally agreed template for explicit reporting of exercise programmes. The template will be generalisable across all types of exercise interventions. The findings will be disseminated through peer-reviewed publications and conference presentations.

Effect of compensatory acceleration training in combination with accommodating resistance on upper body strength in collegiate athletes

PURPOSE

To determine the impact of inclusion of a band or chain compensatory acceleration training (CAT), in a 5-week training phase, on maximal upper body strength during a 14-week off-season strength and conditioning program for collegiate male athletes.

PATIENTS AND METHODS

Twenty-four National Collegiate Athletic Association (NCAA) collegiate baseball players, who were familiar with the current strength and conditioning program and had a minimum of 1 year of formal collegiate strength and conditioning experience, participated in this off-season training study. None of the men had participated in CAT before. Subjects were matched following a maximal effort (1-repetition maximum [1-RM]) bench press test in week 1, then were randomly assigned into a band-based CAT group or a chain-based CAT group and participated in a 5-week training phase that included bench pressing twice per week. Upper body strength was measured by 1-RM bench press again at week 6. A 2 × 2 mixed factorial (method × time) analysis of variance was calculated to compare differences across groups. The alpha level was set at P<0.05.

RESULTS

No difference (F 1,22=0.04, P=0.84) existed between the band-based CAT and chain-based CAT groups. A significant difference was observed between pre- and posttests of 1-RM bench (F 1,22=88.46, P=0.001).

CONCLUSION

A 5-week band CAT or chain CAT training program used in conjunction with an off-season strength and conditioning program can increase maximal upper body strength in collegiate baseball athletes. Using band CAT and/or chain CAT as a training modality in the off-season will vary the training stimulus from the traditional and likely help to maintain the athlete's interest.

Pre-operative quadriceps strength predicts IKDC2000 scores 6 months after anterior cruciate ligament reconstruction

BACKGROUND

Quadriceps strength deficits are ubiquitous after anterior cruciate ligament (ACL) injury. Deficits prior to surgery can influence knee function post-operatively. Inhibition contributes to quadriceps strength deficits after an ACL injury. Body mass index, meniscal injury, and sex influence functional outcomes after ACL reconstruction. The purpose of this study is to examine the relationship of pre-operative quadriceps strength and post-operative knee function and to investigate how other pre-operative factors may influence this relationship.

METHODS

After an ACL injury, subjects received pre-operative rehabilitation and performed quadriceps strength testing. Subjects underwent reconstruction and post-operative rehabilitation. Six months after ACL reconstruction, subjects completed the International Knee Documentation Committee 2000 subjective form (IKDC2000). Linear regression models were developed using IKDC2000 scores at 6 months after ACL reconstruction as the dependent variable.

RESULTS

Fifty-five subjects had complete pre-operative data and IKDC2000 scores at 6 months after ACL reconstruction. Pre-operative involved quadriceps strength was a significant predictor for IKDC2000 scores 6 months after ACL reconstruction. Sex, meniscal injury, pre-operative BMI, and pre-operative involved quadriceps activation ratio were not significant predictors in the regression model.

CONCLUSIONS

Pre-operative quadriceps strength can predict IKDC2000 scores 6 months after ACL reconstruction. Deficits in pre-operative quadriceps strength influence self-reported function 6 months after surgery. Factors that are known to influence quadriceps strength and self-reported outcomes do not influence the relationship between pre-operative quadriceps strength and post-operative IKDC2000 scores.

Symmetry restoration and functional recovery before and after anterior cruciate ligament reconstruction

PURPOSE

The aims of this study were to evaluate the functional recovery before and after ACL reconstruction and to evaluate the sensitivity to change in performance-based and self-reported outcomes prior to and after ACL reconstruction and to determine whether these changes represent clinically relevant improvement.

METHODS

Eighty-three athletes participated in this study. Athletes were tested after an ACL injury, after preoperative training, and 6 and 12 months after ACL reconstruction. Athletes completed quadriceps strength testing, hop testing, and self-reported questionnaires for knee function (International Knee Documentation Committee subjective knee form, Knee Outcome Survey-Activities of Daily Living Scale, and the Global Rating Scale of Perceived Function) at each testing period.

RESULTS

A significant interaction of limb by time was seen in normalized quadriceps strength, and single, triple, and 6-m timed hop, where the involved limb improved more than the uninvolved limb over time. A main effect of time was noted for performance-based limb symmetry indexes and self-reported measures.

CONCLUSION

Limb-to-limb asymmetries are reduced, and normal limb symmetry is restored after perturbation training and aggressive quadriceps strengthening and returned to similar levels 6 months after reconstruction. Performance-based values on the involved limb and self-reported outcomes are sensitive to change over time, and these were clinically relevant improvements.

Characteristics of anterior shoulder instability and hyperlaxity in the weight-training population

Despite case reports implicating anterior instability (AI) as an etiological source of shoulder pain among weight-training (WT) participants, a paucity of case-controlled evidence exists to support this premise. The purpose of this study was to determine if WT participants have clinical characteristics of AI and hyperlaxity. Additionally, we investigated the role of exercise selection. One hundred fifty-nine healthy male participants (mean age 28 years) were recruited and included 123 individuals who engaged in WT a minimum of 2 days per week and 36 controls with no history of WT participation. Before testing, participants completed a questionnaire summarizing their training patterns. Upon completing the questionnaire, 3 reliable and valid tests used to identify clinical characteristics of AI were performed on both groups and included the load and shift, apprehension, and relocation maneuvers. Load and shift test results identified significantly greater anterior glenohumeral joint hyperlaxity in the WT group compared with controls (p = 0.004). The presence of positive apprehension (p < 0.001) and relocation (p < 0.001) tests were also significantly greater in the WT group. A significant association existed between performance of exercises that require the "high-five" position (behind-the-neck latissimus pull-downs and military press) and clinical characteristics of AI. Conversely, an inverse association between performance of external rotator strengthening and clinical characteristics of AI existed. Findings from this study suggest that individuals participating in WT may be predisposed to AI and hyperlaxity. Modification of exercises requiring the high-five position, as well as efforts to strengthen the external rotators, may serve as a useful means to mitigate characteristics associated with AI and hyperlaxity. Future intervention-based trials are needed to investigate a causative effect of exercises.

Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial

BACKGROUND

Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed.

METHODS

A total of 447 office workers with and without neck and/or shoulder pain were randomly allocated at the cluster-level to one of four groups; 1×60 (1WS), 3×20 (3WS) or 9×7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0-9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)).

RESULTS

The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF. Among those with pain ≥3 at baseline (n=256), all three training groups achieved significant reduction in neck pain compared with REF (p<0.01). From a baseline pain rating of 3.2 (SD 2.3) in the neck among neck cases, 1WS experienced a reduction of 1.14 (95% CI 0.17 to 2.10), 3WS 1.88 (0.90 to 2.87) and 9WS 1.35 (0.24 to 2.46) which is considered clinically significant. DASH was reduced in 1WS and 3WS only.

CONCLUSION

One hour of specific strength training effectively reduced neck and shoulder pain in office workers. Although the three contrasting training groups showed no statistical differences in neck pain reduction, only 1WS and 3WS reduced DASH. This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace.

Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression

The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non-weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology.

LEVEL OF EVIDENCE

Therapy, level 5.

Shoulder joint and muscle characteristics among healthy female recreational weight training participants

Shoulder disorders attributed to weight training are well documented in the literature, with prevalence rates exceeding that of the general population. Although researchers have identified both intrinsic and extrinsic risk factors among men who participate in weight training, a paucity of evidence-based research exists to describe risk factors inherent to participation among women. The purpose of this study was to investigate shoulder joint and muscle characteristics among healthy female recreational weight training (RWT) participants to determine specific risk-related adaptations that may occur from training. Eighty-eight women aged 18-55 (mean 26.8), including 57 who participated in upper extremity RWT and 31 controls with no record of RWT participation were recruited. Active range of motion (AROM), posterior shoulder tightness (PST), glenohumeral (GH) joint laxity, body weight-adjusted strength and strength ratios of force couples were compared between the RWT and control groups. Statistical analysis identified significant differences (p ≤ 0.004) between groups when analyzing shoulder internal rotation AROM, PST, and joint laxity. The RWT participants had decreased internal rotation AROM, greater PST, and anterior GH joint hyperlaxity when compared to the control group. No differences in strength ratios between groups were identified (p ≥ 0.109) implying the absence of weight training-induced muscle imbalances. The findings of this investigation suggest that female RWT participants are predisposed to mobility imbalances as a result of training. The imbalances identified in this investigation have been associated with shoulder disorders in both the general and athletic population thus may place weight training participants at risk for injury. Clinicians and strength and conditioning professionals should consider the biomechanical stresses and adaptations associated with RWT when prescribing exercises. Exercise prescription that mitigates mobility imbalances may serve to prevent injury in this population.

Shoulder injuries attributed to resistance training: a brief review

The popularity of resistance training (RT) is evident by the more than 45 million Americans who engage in strength training regularly. Although the health and fitness benefits ascribed to RT are generally agreed upon, participation is not without risk. Acute and chronic injuries attributed to RT have been cited in the epidemiological literature among both competitive and recreational participants. The shoulder complex in particular has been alluded to as one of the most prevalent regions of injury. The purpose of this manuscript is to present an overview of documented shoulder injuries among the RT population and where possible discern mechanisms of injury and risk factors. A literature search was conducted in the PUBMED, CINAHL, SPORTDiscus, and OVID databases to identify relevant articles for inclusion using combinations of key words: resistance training, shoulder, bodybuilding, weightlifting, shoulder injury, and shoulder disorder. The results of the review indicated that up to 36% of documented RT-related injuries and disorders occur at the shoulder complex. Trends that increased the likelihood of injury were identified and inclusive of intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors, namely, that of improper attention to exercise technique. A majority of the available research was retrospective in nature, consisting of surveys and descriptive epidemiological reports. A paucity of research was available to identify predictive variables leading to injury, suggesting the need for future prospective-based investigations.

Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007

BACKGROUND

As participation in weight training in the United States increases, the number of persons at injury risk increases.

PURPOSE

To examine weight training-related injuries in patients presenting to US emergency departments from 1990 to 2007. Study Design Descriptive epidemiology study.

METHODS

Weight training-related injury data were analyzed from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System. Sample weights provided by this organization calculated national estimates of weight training-related injuries from the 100-hospital sample.

RESULTS

From 1990 to 2007, 25 335 weight training injuries were seen in US emergency departments, correlating to an estimated 970 801 injuries nationwide. Patients' mean age was 27.6 years (range, 6-100 years); 82.3% were male. The upper trunk (25.3%) and lower trunk (19.7%) were the most commonly injured body parts. The most common diagnosis was sprain/strain (46.1%). The most common mechanism of injury was weights dropping on the person (65.5%). A large number of injuries occurred with free weights (90.4%). Males had a larger proportion of upper trunk injuries (26.8%; injury proportion ratio [IPR], 1.45; 95% confidence interval [CI]: 1.36-1.57; P <.001) than females (18.4%). Females had a larger proportion of foot injuries (22.9%; IPR, 2.09; 95% CI: 1.93-2.26; P <.001) than males (11.0%). Persons 12 years and younger had a larger proportion of hand (37.9%; IPR, 2.08; 95% CI: 1.76-2.46; P <.001) injuries than persons 13 years or older (18.2%). Persons 55 years and older were injured more when using machines (18.2%; IPR, 1.96; 95% CI: 1.47-2.61, P <.001) than persons 54 years and younger (9.3%). Persons using free weights sustained a greater proportion of fractures/dislocations (23.6%; IPR, 2.44; 95% CI: 1.92-3.09; P <.001) than persons using machines (9.7%).

CONCLUSION

Further research is needed to drive development of targeted, age- and gender-specific, evidence-based injury prevention strategies to decrease injury rates among weight training participants.

Comparison between linear and daily undulating periodized resistance training to increase strength

To determine the most effective periodization model for strength and hypertrophy is an important step for strength and conditioning professionals. The aim of this study was to compare the effects of linear (LP) and daily undulating periodized (DUP) resistance training on body composition and maximal strength levels. Forty men aged 21.5 +/- 8.3 and with a minimum 1-year strength training experience were assigned to an LP (n = 20) or DUP group (n = 20). Subjects were tested for maximal strength in bench press, leg press 45 degrees, and arm curl (1 repetition maximum [RM]) at baseline (T1), after 8 weeks (T2), and after 12 weeks of training (T3). Increases of 18.2 and 25.08% in bench press 1 RM were observed for LP and DUP groups in T3 compared with T1, respectively (p < or = 0.05). In leg press 45 degrees , LP group exhibited an increase of 24.71% and DUP of 40.61% at T3 compared with T1. Additionally, DUP showed an increase of 12.23% at T2 compared with T1 and 25.48% at T3 compared with T2. For the arm curl exercise, LP group increased 14.15% and DUP 23.53% at T3 when compared with T1. An increase of 20% was also found at T2 when compared with T1, for DUP. Although the DUP group increased strength the most in all exercises, no statistical differences were found between groups. In conclusion, undulating periodized strength training induced higher increases in maximal strength than the linear model in strength-trained men. For maximizing strength increases, daily intensity and volume variations were more effective than weekly variations.

Technique and safety aspects of resistance exercises: a systematic review of the literature

A systematic review of the scientific literature was conducted to identify the optimal ranges of motion for preventing injury in the main joints of the body during resistance exercise performance. These ranges of motion are independent of the type in which the resistance exercises could be applied (ie, adults, elderly, athletes, recreational exercisers), and the regions examined include the shoulder, spine, and knee, which are injured most often. It can be concluded that during the performance of any resistance exercise, it is possible to put anatomical structures at risk with certain body positions; therefore, it is necessary to understand these movements so injury can be avoided.

Shoulder joint and muscle characteristics in the recreational weight training population

Shoulder disorders attributed to weight training are well documented in the literature; however, a paucity of evidence-based research exists to describe risk factors inherent to participation. Shoulder joint and muscle characteristics in the recreational weight training (RWT) population were investigated to determine specific risk-related adaptations that may occur from participation. Ninety participants, men between the ages of 19 and 47 (mean age 28.9), including 60 individuals who participated in upper-extremity RWT and 30 controls with no record of RWT participation, were recruited. Active range of motion (AROM), posterior shoulder tightness (PST), body weight-adjusted strength values, and agonist/antagonist strength ratios were compared between the RWT participants and the control group. Statistical analysis identified significant differences (p < 0.001) between the groups when analyzing shoulder mobility. The RWT participants had decreased mobility when compared with the control group for all AROM measurements except external rotation, which was greater. Strength ratios were significantly greater in the RWT group when compared with the control group (p <or= 0.001), implying agonist/antagonist muscle imbalances. The findings of this investigation suggest that RWT participants are predisposed to strength and mobility imbalances as a result of training. The imbalances identified have been associated with shoulder disorders in the general and athletic population; thus, these imbalances may place RWT participants at risk for injury. Common training patterns are biased toward large muscle groups such as the pectorals and deltoids but neglect muscles responsible for stabilization such as the external rotators and lower trapezius. Exercise selection that mitigates strength and mobility imbalances may serve to prevent injury in this population. Clinicians and strength and conditioning professionals should consider the biomechanical stresses and adaptations associated with RWT when prescribing upper-extremity exercises.

Epidemiology of injuries and illnesses in America's Cup yacht racing

OBJECTIVES

To determine the incidence and severity of injuries and illnesses incurred by a professional America's Cup yacht racing crew during the preparation for and participation in the challenge for the 2003 America's Cup.

METHODS

A prospective study design was used over 74 weeks of sailing and training. All injuries and illnesses sustained by the 35 professional male crew members requiring medical treatment were recorded, including the diagnosis, nature, location, and mechanism of injury. The volume of sailing and training were recorded, and the severity of incidents were determined by the number of days absent from both sailing and training.

RESULTS

In total, 220 injuries and 119 illnesses were recorded, with an overall incidence of 8.8 incidents/1000 sailing and training hours (injuries, 5.7; illnesses, 3.1). The upper limb was the most commonly injured body segment (40%), followed by the spine and neck (30%). The most common injuries were joint/ligament sprains (27%) and tendinopathies (20%). The incidence of injury was significantly higher in training (8.6) than sailing (2.2). The most common activity or mechanism of injury was non-specific overuse (24%), followed by impact with boat hardware (15%) and weight training (13%). "Grinders" had the highest overall injury incidence (7.7), and "bowmen" had the highest incidence of sailing injuries (3.2). Most of the illnesses were upper respiratory tract infections (40%).

CONCLUSIONS

The data from this study suggest that America's Cup crew members are at a similar risk of injury to athletes in other non-collision team sports. Prudent allocation of preventive and therapeutic resources, such as comprehensive health and medical care, well designed conditioning and nutritional programmes, and appropriate management of recovery should be adopted by America's Cup teams in order to reduce the risk of injury and illness.