Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus

OBJECTIVE

To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions.

DATA SOURCES

A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years.

REVIEW METHODS

Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts.

RESULTS

Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain.

CONCLUSIONS

The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

Chronic Ankle Instability and Neuromuscular Performance in Prerecruitment Infantry Soldiers

CONTEXT

Ankle instability can describe various impairments, including perceived instability (PI), mechanical instability (MI), and recurrent sprains (RSs), alone or combined.

OBJECTIVE

To examine the prevalence of 8 ankle impairment subgroups and their effect on neuromuscular performance in prerecruitment combat soldiers.

DESIGN

Cross-sectional study.

SETTING

Military infantry basic training base.

PATIENTS OR OTHER PARTICIPANTS

A total of 364 infantry male combat soldiers entering basic training (aged 18-21 years).

MAIN OUTCOME MEASURE(S)

Participants were assessed for PI (via the Cumberland Ankle Instability Tool), MI (using the Anterior Drawer Test and Medial Talar Tilt Test), and RSs (based on history) of their dominant and nondominant legs. Injuries were categorized in 8 subgroups: PI, RSs, PI + RSs, MI, PI + MI, MI + RSs, PI + MI + RSs, and none. Participants were screened for neuromuscular performance (dynamic postural balance, proprioceptive ability, hopping agility, and triceps surae muscle strength) during the first week of military basic training.

RESULTS

For the dominant and nondominant legs, RSs were reported by 18.4% (n = 67) and 20.3% (n = 74) of the participants, respectively; PI was reported by 27.1% (n = 99) and 28.5% (n = 104) of the participants, respectively; and MI was seen in 9.9% (n = 36) and 8.5% (n = 31) of the participants, respectively. A 1-way analysis of variance showed differences in the mean proprioceptive ability scores (assessed using the Active Movement Extent Discrimination Apparatus) of all subgroups with impairments in both the dominant and nondominant legs (F = 6.943, η2 = 0.081, P < .001 and F = 7.871, η2 = 0.091, P < .001, respectively). Finally, differences were found in the mean muscle strength of subgroups with impairment in the nondominant leg (F = 4.884, η2 = 0.056, P = .001).

CONCLUSIONS

A high prevalence of ankle impairments was identified among participants who exhibited reduced abilities in most neuromuscular assessments compared with those who did not have impairments. Moreover, participants with 1 impairment (PI, MI, or RSs) exhibited different neuromuscular performance deficits than those with >1 impairment.

Use of Dual-Task Timed-Up-and-Go Tests for Predicting Falls in Physically Active, Community-Dwelling Older Adults-A Prospective Study

This prospective study aimed to determine which specific mobility tests were the most accurate for predicting falls in physically active older adults living in the community. Seventy-nine physically active older adults who met the American College of Sports Medicine physical activity guidelines volunteered. Participants were assessed and followed up for 12 months. Mobility assessments included the 30-s sit-to-stand test, five times sit-to-stand test, single-task timed-up-and-go test (TUG), motor dual-task TUG (Mot-TUG), and cognitive dual-task TUG (Cog-TUG). Mot-TUG and Cog-TUG performances were moderately correlated with number of falls (r = .359, p < .01 and r = .372, p < .01, respectively). When Mot-TUG, Cog-TUG, or Age were included as fall predictors, discrimination scores represented by the area under the receiver operating characteristic curve (AUC) were AUC (Mot-TUG) = 0.843 (p < .01), AUC (Cog-TUG) = 0.856 (p < .01), and AUC (Age) = 0.734 (p < .05). The cutoff point for Cog-TUG was 10.98 s, with test sensitivity of 1.00 and specificity of 0.66. Fall predictors for different populations may be based on different test methods. Here, the dual-task TUG test more accurately predicted falls in older adults who met American College of Sports Medicine's physical activity guidelines.

The effect of compression and combined compression-tactile stimulation on lower limb somatosensory acuity

Background

Lower limb somatosensation and proprioception are important for maintaining balance. Research has shown that compression garments or exposure to textured surfaces, can enhance somatosensation however, little is known about the effect of combined compression and texture on somatosensory acuity in the lower limb. This study aimed to assess the effects of combined compression socks with a plantar textured sole, on lower limb somatosensory acuity.

Methods

Thirty participants completed a somatosensory acuity task (active movement extent discrimination apparatus; AMEDA) under three conditions: barefoot (control condition), standard knee-high compression sock (compression sock), and knee-high compression sock with internal rubber nodules situated on the sole (textured-compression sock). Somatosensory acuity was assessed between the different sock conditions for the (i) entire group, (ii) high performers, and (iii) low performers. It was hypothesized that low performers would see gains wearing either sock, but the greatest improvement would be in the textured-compression sock condition.

Results

AMEDA scores were not significantly different between conditions when the entire group was analyzed (p = 0.078). The low performers showed an improvement in somatosensory acuity when wearing the compression sock (p = 0.037) and the textured compression sock (p = 0.024), when compared to barefoot, but there was no difference between the two sock conditions (p > 0.05). The high performers did not show any improvement (p > 0.05 for all).

Conclusion

These findings demonstrate that additional sensory feedback may be beneficial to individuals with lower baseline somatosensory acuity but is unlikely to provide benefit for those with higher somatosensory acuity.

Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI.

METHODS

Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale.

RESULTS

Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI.

CONCLUSIONS

The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.

Externally validated machine learning algorithm accurately predicts medial tibial stress syndrome in military trainees: a multicohort study

Objectives

Medial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical to reducing operational burden. Therefore, this study aimed to build a decision-making model to predict the individual risk of MTSS within officer cadets and test the external validity of the model on a separate military population.

Design

Prospective cohort study.

Methods

This study collected a suite of key variables previously established for predicting MTSS. Data were obtained from 107 cadets (34 women and 73 men). A follow-up survey was conducted at 3 months to determine MTSS diagnoses. Six ensemble learning algorithms were deployed and trained five times on random stratified samples of 75% of the dataset. The resultant algorithms were tested on the remaining 25% of the dataset, with models then compared for accuracy. The most accurate new algorithm was tested on an unrelated data sample of 123 Australian Navy recruits to establish external validity of the model.

Results

Calibrated random forest modelling was the most accurate in identifying a diagnosis of MTSS; (area under curve (AUC)=98%, classification accuracy (CA)=96%). External validation on a sample of Navy recruits resulted in comparable accuracy; (AUC=95%, CA=94%). When the model was tested on the combined datasets, similar accuracy was achieved; (AUC=92%, CA=91%).

Conclusion

This model is highly accurate in predicting those who will develop MTSS. The model provides important preventive capacity which should be trialled as a risk management intervention.

Another Look at Fatigued Individuals with and without Chronic Ankle Instability: Posturography and Proprioception

Fatigue can impair function of the three sensory systems (vestibular, visual, and somatosensory) that control postural balance. Yet impairment may be greater among individuals with than those without chronic ankle instability (CAI). The present study used posturography assessment to extend previous findings demonstrating reduced function of the three systems in CAI participants following fatigue. Our aim in this study was to examine the influence of anaerobic and aerobic protocols on the function of these three sensory systems in individuals with and without CAI. We assessed 60 healthy physical education students (Mage = 24.3, SD = 3.4) by a Tetrax® Posturography device for Stability-Index and Fourier-frequencies [low sway (F1) visual input, medium-low sway (F2-F4) vestibular input, medium-high sway (F5-F6) somatosensory input] and by the Active Movement Extent Discrimination Assessment (AMEDA) for active ankle somatosensory ability, before and after performing anaerobic or aerobic protocols. Among participants, 45% were identified with CAI. We found significant Time effect (pre-post), CAI effect, and CAI X Time interactions for Fourier frequencies, Stability-Index, and AMEDA scores, indicating greater pre-post deterioration for those with CAI compared to those without CAI (p < .05). CI (95%) showed that, although there was a Time effect for F1, F2-F4, and F5-F6, only F5-F6 frequencies (i.e., somatosensory input) showed the CAI effect and the Time X CAI interaction. Thus, participants with and without CAI showed reduced visual, vestibular, and somatosensory ability following fatigue. While we found greater deterioration in both passive and active somatosensory ability (F5-6 and AMEDA) among individuals with CAI compared with those with no-CAI, we recommend intervention programs for improving vestibular abilities following fatigue in both those with and without CAI.

The Function of the Proprioceptive, Vestibular and Visual Systems Following Fatigue in Individuals With and Without Chronic Ankle Instability

To maintain postural balance, the proprioceptive, vestibular, and visual systems continuously provide body position and movement data to the central nervous system. In this study, our main aim was to examine, for the first time, the influence of anaerobically or aerobically induced fatigue on these separate functions in persons with and without chronic ankle instability (CAI). We obtained assessments pre- and post-fatigue protocols from 60 physical education students (Mage = 24.3, SD = 3.4) Twenty-seven students had CAI, and 33 students did not have CAI). To measure proprioception, we used the AMEDA device; for vision, we used near point of convergence (NPC); and, for vestibular function, we used subjective visual vertical (SVV). We found a pre-post proprioception (AMEDA) effect in the aerobic group (p < .001), and a visual (NPC) effect in both anaerobic and aerobic participant groups (both p < .001). There were no visual system (NPC) fatigue effect differences among aerobic or anerobic participants who had or did not have CAI (p = .047); there was a significant aerobic fatigue effect on proprioception (AMEDA) (p = .010) that favored participants without CAI. There was a significant interaction effect between time of testing and CAI for visual (NPC) (p = .003) in the aerobic group only. In both the anaerobic and aerobic groups, post-fatigue vestibular function (AMEDA) was significantly lower for those with than those without CAI (anaerobic: p = .030; and aerobic: p =.016). Thus, post-fatigue, participants with CAI showed worse proprioceptive, visual, and vestibular function than those without CAI. Future investigators should further examine each movement sense system in individuals with CAI.

Ankle Inversion Proprioception Impairment in Persons with Chronic Ankle Instability Is Task-Specific

While investigators have often compared ankle proprioception between groups with and without chronic ankle instability (CAI), findings have been inconsistent. Possibly this is because ankle proprioceptive impairment in this population is task-specific. Thus, we aimed to compare ankle inversion proprioception in individuals with and without CAI in two task conditions: (i) when standing (not challenging) and (ii) when on a step-down landing (minimally-challenging). Ankle inversion proprioception was measured in both conditions for 38 recreational sport player volunteers with CAI (n = 19) and without CAI (n = 19). We used the Active Movement Extent Discrimination Apparatus (AMEDA) for the standing condition and the Ankle Inversion Discrimination Apparatus-Landing (AIDAL) for step-down landing. From analysis of variance (ANOVA) tests, CAI and non-CAI participants performed equally well on the AMEDA when standing; but the CAI group performed significantly worse than the non-CAI group on the AIDAL step-down landing task (p = 0.03). Within the non-CAI group, the AIDAL proprioceptive scores, as area under the receiver operating characteristics curve (AUC), were significantly higher than their AMEDA AUC scores (p = 0.03), while there was no significant difference between AIDAL and AMEDA AUC scores in the CAI group. Cumberland Ankle Instability Tool CAIT scores were significantly correlated with AIDAL scores (Spearman's rho = 0.391, p = 0.015), but not with the AMEDA scores; and there was no significant correlation between the AIDAL and AMEDA scores. Thus, an ankle inversion proprioceptive deficit was evident for persons with CAI on the step-down AIDAL, and in a dose-response way, but not evident on the standing AMEDA, suggesting that ankle proprioceptive impairment is task-specific. Selected proprioceptive tests must present some minimal degree of challenge to the ankle joint in a functional task in order to differentiate CAI from non-CAI participants.

The impact of unexpected platform perturbation on ankle proprioception ability in static and dynamic starting positions

AIMS

To examine the relationship between ankle proprioception and the ability to maintain balance with increased magnitudes of unexpected perturbations; and to compare the participants' ability to maintain balance following perturbations when starting from static and dynamic positions.

METHODS

Sixty physical education students (average 24.6 years) were tested for proprioception ability (AUC scores) and balance challenges presented on a perturbation treadmill. The degree at which participants lost postural balance was recorded in seven starting positions: standing-eyes-open (SO), standing-eyes-closed (SC), tandem-dominant (TD), tandem non-dominant, (TND) single-leg lateral side perturbation (SLP), single-leg medial side perturbation (SMP), and walking. Perturbation scores were analysed divided by tertiles. Multidimensional Unfolding SPSS Statistics 25 (PREFSCAL) was used to examine the relationships between data sets.

RESULTS

AUC scores of both dominant and non-dominant legs were significantly correlated with SO (r = 0.316; r = 0.445), SC (r = 0.364; r = 0.413), TD (r = 0.346; r = 0.308), and walking (r = 0.265; r = 0.439), respectively. In the dominant-leg, AUC scores of individuals with below-median SO scores were significantly worse compared to those with median SO scores (p = .046). In the non-dominant leg, individuals with above-median SC had significantly better AUC scores compared to those with lower-than-median SC (p = .008). Those with median and above-median SO and walking achieved better AUC scores than those with below-median (SO: p = .049, p = .004; walking: p = .016, p < .001, respectively). In dimension I, the SLP and SMP were located opposite one another; in dimension II, the TD and TND were located at the upper side, whereas SC, SO and walking were at the lowest side.

CONCLUSIONS

AUC scores were significantly correlated with the level at which postural balance was lost, whereby the better the proprioception ability, the better the ability to maintain balance. As such, the ability to maintain balance is harder in tandem positions than in standing and walking positions. This ability differed when perturbations were to the lateral or medial sides.

Is high intensity laser therapy more effective than other physical therapy modalities for treating knee osteoarthritis? A systematic review and network meta-analysis

Background

The use of physical therapy modalities, especially high intensity laser therapy (HILT), for individuals with knee osteoarthritis (KOA) is still controversial.

Objective

To compare the effects of HILT to other physical therapy modalities on symptoms and function in individuals with KOA.

Methods

Six databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro) were searched in March 2022. Included studies were randomized controlled trials involving HILT conducted on individuals with KOA. The end-trial weighted mean difference (WMD) and standard deviations (SD) with 95% confidence intervals (CI) were analyzed.

Results

Ten studies with 580 participants were obtained, of which nine were included in the final network meta-analysis. In terms of relieving pain, HILT demonstrated the highest probability of being among the most effective treatments, with surface under the cumulative ranking (SUCRA) = 100%, and compared to a control (placebo laser or exercise or a combination of both) on the visual analog scale (VAS) for pain it demonstrated significant benefits (WMD 1.66, 95% CI 1.48–1.84). For improving self-reported function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores, the HILT SUCRA value led with 98.9%. When individuals with KOA were treated by HILT, the improvement in stiffness was statistically significant (WMD 0.78, 95% CI 0.52–1.04) but the amount of improvement was smaller than the minimal clinically important difference (MCID).

Conclusion

The current evidence suggests that HILT may be more effective than other physical therapy modalities for improving pain and function in individuals with KOA. For improving stiffness, however, it may not be clinically effective.

Systematic review registration

[https://www.researchregistry.com], identifier [1148].

Can therapeutic exercises improve proprioception in chronic ankle instability? a systematic review and network meta-analysis

OBJECTIVE

To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI).

DATA SOURCES

Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021.

STUDY SELECTION

Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included.

DATA EXTRACTION

Data were extracted by two independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the PEDro scale.

DATA SYNTHESIS

The end-trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense (JPS) in multiple directions was evaluated.

RESULTS

Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the Network Meta-Analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking (SUCRA)=74.6%). The next two were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels, and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively.

CONCLUSIONS

Foot and ankle muscle strengthening exercise may have a good effect when used to improve JPS in individuals with CAI. Probably, the more complex balance exercise intervention becomes, the less effective the proprioceptive outcome.

PROSPERO REGISTRATION NUMBER

CRD42021240331.

Association Between Neck Pain, Range of Motion, and Proprioception in Elite Female International Standard Dancers: A Case-Control Study

BACKGROUND

Neck pain is common in dancers, especially female dancers, and the injury pattern varies in different genres of dance. Among dancesport performers, intensive neck left rotation is required in female International Standard dancers, but it is unknown whether neck pain is associated with neck rotation range of motion and proprioception.

OBJECTIVES

To explore the associations between neck pain, cervical rotation range of motion, and proprioception in female International Standard dancers.

METHODS

Twelve dancers with dance-related neck pain (age 19.9±1.9 yrs) volunteered, matched with 12 not reporting neck pain (age 22.2±2.4 yrs). A 100-mm visual analog scale (VAS) was used to record neck pain. Active rotation range of motion (AROM) of the cervical spine was measured using a tape measure. A cervical rotation reposition test that used a head-mounted laser projector on a linear scale was employed to measure the cervical spine proprioception, and the absolute error (AE) and variable error (VE) were calculated as proprioceptive acuity scores.

RESULTS

Nine of 12 participants in the group with neck pain declared left side pain, with 2 reporting pain on both sides. The group with neck pain had significantly lower left rotation AROM (p<0.05). For proprioceptive acuity, mixed model ANOVA only showed that repositioning of the right side of the neck is more accurate and consistent than that of the left (both AE and VE p<0.05). Linear regression analysis indicated that left rotation AROM was significantly influenced by left neck pain (t=3.061, p=0.006, adjusted R2 = 0.267, and Durbin-Watson value = 1.776).

CONCLUSIONS

Most participants in the group with neck pain showed left side pain, associated with decreased left rotation AROM. Early screening on cervical rotation mobility may be necessary to reduce future dance-related injury after the onset of neck pain. Proprioceptive acuity of the left side neck was significantly impaired compared with that of the right, indicating future proprioceptive intervention on the left side neck.

Does Strength Training for Chronic Ankle Instability Improve Balance and Patient-Reported Outcomes and by Clinically Detectable Amounts? A Systematic Review and Meta-Analysis

OBJECTIVE

Strength training as a form of exercise therapy has long been used to maintain or promote strength, but its effectiveness as a treatment intervention in chronic ankle instability (CAI) is not fully understood. The purpose of this study was to evaluate the effects of strength training compared with no exercise and neuromuscular control training on balance and self-reported function in people with CAI.

METHODS

Eight databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, and WanFang) were searched in June 2020. Randomized controlled trials (RCTs) involving strength training conducted on individuals with CAI were included. Data were extracted by 2 independent reviewers using a standardized form. Methodological quality and risk of bias were assessed by using the PEDro Scale. In addition, the GRADE evaluation system (Grading of Recommendations Assessment, Development and Evaluation) was used to determine the strength of evidence. A total of 554 studies were initially screened, resulting in a final selection of 11 RCTs involving 428 participants, and 8 RCTs were included in the final meta-analysis. Compared with no exercise, strength training demonstrated some benefits in the Star Excursion Balance Test (anterior: weighted mean difference [WMD] = 2.39, 95% CI = 0.60-4.18; posteromedial: WMD = 3.30, 95% CI = 0.24-6.35; posterolateral: WMD = 2.97, 95% CI = 0.37-5.57), but these intervention results did not reach the minimal detectable change values.

CONCLUSION

Available evidence showed that, compared with controls, strength training did not produce any minimal detectable changes on Star Excursion Balance Test or Foot and Ankle Ability Measure scores in individuals with CAI. Clinicians should use strength training cautiously for improving balance and symptoms in CAI.

IMPACT

The results of this study may have an impact on selecting effective physical therapy interventions for managing symptoms associated with CAI.

Assessing Proprioception in an Older Population: Reliability of a Protocol Based on Active Movement Extent Discrimination

Proprioceptive ability - the sense of where body parts are located in space - is one of many factors thought to affect falls risk among the elderly. Active movement extent discrimination is an approach to measuring proprioception that is administered in an ecologically valid testing environment to better reflect the exercise of proprioceptive skills in daily life. The Active Movement Extent Discrimination Apparatus (AMEDA) was developed to objectively measure this proprioceptive discrimination. However, the current absolute identification testing protocol is cognitively demanding, and it yields results that are insufficiently reliable to assess performance at the individual level. The objectives of this pilot study were to test the reliability and feasibility of a proposed new AMEDA testing protocol and to explore how performance related to cognitive ability and any perceived dysfunction in the foot or ankle. We tested 42 participants (aged 19 - 94 years) three times on the ankle AMEDA using a newly developed protocol that asked participants to report whether a given angle of ankle inversion was shallower or deeper than the immediately preceding inversion. Participants also completed the Stroop test, as a measure of cognitive ability, and two validated questionnaires for identifying foot or ankle dysfunction (the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure). The proportion of correct responses for the AMEDA test showed the expected sigmoid shape of the psychometric function as signal strength increased. The intraclass correlation coefficient measured over the three tests was 0.65 (95% confidence interval: 0.49 - 0.78), suggesting moderate reliability. We found a positive and statistically significant correlation between AMEDA performance and Stroop results but no relationship between the AMEDA score and questionnaire-measured foot or ankle dysfunction. This study confirmed that the alternative testing protocol was simple to administer and easily understood by participants.

Kinesiology tape length and ankle inversion proprioception at step-down landing in individuals with chronic ankle instability

OBJECTIVES

To determine the effect of different lengths of kinesiology tape (KT) on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI).

DESIGN

A repeated measures study.

METHODS

Fifteen participants with unilateral CAI and fifteen participants with no CAI volunteered. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL) was used to measure ankle proprioceptive acuity. All participants were tested under four KT conditions: no tape (baseline), short tape length (only foot and ankle complex involved), mid length (below the knee) and long length (above the knee) taping. After the baseline test, participants underwent the 3 different taping tests in a random order.

RESULTS

Repeated measures ANOVA indicated that, compared to those without CAI, individuals with CAI performed significantly worse across the 4 different conditions (F = 8.196, p = 0.008). There was a significant KT main effect (F = 7.489, p < 0.001) and a significant linear effect (F = 17.083, p < 0.001), suggesting that KT significantly improved ankle proprioceptive performance in landing, and with longer tape length there was greater proprioceptive enhancement. Post-hoc analysis showed that for the CAI group, both mid length (p = 0.013, 95%CI = -0.063, -0.009) and long length (p = 0.010, 95%CI = -0.067, -0.011) taping can significantly improve ankle proprioceptive performance compared to no tape, whereas for the non-CAI group, ankle proprioceptive acuity was significantly improved only with long length taping (p = 0.007, 95%CI = -0.080, -0.015).

CONCLUSIONS

KT can be used to improve ankle inversion proprioceptive performance during landing in both individuals with and without CAI and increasing tape length may achieve greater proprioceptive improvement.

Self-reported chronic ankle instability effects on the development of fitness during an Infantry Commanders Course

OBJECTIVES

To determine whether self-reported chronic ankle instability (CAI) affects the physical performance of soldiers during army training, in routine army fitness tests and other sensorimotor tests.

DESIGN

Prospective cohort comparison.

METHODS

Soldiers enrolled on the Infantry Commanders Course (ICCourse) of the Israeli Defense Force were tested in weeks one and fourteen of the course, including a 3000 m timed run, an agility test over an X-shaped course, the Y Balance Test (YBT) and the Active Movement Extent Discrimination Assessment (AMEDA) somatosensory test. Soldiers were trained using routine ICCourse physical training throughout the course. Changes in physical performance were analysed using a two-way ANOVA, for soldier groups categorised as having healthy ankles or CAI.

RESULTS

Soldiers improved their scores on all 4 tests (3000 m run, X-agility test, YBT and AMEDA) during the course. However, soldiers with CAI did not improve on the X-agility test, whilst those with healthy ankles did. Soldiers with CAI performed worse on the YBT-PM (postero-medial direction) at the start of the course, but this difference was no longer present at 14 weeks. Soldiers with CAI performed better on the AMEDA at the start and 14-week testing points.

CONCLUSIONS

Self-reported CAI restricts agility performance gains in soldiers during 14-weeks of physical training but has no effect on 3000 m running performance. Soldiers with CAI perform worse in YBT balance tests. Soldiers with CAI have better proprioceptive acuity than those with stable ankles. These findings indicate possible sensorimotor factors for training of soldiers with known CAI.

Ankle inversion proprioception measured during landing in individuals with and without chronic ankle instability

BACKGROUND

Research evidence has suggested that a more sensitive ankle proprioceptive testing method with higher ecological validity is needed for assessing proprioceptive deficits in individuals with chronic ankle instability (CAI).

OBJECTIVES

(1) To determine the test-retest reliability of a novel ankle proprioception assessment tool, the Ankle Inversion Discrimination Apparatus for Landing (AIDAL); (2) To assess whether AIDAL scores were sufficiently sensitive to detect proprioceptive deficits in chronic ankle instability (CAI); and (3) To examine whether AIDAL scores correlated with Cumberland Ankle Instability Tool (CAIT) scores.

DESIGN

Cross-sectional study.

METHODS

The AIDAL was purpose-built to assess ankle discrimination in four positions of ankle inversion (10°, 12°, 14° and 16°) upon landing from a 10cm drop. Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. Seven-day test-retest reliability was evaluated with 23 university students (12 CAI and 11 non-CAI), and another 36 university students (18 CAI and 18 non-CAI) were in the comparison study.

RESULTS

The test-retest reliability ICC score for the whole group was 0.763 (95% CI=0.519-0.892), which showed an excellent reliability level. ICC _(3,1) was 0.701 for the non-CAI group (95%CI=0.210-0.910) and 0.804 for the CAI group (95%CI=0.451-0.939). The CAI group performed at a significantly lower level on the AIDAL assessment than the non-CAI group (0.777±0.05 vs. 0.815±0.05, F=5.107, p=0.03). The discriminative AUC value for the AIDAL test was 0.756 with a cut point of 0.819 (sensitivity=0.733, specificity=0.800). The MDC₉₀ scores for CAI and non-CAI groups were both 0.04. Spearman's correlation showed that the CAIT scores were significantly correlated with the ankle proprioceptive discrimination scores (rho=0.401, p=0.015).

CONCLUSION

The AIDAL showed good test-retest reliability for both non-CAI and CAI groups. Measuring ankle inversion proprioception during landing may be important for assessing the outcomes of CAI rehabilitation, as proprioceptive performance obtained from the AIDAL was significantly correlated with severity of functional ankle instability CAIT scores.

The Relationship Between Ankle Proprioception and Functional Mobility in People With Parkinson's Disease: A Cross-Sectional Study

Previous research has found ankle proprioception to be impaired in people with Parkinson's disease (PD). However, the relationship between ankle proprioception and functional mobility in people with PD has not been fully investigated. The purpose of this study was to examine whether ankle proprioception is related to the functional mobility of people with PD. Forty-two participants with mild to moderate PD volunteered. Ankle proprioceptive acuity was measured in standing, by using active movement extent discrimination assessment (AMEDA). Functional mobility measures included the timed-up-and-go test (TUG), 30 s sit-to-stand test (30s-STS) and 10-meter walking test (10MWT). Step length and step cadence were recorded during the 10MWT. No significant correlation was found between ankle proprioceptive discrimination scores and any mobility performance measure in people with PD (−0.20<r<0.04, all p > 0.05). However, ankle proprioception scores were significantly correlated with step length (r = 0.38, p < 0.05) and step cadence (r = −0.30, p < 0.05), and were significantly and negatively correlated with the stage of modified Hoehn and Yahr (rho = −0.53, p < 0.01). The lack of relationship between ankle proprioceptive acuity and functional mobility in PD suggests that people with PD may be more limited by reduced sensorimotor integration or may rely more on other sensory input, rather than ankle proprioception, to achieve functional mobility, a finding consistent with sensory reweighting theory. In addition, poorer ankle proprioceptive acuity was associated with decreased step length and increased step cadence, suggesting that the shuffling gait observed in PD may be related to impaired ankle proprioception, which has important clinical implications for gait retraining in people with PD. Given that ankle proprioception was significantly and negatively correlated with the stage of modified Hoehn and Yahr, it may warrant being used as an objective biomarker to monitor the progression of PD.

Vibration of calf muscles has reverse effects on right and left ankle proprioception in high and low proprioceptive performer groups

PURPOSE

Previous research has found hemispheric asymmetries in the utilization of proprioceptive information. It is undetermined, however, if there is any change in asymmetry in proprioceptive function when external stimulation, such as vibration, is presented. The present study was to investigate the immediate effects of vibration stimulation (VS) on bilateral ankle proprioception.

MATERIALS AND METHODS

Forty-six recreational male basketball players were included. Proprioception was assessed by using the active movement extent discrimination apparatus (AMEDA) in standing, and vibration was provided by using a vibrating form roller on the peroneal or gastrocnemius muscles.

RESULTS

When participants were divided into high score and low score groups, according to the median of the baseline proprioceptive performance, VS (irrespective of whether vibrating the peroneal or gastrocnemius muscles) significantly improved left non-dominant ankle proprioception in the low proprioceptive performer group (p = 0.019), while significantly deteriorated right dominant ankle proprioception in the high proprioceptive performer group (p = 0.011).

CONCLUSIONS

The results found that external stimuli reversely affect proprioception in better and worse performing groups. This suggests that there are differences in the processing of external stimulus signals on different bilateral hemispheres and in different groups (high score vs low score groups), which may be related to hemispheric asymmetry and stochastic resonance. Therefore, it is necessary to explore more specific interventions in the future.

Does ankle tape improve proprioception acuity immediately after application and following a netball session? A randomised controlled trial

OBJECTIVES

To assess whether ankle tape applied by a Sport and Exercise Physiotherapist (SEP) or self-applied by the athlete results in a change in proprioception and whether it is maintained during a netball session.

DESIGN

Randomised controlled trial.

SETTING

Australian Institute of Sport.

PARTICIPANTS

53 pre-elite netball athletes.

MAIN OUTCOME MEASURES

Athlete proprioception was assessed using the Active Movement Extent Discrimination Apparatus (AMEDA) on four occasions for each taping condition: 1) pre-tape, 2) post-tape, 3) post-netball & 4) post-netball no-tape.

RESULTS

Mixed effect linear models were used for analysis. A significant increase in proprioception was observed when self-tape: 0.022 (95% CI: [-0.000 - 0.044], p = 0.05), and SEP tape: 0.034 (95% CI: [0.012-0.055], p < 0.01), were initially applied. These improvements were maintained during a netball session for both, self-taping: 0.01 (95% CI: [-0.01 - 0.02], p = 0.45) and SEP-taping: <0.01 (95% CI: [-0.02 - 0.01], p = 0.56). Results also indicate there was no significant difference between taping conditions (β = -0.001, 95% CI: [-0.02 - 0.02], p = 0.90).

CONCLUSIONS

Proprioception improves and is maintained during a netball session with either SEP or self-applied taping.

Using the Active Movement Extent Discrimination Apparatus to Test Individual Proprioception Acuity: Implications for Test Design

The Active Movement Extent Discrimination Apparatus (AMEDA) has been used for measuring proprioception at various joints in the body for more than two decades. The utility of this instrument for discriminating groups has been reported in terms of an area under the curve (AUC) derived from an absolute identification test. This metric has supported statistically significant group differences, but it is not clear whether the AMEDA's testing protocol is suitable for measuring individual proprioception acuity changes. This study aimed to test the reliability, variance and absolute AUC scores obtained with the AMEDA with reference to other studies that have tested absolute identification acuity in other domains and the theoretical underpinnings of the testing protocol. We re-analyzed raw data from a 2013 study involving 65 people, most of whom were tested three times over two separate sessions on the ankle AMEDA by now assessing the accuracy of individual responses and calculating the sensitivity index, d', in addition to the AUC. To assess reliability, we calculated the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for those who completed all three tests. Fewer than 50% of presented stimuli were accurately identified and relatively poor discrimination was achieved between adjacent stimuli (in only one case was the median d' value greater than 1). The ICC of AUC scores across the three tests was poor (0.47). The SEM was 0.04, while 90% of participants' AUC scores fell between 0.59 and 0.76. The variation in performance at the individual level was substantial, producing a large SEM relative to the population spread of scores. We considered potential theoretical factors that may be affecting these results and concluded that an alternative approach will be needed in order for the apparatus to be used to explore individual proprioceptive performance.

Can musculoskeletal screening test findings guide interventions for injury prevention and return from injury in field hockey?

OBJECTIVES

The aim of this study is to identify if intrinsic factors tested in the preseason screening (PSS) can identify an elevated risk of injury. This aim has two aspects; to assess whether previous injury is associated with ongoing deficits in performance, and to assess if the PSS can identify differences in intrinsic factors that profile risk of future injury.

DESIGN

A cohort of state level field hockey players were tested on a screening test battery including proprioception, postural stability, muscular strength and range of motion, to establish if these intrinsic factors were useful in identifying elevated risk of injury. Retrospective injury data was collated to determine association with previous injury and prospective injury data was collated to determine association with future injury.

PARTICIPANTS

A total of 130 field hockey players were included in this study, from state level squads (age ± SD = 20.96 (3.75); height = 176.09 cm). Groups for prescreening and post screening injury status (injured/not injured) were established for comparison to screening test results.

RESULTS

Right Active Movement Extent Discrimination Assessment (AMEDA), left AMEDA and right Y-balance test (YBT) anterior direction (Ant) were significantly associated (p < 0.05) with injury prior to screening. Right YBTAnt and right and left hip internal rotation (IR) were significantly associated (p < 0.05) with injury post screening. The YBTAnt and YBT posteromedial (PMed) reach directions and Hip IR are associated with previous hamstring injury and show a difference between post screening injured and non-injured groups.

CONCLUSIONS

AMEDA, R YBTAnt, Hip IR tests should be a focus for recovery after previous injury and during season preparation. Full recovery may improve readiness to return to play and reduce risk of primary injury or re-injury. YBTAnt and YBTPmed and Hip IR show a performance deficit link between previous injury and subsequent re-injury of hamstrings. Since these are the most common re-injury types in this cohort, these tests are clinically useful in informing return to play decisions for hockey players.

Effects of Pre-exercise Acute Vibration Training on Symptoms of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis

Tan, J, Shi, X, Witchalls, J, Waddington, G, Lun Fu, AC, Wu, S, Tirosh, O, Wu, X, and Han, J. Effects of pre-exercise acute vibration training on symptoms of exercise-induced muscle damage: a systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2020-Exercise-induced muscle damage (EIMD) normally occurs after unaccustomed high-intensity eccentric exercises. Symptoms of EIMD include delayed-onset muscle soreness (DOMS), tenderness, stiffness, swelling, reduced strength, and increased creatine kinase (CK) levels in the blood. Vibration training (VT) may be useful as a pre-exercise intervention in attenuating EIMD on the basis of tonic vibration reflex (TVR) through a more efficient distribution of contractile stress over muscle fibers. The objective of this meta-analysis is to examine the effects of acute VT on symptoms of EIMD when performed as the pre-exercise intervention. Randomized controlled trials (RCTs) published in the 8 databases of Cochrane Library, PubMed, Embase, Web of Science, EBSCO, China National Knowledge Infrastructure, Airiti Library and WanFang Data from 1966 (the earliest available time) to January 2019 were searched. A total of 2,324 records were identified and 448 articles were screened with the title and abstract. Two investigators identified eligible studies, extracted data, and assessed the risk of bias independently. Review Manager 5.3 designed by Cochrane was used for the current meta-analysis. Six RCTs involving 180 subjects were included in the analysis. A low-to-moderate methodological quality of the included studies was revealed using the physiotherapy evidence database scale. The results showed that acute VT was superior to the control group for the reduction of DOMS on pain visual analogue scale at 24, 48 hours and pressure pain threshold at 24 hours. In addition, superior effects of acute VT were also found on the indirect markers of muscle damage including CK at 24, 72 hours, and lactate dehydrogenase at 24 hours. The current meta-analysis has collated the evidence to demonstrate that receiving acute VT before unaccustomed high-intensity eccentric exercises may be effective in attenuating markers of muscle damage and the development of DOMS when compared with a control group. The possible mechanisms of this effect could be attributed to an improved synchronization of muscle fiber caused by TVR, which could result in even distribution of exterior loads and eventually attenuate disruptions of muscle fibers. In addition, increased blood flow may also be helpful to prevent accumulation of metabolic substances and attenuate subsequent symptoms of EIMD. Vibration training may be used as a pre-exercise intervention to alleviate symptoms of EIMD caused by unaccustomed high-intensity eccentric exercise. Because of the limited quantity and quality of included studies, more high-quality studies are required to ascertain the effect of VT on symptoms of EIMD.

Use of the lower extremity functional test to predict injury risk in active athletes

BACKGROUND

The purpose of the current study was to assess the reliability and validity of the lower extremity functional test (LEFT) for predicting low back and lower limb injury in active athletes.

METHODS

Seventy athletes (45M, 25F; mean age: 21±2 years) from seven different sports volunteered. The LEFT was a battery of five weight-bearing functional movements involving different movement planes, directions, modes, and at varying intensities. Both legs were assessed in a random order and each athlete was given both movement quality and associated symptom scores. Intratester, intrarater and inter-rater reliability were evaluated. Participants were followed up for 12 months, and their exposure to sport and subsequent injuries were recorded. Independent samples t-tests were performed to determine if a significant difference existed in LEFT scores between injured and non-injured athletes. Receiver operating characteristic (ROC) curve analysis was employed to assess the instrument's capacity to predict injury.

RESULTS

The intratester reliability ICC2, 1 was 0.875. The ICC2, 3 of intrarater reliability was 0.953 and the inter-rater reliability was 0.949, respectively. Nineteen participants had an injury in the low back or lower limb within the following 12 months. Injured athletes had significant lower movement quality and symptom scores of the LEFT than non-injured (t=4.278, P=0.000, Cohen's d=1.2; t=3.654, P=0.001, Cohen's d=1.3, respectively). When movement quality or symptom score alone was included in the ROC analysis, the area under the ROC curve (AUC) scores were 0.772 (P=0.000, 95% CI: 0.653-0.891) and 0.771 (P=0.001, 95% CI: 0.638-0.905), respectively. When movement quality and symptom scores were combined to predict injury, the AUC discrimination score was 0.853 (P=0.000, 95% CI: 0.754-0.953), resulting in 85.3% of cases being correctly predicted as low back or lower limb injured/noninjured.

CONCLUSIONS

The findings from the current study suggest that the LEFT appears to be a reliable and valid functional assessment tool for predicting low back or lower limb injury risk in these college athletes, especially when movement quality and symptom scores were used in combination.

Proprioceptive abilities improve in expert skiers and snowboarders from early-season to mid-season

OBJECTIVES

To determine whether the proprioceptive ability of advanced and expert snowsport participants increased with time on-snow, and whether gender, age, snowsport discipline and/or previous ankle injury were factors in proprioceptive ability at the start of the winter snow season (T1, n=80) compared to mid- season (T2, n=39).

DESIGN

Observational study METHOD: Participants completed a questionnaire at T1, and proprioception was measured at T1 and T2 by the Active Movement Extent Discrimination Apparatus (AMEDA), which tests lower limb proprioception.

RESULTS

At T1 there was no significant difference between the proprioception scores of the two cohorts of advanced and expert snowsport participants, between females and males, younger and older age groups, nor between alpine skiers and snowboarders. At T2, after a minimum of 5 weeks on-snow, the whole group had improved their proprioception by 0.04 (p<.0001) as measured by the AMEDA. Groups undertaking different snowsport disciplines achieved different gains across the season, with minimal change of 0.02 in skiers (p=.056), while snowboarders and mixed ski/snowboard participants gained 0.05 (p=.034) and 0.06 (p=.005) (η² 0.63 and 0.47 respectively). Males, females, instructors and elite youth participants all improved their proprioception by mid-season (η² 0.29-0.46).

CONCLUSIONS

Amongst an established group of snowsports participants, lower limb proprioception is a consistent skill that is equally well developed in all cohorts. Several weeks of regular snowsport exposure improves this proprioceptive acuity amongst snowboarders, and those who mix snowboarding with skiing. Exposure to a prolonged period of snowsport improves proprioception, with benefits to neuromuscular control mechanisms.

The Effect of Acute Body Unloading on Somatosensory Performance, Motor Activation, and Visuomotor Tasks

Evaluating countermeasures designed to reduce the impact of microgravity exposure on astronaut performance requires the development of effective methods of assessing changes to sensorimotor function in 1g analog systems. In this study, somatosensation at the ankle and fingers, lower leg muscle activity and visuomotor control were assessed using a full body loading and acute unloading model to simulate microgravity. It was hypothesized that the function of the hands and eyes are not constrained to 'weight bearing' postures for optimal function and would not differ between the loaded and acute unloaded conditions, whereas lower leg muscle activity and ankle somatosensation would be reduced in the acute unloaded condition. Somatosensation was recorded using the Active Movement Extent Discrimination Apparatus (AMEDA) protocol where participants were required to make an absolute judgment of joint position sense. A score closer to 1.0 demonstrates higher accuracy. Lower leg muscle activity was recorded using electromyography of major lower leg musculature to observe peak muscle activity and duration of contraction. The King Devick infrared eye tracking test was used to asses visuomotor control by monitoring saccade velocity and fixation time. In acute unloading, it was found that ankle somatosensation had decreased accuracy (loaded 0.68, unloaded 0.66, p = 0.045) while finger somatosensation improved (loaded 0.77, unloaded 0.79, p = 0.006). When acutely unloaded, peak lower leg muscle activation reduced ( > 27%) and total contraction time increased (2.02 × longer) compared to loading. Visuomotor assessment results did not vary between the loaded and acute unloaded postures, however the underlying techniques used by the participant to complete the task (saccade velocity and fixations time) did increase in acute unloaded conditions.

Significance

This research provides an insight to how to the human body responds immediately to acute changes of gravitational load direction. It provides insight to the acute affects' astronauts may encounter when in microgravity.

Reduced shoulder strength and change in range of motion are risk factors for shoulder injury in water polo players

OBJECTIVE

To determine whether pre-season shoulder ROM and strength can be used to identify athletes at risk of future shoulder injury.

DESIGN

Prospective cohort.

SETTING

High performance sports institute.

PARTICIPANTS

76 sub-elite water polo players.

MAIN OUTCOME MEASURES

Mean pre-season shoulder internal (IR) and external rotation (ER) ROM and strength values compared by gender, dominance and prospective injury status.

RESULTS

14-dominant shoulder injuries were recorded. There was a significant difference (p = 0.05) in total ROM difference (TROM) between the prospectively injured and no injury groups (-17.2°(30.4);-0.8°(13.3)), and dominant side ER strength (11.7%(2.4) vs 14.5%(2.8), p = 0.03) and IR strength (16.5%(3.0) vs 21.6%(4.9) as a percentage body weight (PBW) were also significantly different (p ≤ 0.03). Separate significant associations were found between future episodes of shoulder injury and; dominant shoulder TROM difference of ≥7.5°(OR 3.6,95%CI 0.8-16.0), ER strength as a PBW≤12.5%(OR 5.2,95%CI 1.0-27.9), and IR strength as a PBW≤16.8%(OR 13.8,95%CI 2.2-88.0).

CONCLUSION

Pre-season dominant TROM difference, and reduced shoulder IR and ER strength relative to body weight were significant predictors for future shoulder injury. Although further investigation with a larger sample size is required, achieving optimal values on these measures may reduce future episodes of shoulder injury in water polo players.

A Systematic Review and Meta-Analysis About the Prevalence of Neck Pain in Fast Jet Pilots

BACKGROUND: During flight, fast jet pilots frequently move their heads into extreme positions while withstanding large amounts of stress on their cervical spines. These factors are thought to contribute to episodes of neck pain.METHODS: We conducted a systematic review and meta-analysis of previous neck pain prevalence data in fast jet pilots to determine an overall pooled prevalence. Subgroup analyses were performed according to when pilots complained about their neck pain, whether these same pilots sought treatment, and if they lost time from flying. Four research databases were searched. Studies were eligible for inclusion if they were written in English, involved a group of fast jet pilots who were actively flying high performance aircraft, and reported quantitative prevalence data about neck pain in these pilots. These eligibility criteria were independently applied by two reviewers and risk of bias was evaluated. MetaXL software was used to conduct the meta-analysis.RESULTS: In total, 8003 fast jet pilots across 18 eligible studies were included in the review. The overall pooled prevalence of neck pain in fast jet pilots was 51%. It was found that 39% of subjects lost time from flying, while only 32% sought medical treatment.DISCUSSION: Neck pain in fast jet pilots adversely affects operational capabilities of defense forces. The prevalence of neck pain varies according to the definitions or thresholds of complaints used across the literature. Further research is required to standardize the definition of neck pain.Riches A, Spratford W, Witchalls J, Newman P. A systemic review and meta-analysis about the prevalence of neck pain in fast jet pilots. Aerosp Med Hum Perform. 2019; 90(10):882-890.

Throwing performance in water polo is related to in-water shoulder proprioception

Water polo players require a high level of upper-extremity strength, flexibility and coordination to achieve a peak level of throwing performance. Increased levels of shoulder proprioceptive acuity, strength and range of motion (ROM) have been previously associated with higher sporting performance. A coach-rating scale, used to quantify an athlete's kicking proficiency in soccer; was adapted in the current study to measure each coach's subjective expert opinion regarding athletes' throwing mechanics, velocity, and accuracy. To examine this hypothesis shoulder proprioception acuity of 18 water polo players was measured both in-water and on-land using an AMEDA apparatus and correlated with coach-rated throwing performance and clinical measures of shoulder strength and ROM. There was a moderate positive correlation between the in-water and the on-land proprioception acuity (r = 0.47, p < 0.05). The in-water score showing a strong positive correlation with coach rated throwing mechanics (r = 0.68, p < 0.05) and velocity (r = 0.75, p = 0.02), suggesting that superior proprioception acuity contributed to fast, mechanically-efficient throwing. These findings support the notion that in-water proprioceptive acuity is an important determinant of the throwing performance achieved by water polo athletes and its measurement may be a valuable adjunct to current athlete screening.

Somatosensory perception sensitivity in voluntary postural sway movements: Age, gender and sway effect magnitudes

OBJECTIVES

1) to develop a reliable device for assessing somatosensory perception sensitivity in voluntary postural sway movement, specifically a sway discrimination apparatus (SwayDA) for testing voluntary lateral sway discrimination sensitivity (VLSDS); 2) to explore the relationship between mobility performance and VLSDS in older adults, and 3) to determine the effects of age, gender and sway magnitude on VLSDS.

METHODS

First, eighteen healthy young adults (8 males, 10 females, age ranging from 22 to 70) were recruited for a test-retest reliability study. During the SwayDA test, the participants were asked to discriminate between four possible medial-lateral sway extents when moving away from neutral standing. For Objective 2, twenty-five older participants (9 males, 16 females, mean age 70.1) undertook both the SwayDA and the mobility tests. The mobility testing battery consisted of single task and cognitive dual task timed-up and-go tests, and the 5 times sit-to-stand test. Pearson's correlation was calculated between SwayDA scores and mobility performance. For Objective 3, 20 community-dwelling adults over 65 years old (10 males, 10 females, mean age 71.3) and 20 young volunteers (10 males, 10 females, mean age 23.6) were recruited to study the effects of age, gender and sway magnitude on VLSDS. To obtain a bias-free measure of VLSDS, the probability of correct response was considered as the true-positive judgment, while the probability of incorrect response was considered as false-positive judgment, and these were cumulated across the response values. A receiver operating characteristic (ROC) curve was then generated and the Area Under the ROC Curve (AUC) was used to measure VLSDS.

RESULTS

There was no significant difference in AUC scores between Day 1 and Day 8 (p > 0.05). ICC(3,1) reliability indices were 0.750 for sway to the left and 0.879 for sway to the right. Pearson's correlation revealed a significant correlation between the SwayDA sores and timed-up-and-go (TUG), cognitive dual task TUG, 5 times sit-to-stand test (r = -0.456, -0.522, and - 0.416 respectively, all p < 0.05). Factorial ANOVA showed age and gender main effects (F = 8.144, p < 0.01, and F = 8.806, p < 0.01, respectively), suggesting older adults and females had worse VLSDS. In addition, a significant difference was found between the young and older participants in the inner range of VLSDS (t = -2.875, p < 0.017), indicating that the decline of somatosensory perception of postural sway in older people may be magnitude-specific, and greatest for small deviations from upright stance.

CONCLUSIONS

The SwayDA has good to excellent test-retest reliability. The finding that VLSDS score was significantly correlated with mobility performance in older adults highlights the importance of somatosensory perception in postural control. More importantly, the significantly worse VLSDS in older people observed in the inner lateral movement range may represent a unique characteristic of neuromuscular degeneration associated with aging, which should be monitored and addressed in rehabilitation programs.

Shoulder internal and external rotation strength and prediction of subsequent injury in water-polo players

Water-polo players have greater isokinetic shoulder strength than age-matched controls. Due to the repetitive demands of throwing, however, water-polo players demonstrate an altered strength ratio, with greater internal rotation (IR) strength relative to external rotation (ER). The relationship between shoulder strength and risk of shoulder injury is unknown. In addition, the effect on test position for strength testing on the reliability of handheld dynamometry (HHD) in this population is not known. The aims were to determine the: (a) Inter-rater reliability of HHD testing of IR and ER strength in two positions: neutral and 90°abduction-90°ER (90-90) and (b) relationship between preseason shoulder strength and occurrence of future injury in sub-elite water-polo players. Two assessors measured shoulder IR and ER strength using HHD in 15 water-polo players across two testing days. Athletes were followed over a 6-month period, and injury was assessed and recorded by the team physiotherapist. Measurement of water-polo players' isometric IR and ER strength in the clinical setting had good to excellent inter-rater reliability; however, systematic error was observed in the neutral position but not the 90-90 position. Irrespective of testing position, the neutral and 90-90 test position showed a significant difference (P = 0.01) in absolute preseason IR and ER mean strength between prospectively injured and non-injured players. There was no significant difference in strength ratio or strength normalized for body mass index. These results suggest that preseason strength testing may help identify players at risk of in-season shoulder injury.

Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: A systematic review with meta-analysis?

QUESTION

Can manual therapy improve functional outcomes for individuals with chronic ankle instability?

DESIGN

Systematic review with meta-analysis of randomized controlled trials.

PARTICIPANTS

Individuals with chronic ankle instability.

INTERVENTION

Manual therapy is defined as an intervention that involves joint mobilization, and mobilization with movement.

OUTCOME MEASURE

The primary outcome is patient reported function (PRF) questionnaires scores, the secondary outcomes are ankle dorsiflexion range of motion (DFROM) and balance control.

RESULTS

Four studies were included (n = 208, mean age = 24.4) in the meta-analysis, with moderate to high quality on the PEDro scale (range 6-8). For patient reported function (PRF) questionnaires, two studies reported significant improvement after six-session manual therapy measured by foot and ankle ability measures sport subscale (FAAMS) and Cumberland ankle instability tool (CAIT), respectively. For DFROM, one session manual therapy had no significant effect on the weight-bearing lunge test (WBLT) (3 studies, n = 147, SMD = 1.24 (95%CI -0.87 to 3.36), I² = 96%) or non-weight-bearing inclinometer test (2 studies, n = 47, MD = 3.41° (95%CI -0.26 to 7.09),I² = 43%), while six-sessions manual therapy showed, a significantly positive effect on WBLT(2 studies, n = 80, SMD = 2.39, (95% CI 0.55, to 4.23), I² = 93%). For the SEBT, one-session manual therapy had no significant effect on overall star excursion balance test (SEBT) score (3 studies, n = 137,MD = 2.05,95%CI (-0.96,5.05), I² = 75%), while qualitative analysis of 2 included studies showed significant improvement both on the SEBT score and single limb balance test (SLBT).

CONCLUSIONS

Six sessions rather than one session of manual therapy improves ankle functional performance for individuals with CAI.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42017054715.

Epidemiology of shoulder injury in sub-elite level water polo players

OBJECTIVE

Investigate the patterns and circumstances of shoulder injury, in both male and female sub-elite water polo players, through evaluating the injury incidence, mechanism and subsequent training time lost.

DESIGN

Retrospective cohort.

SETTING

Sports institute.

PARTICIPANTS

80 sub-elite water polo players.

MAIN OUTCOME MEASURES

Total injury number and incidence, mechanism of injury, lost training time and time from injury onset to seeking treatment.

RESULTS

For the athlete self-report data set (2009-2013), 218 total injuries were reported with 54 (25%) being shoulder injuries. From 2014 to 2016, 133 physiotherapist-report injuries were recorded, the shoulder accounting for 21 (16%) of total injuries. The shoulder was the most frequently injured site and accounted for 25% of lost training days. Two thirds of shoulder injuries were due to overuse (67%). The average time between sustaining a shoulder injury and presenting to the team physiotherapist was 10 days.

CONCLUSION

Irrespective of data collection method, shoulder injuries were the most common injury for both male and female sub-elite water polo players. Future injury prevention strategies could address overuse through optimising throwing volumes, and include athlete education about injury management to determine whether reducing time delay between injury occurrence and seeking treatment improves outcomes.