The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial

INTRODUCTION

Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation.

OBJECTIVE

To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements.

METHODS

Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels.

RESULTS

Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [-2.18, -1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM.

CONCLUSION

Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain.

REGISTRATION

ClinicalTrials.gov identifier: NCT05589623.

A comparison of the range of motion and dynamic stability of the ankle joint of athletes with an ankle sprain as compared to healthy controls: A cross-sectional study

Background

Ankle sprains are the most common lower-leg musculoskeletal injuries, frequently occurring among athletes and other physical activity individuals. The objective of this study was to compare the ankle range of motion and dynamic stability of healthy and injured athletes for their dominant and nondominant legs.

Methods

A cross-sectional study design was selected to investigate this study with 32 male soccer players with average age: 22.6 ± 3.3 years, weight: 69.6 ± 5.7 kg, height: 176.8 ± 5.32 cm, with a history of a lateral ankle sprain on the dominant leg for the past 2 years. Ankle range of motion was determined using dorsiflexion and plantar flexion by a goniometer. The dynamic stability was determined using the SWAY medical system. An independent t-test was used to study the differences between healthy and injured groups and between dominant and nondominant legs for dynamic stability, dorsiflexion, and plantar flexion range.

Results

There were higher significant differences for dynamic stability in healthy participants than in injured participants for their dominant (P = 0.001) and nondominant (P = 0.001) legs. There were significant differences in dynamic stability in the dominant and nondominant leg (healthy [P = 0.033] and injured [P = 0.000] participants). The dominant leg shows higher dynamic stability in healthy group, whereas nondominant leg shows higher dynamic stability in the injured group.

Conclusion

The study found significant differences between the injured and sound legs. The injured dominant and nondominant leg revealed a striking disparity in the ankle range of motion. Therefore, the study demonstrated that ankle sprain causes due to less stability of the ankle joint, which limits ankle movements.

Reliability and validity of smartphone applications to measure the spinal range of motion: A systematic review

Introduction: The objective of this study is to conduct a systematic review on the reliability and validity of various smartphone applications for spinal range of motion (ROM) measurements.Methods: Eleven studies were selected following an electronic search of PubMed, CINAHAL, Medline, Embase and SPORTDiscus. Quality appraisals of selected studies were conducted using a standardized appraisal tool.Results: Most studies demonstrated a good intra- and inter-rater reliability, as well as validity in more than 50% of joint movements. At the same time, relative reliability/validity outcomes (e.g. interclass correlation co-efficient) were stronger than absolute reliability/validity outcomes (e.g. mean differences, limits of agreement). Spinal rotation movement showed less reliability and validity when compared to other spinal movements.ConclusionsːResult of the study supports the use of smartphone applications for ROM measurements of spinal joints. However, we cannot advocate the most appropriate application for spinal ROM measurement or suggest which application is superior to all others. As clinicians have multiple options in selecting applications, it is recommended they use applications that have proven reliable and valid for that particular joint. Data from this study provides clinicians with evidence-based research on smartphone devices for measuring spinal joint ROM in clinical settings.

Comparison of instability resistance training, traditional resistance training and plyometric training on athletic performance parameters

OBJECTIVES

The objective of the study was to compare traditional resistance, instability resistance, and plyometric training methods on measures of athletic performance in healthy subjects.

METHODS

Sixty five healthy, physically active male students were randomly assigned to the following groups: traditional resistance training (RT, n=22), instability training (IT, n=22), and plyometric training (PLY, n=21).Athletic performance parameters were assessed pre- and post-training using chair squat test, standing stork test, shuttle run test, t-test, and vertical jump test.

RESULTS

General linear univariate model with baseline as covariate (ANCOVA) was used for analyzing the change in outcome from baseline to post-treatment. Statistically significant improvement was observed in all the athletic performance parameters in all three groups after seven weeks of training (p-value<0.05). The highest change in chair squat test was reported for RT compared to IT (p-value<0.001) and PLY (p-value<0.001). The change in standing stork test among the IT group was substantially higher than that among RT (p-value=0.007) but did not significantly differ from that among the PLY (p-value=0.27). No statistically significant difference was observed in post-test values of vertical jump test among three groups. The highest change in t-test and shuttle run test was reported for PLY compared to IT (p-value<0.001) and RT (p-value<0.001).

CONCLUSIONS

Based on the findings of this study, it is suggested that IT and PLY can be included with traditional RT to improve various aspects of athletic performance in healthy physically active individuals. The current study will give an insight to athletes, coaches, and trainers regarding utilization of appropriate training methods in enhancing athletic performance. However, further research is required to establish the effectiveness.

Comparison of plantar loading patterns on natural grass and artificial turf during various athletic activities

BACKGROUND

This study aimed to investigate the differences in plantar pressure during various athletic activities on natural grass and artificial turf.

METHODS

Twenty-one athletes were fitted with properly sized soccer shoes and corresponding F-Scan system insoles and performed walking, running, vertical jumping and cutting activities to the right and left sides on both natural and artificial turf.

RESULTS

There were no statistically significant differences between natural grass and artificial turf in peak pressure, maximum force and force-time integral during all the athletic activities (P˃0.05). On both turfs, the highest peak pressure and maximum force values occurred during running and cutting to the right, and the highest force-time integral value occurred during cutting to the right. There were no statistically significant differences between the two turfs in peak pressure in the various anatomical regions during any of the athletic activities (P˃0.05). The peak pressure was the highest on the first metatarsal and the hallux during all five activities. A clinically meaningful difference between the surfaces in peak pressure on the second to fifth metatarsals was found during walking, indicating more loading on artificial turf than on natural grass. There was more loading on artificial turf than on natural grass during cutting left and at hallux and third toe on natural grass during cutting right. However, these differences were not statistically significant (P˃0.05).

CONCLUSIONS

The results of this study suggest that it is important to limit or prevent athletes from undertaking certain activities that increase the risk of re-injury during rehabilitation.

Rehabilitation of patellar tendinopathy

Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals' decision making in the management of this disorder.

Aerobic Profile During High-intensity Performance in Professional Saudi Athletes

BACKGROUND AND OBJECTIVE

The aerobic power, expressed relative to body mass, of different Saudi elite players is one of the most important area of interest and with great values because of its restrictively that reported in the previously literatures, the present study was conducted to investigate the aerobic characteristics of Saudi elite, Saudi triathlon and soccer players and to compare between measures of aerobic power between both players using graded treadmill protocol to assess maximal cardiorespiratory fitness (VO2max), within a groups of high trained youth Saudi elite players.

MATERIALS AND METHODS

Twenty two professional Saudi athletes, 11 Saudi triathlon athletes, 11 Saudi soccer players were selected. Their Mean±SD for age, height, weight, body mass index (BMI), body fat mass (%), body fat free mass percentage, cardiovascular parameter, including, absolute and relative peak oxygen consumption "VO2max" and maximal heart rate "HR max". Data were analyzed using independent sample t-test and SPSS software.

RESULTS

Descriptive statistics for anthropometric characteristics were performed to compare between the means, independent sample. T-test showed mean value of absolute "VO2max" (3605.18±515.74), for triathlon athletes, while football players absolute VO2max, (3645.63±897.60) with non-significant different between the groups. Overall mean of peak training values was (3625.40 mL min-1), relative VO2max was appears to be (53.46±7.242) mL-1 min-1 kg-1, for triathlon athletes, while football athletes relative VO2max has a mean value and ±SD of (52.35±6.342) mL-1 min-1 kg-1 with non-significant different between the groups. HR max was (157.90±8.167) beats min-1 for triathlon athletes, while football players HR max, was (139.18±6.646) beats min-1 with non-significant difference between the groups.

CONCLUSION

This clinical approaches that use Cardio Pulmonary Exercise Testing (CPET) in performance testing revealed that aerobic power, expressed relative to body mass, of Saudi soccer players was in the near range of values normally reported in the literatures for soccer players and triathletes during exercise training as well. Degrees of aerobic achievements during both exercise testing seems to be with non-significant different between Saudi soccer player and Saudi triathlon.

Effects of Neuromuscular Fatigue on Eccentric Strength and Electromechanical Delay of the Knee Flexors: The Role of Training Status

Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength and electromechanical delay (EMD) of the knee flexors in healthy young adults of different training status.

Methods: Seventy-five male participants (27.7 ± 5.0 years) were enrolled in this study and allocated to three experimental groups according to their training status: athletes (ATH, n = 25), physically active adults (ACT, n = 25), and sedentary participants (SED, n = 25). The fatigue protocol comprised intermittent isometric knee flexions (6-s contraction, 4-s rest) at 60% of the maximum voluntary contraction until failure. Pre- and post-fatigue, maximal eccentric knee flexor strength and EMDs of the biceps femoris, semimembranosus, and semitendinosus muscles were assessed during maximal eccentric knee flexor actions at 60, 180, and 300°/s angular velocity. An analysis of covariance was computed with baseline (unfatigued) data included as a covariate.

Results: Significant and large-sized main effects of group (p ≤ 0.017, 0.87 ≤ d ≤ 3.69) and/or angular velocity (p < 0.001, d = 1.81) were observed. Post hoc tests indicated that regardless of angular velocity, maximal eccentric knee flexor strength was lower and EMD was longer in SED compared with ATH and ACT (p ≤ 0.025, 0.76 ≤ d ≤ 1.82) and in ACT compared with ATH (p = ≤0.025, 0.76 ≤ d ≤ 1.82). Additionally, EMD at post-test was significantly longer at 300°/s compared with 60 and 180°/s (p < 0.001, 2.95 ≤ d ≤ 4.64) and at 180°/s compared with 60°/s (p < 0.001, d = 2.56), irrespective of training status.

Conclusion: The main outcomes revealed significantly higher maximal eccentric strength and shorter eccentric EMDs of knee flexors in individuals with higher training status (i.e., athletes) following fatiguing exercises. Therefore, higher training status is associated with better neuromuscular functioning (i.e., strength, EMD) of the hamstring muscles in fatigued condition. Future longitudinal studies are needed to substantiate the clinical relevance of these findings.

Translation and validation of the stroke specific quality of life scale into Arabic

BACKGROUND

There is a need to validate one of the specific stroke quality of life (QOL) scales into Arabic.

OBJECTIVE

To translate and validate the stroke specific quality of life (SSQOL) into Arabic.

METHODS

The SSQOL was translated into Arabic (SSQOL-A) according to a forward/backward translation protocol. 147 first time stroke survivors and 60 healthy subjects were recruited. Cronbach's α was used to measure internal consistency, test-retest reliability was measured by intraclass correlation coefficient (ICC). Acceptability was established by studying floor and ceiling effects. A linear correlation between SSQOL-A and the Short Form 36, the Beck Depression Inventory II, the Barthel Index and the National Institutes of Health Stroke Scale was done to assess construct validity. Discriminant and convergent validity were evaluated by correlating item to scale of each of the domains using Pearson correlation (rp).

RESULTS

The SSQOL-A has shown good internal consistency (Cronbach's α  = 0.78-0.94) and test-retest reliability (ICC = 0.77-0.94). It has also shown acceptable construct validity (r2 = 0.06-0.55). Item to scale correlation showed acceptable convergent (0.76-0.98) and discriminant (0.12-0.53) validity. Mann-Whitney U test showed the ability of the SSQOL-A to differentiate between stroke survivors and healthy participants QOL.

CONCLUSIONS

SSQOL-A has good validity and reliability for patients with mild to moderate stroke.

Effect of core training on dynamic balance and agility among Indian junior tennis players

BACKGROUND

The effect of core training on dynamic balance and agility has yet to be established in literature, especially among junior athletes.

OBJECTIVE

To investigate the effect of core training on dynamic balance and agility among Indian junior tennis players.

METHOD

Thirty junior tennis players from various parts of Delhi and the national capital region participated in the study. The study featured a pre-test/post-test experimental design. The subjects were divided into the experimental group (mean age = 15.20 ± 0.41, mean BMI = 20.23 ± 1.54) and the control group (mean age = 15.53 ± 1.06, mean BMI = 20.71 ± 1.53). The control group performed regular training, and the experimental group followed a five-week core training program along with regular training. The subjects were evaluated with t-test for agility and the Star Excursion Balance Test (SEBT) for dynamic stability.

RESULTS

A significant difference was found in the post-test values of agility (t-test p= 0.000) and dynamic balance using SEBT ((anterolateral; p= 0.00), (lateral; p= 0.02), (posterolateral; p= 0.00), (posterior; p= 0.00), (posteromedial; p= 0.01), (medial; p= 0.03), and (anteromedial; p= 0.03)] except in the anterior direction (p= 0.23)) between the experimental and the control group. The experimental group showed a significant difference in the pre- and post-test values of the t-test and SEBT except in the anterior direction.

CONCLUSION

Core training programs can be incorporated safely with players' regular training to improve their dynamic balance and agility, which can eventually lead to better performance.

Efficacy of complex training on angular velocity of shoulder in collegiate basketball players

BACKGROUND

Shoulder internal rotation angular velocity at the time of ball release is a crucial factor deciding the ball velocity in throwing. Even though there are some studies conducted regarding the effectiveness of complex training on the lower limb, the researchers has not given much attention to the upper limb.

OBJECTIVE

To investigate the efficacy of a complex training program combining plyometric and weight training on the angular velocity of shoulder with a program composed of only plyometric training or only weight training.

METHODS

It was a pre-test - post-test experimental study. Thirty healthy male collegiate basketball players were randomly divided into three groups: Plyometric training group (n= 10), weight training group (n= 10), complex training group which includes both plyometric training and weight training (n= 10). The training was given for six weeks with a frequency of two days per week. Subjects were measured for angular velocity of shoulder before and after the training period by using Biodex upper body cycle. All the three groups were compared by using one way ANOVA. Post-hoc fisher least significant difference (LSD) test was used to find out the difference between groups.

RESULTS

All the groups showed a significant gain in angular velocity after the six-week training period (p< 0.05). However, the improvement attained in complex training group were significantly greater than other training groups (p< 0.05).

CONCLUSION

The study concluded that a combination of plyometric and weight training (complex training) can improve the angular velocity of shoulder in male collegiate basketball players more than plyometric or weight training alone.

Efficacy of FIFA 11+ training program on functional performance in amateur male soccer players

BACKGROUND

The FIFA-Medical and Assessment Research Centre developed FIFA 11+ program as a warm-up program for soccer players. Although the FIFA 11+ program is a well-established warm-up protocol for injury prevention among soccer players, the program's performance enhancement aspect is not frequently discussed in the literature.

OBJECTIVE

To investigate the effects of the FIFA 11+ training program on functional performance in amateur male soccer players.

METHODS

The study included 57 amateur male soccer players from Jamia Hamdard University, who were randomly placed in an experimental group (n= 29) or a control group (n= 28). The experimental group underwent the FIFA 11+ training program for 12 weeks (five times per week) and the control group continued their regular training. The study adopted a pretest-posttest design. The outcome measurements included the following tests: vertical jump, 20-yard sprint run, Illinois agility run test, and t-tests.

RESULTS

Vertical jump and sprint speed were significantly improved in the FIFA 11+ program group compared to the control group (p< 0.05). No statistically significant difference in agility parameters (p> 0.05) was found between the groups.

CONCLUSION

The results show that the FIFA 11+ program may improve the performance of young amateur soccer players. This study may serve as the foundation for further studies with larger participant numbers.

Comparison of Lower Extremity Muscle Flexibility in Amateur and Trained Bharatanatyam Dancers and Nondancers

OBJECTIVE

This study compared lower limb muscle flexibility between amateur and trained female Bharatanatyam dancers and nondancers.

METHODS

Subjects consisted of 105 healthy female volunteers, with 70 female Bharatanatyam dancers (35 trained, 35 amateurs) and 35 controls, with a mean (±SD) age of 16.2±1.04 yrs, height 155.05±4.30 cm, and weight 54.54±2.77 kg. Participants were assessed for range of motion (ROM) in hip flexion, hip extension, hip abduction and adduction, hip external rotation, hip internal rotation, knee flexion, knee extension, ankle dorsiflexion (DF), and ankle plantar flexion (PF) by using a standardized goniometer. To assess for significant difference between groups, one-way ANOVA was applied, and multiple comparisons were made using Bonferroni correction.

RESULTS

Trained dancers had a significantly greater hip flexion, extension, abduction, and external rotation ROM than amateurs and nondancers (p<0.05). Also, internal rotation and adduction were markedly less in trained dancers (p<0.05). Knee flexion, extension, and ankle DF were higher and ankle PF ROM was lesser in trained dancers. However, not much variation was found in ankle DF and PF between amateur dancers and nondancers (p>0.05).

CONCLUSION

Results showed that there are significant differences in lower limb muscle flexibility between trained and amateur Bharatanatyam dancers and nondancers. These differences may be due to individual dance postures such as araimandi and muzhumandi.

Does gender make a difference in knee rotation proprioception and range of motion in healthy subjects?

BACKGROUND

Knee proprioception is an integral component of neuromuscular control system that stabilizes the joints, reducing incidence of injury. Knee injuries' incidences differ between genders. Knee rotation is a component of different knee injury mechanisms. Gender differences in knee proprioception in internal (IR) and external (ER) rotations are not sufficiently studied.

OBJECTIVE

To check whether proprioceptive acuity in IR and ER directions of knee rotation is inherently lower in women compared to men. Moreover, to assess gender difference in ranges of knee rotation.

METHODS

Thirty volunteers (15 women and 15 men) participated. Knee proprioception acuity and ranges of knee rotation were assessed using the knee rotatory kinesthetic device (KRKD). Proprioception was tested using absolute judgment task, subject's ability to discriminate different rotation movements (stimuli) randomly presented, then just notable difference (JND) was calculated; least difference accurately discriminated in 75% of trials.

RESULTS

Women had lower proprioception acuity in IR than men (1.70∘± 0.79∘ and 1.12∘± 0.32∘, p= 0.011) respectively. Active IR (women: 41.29∘± 7.46∘, men 32.80∘± 3.64∘, p= 0.000), and passive IR (women: 53.43∘±11.67∘, men: 37.94∘± 5.22∘, p= 0.000) were higher in women compared to men. Active ER (women: 49.71∘± 11.37∘, men: 39.16∘± 5.46∘, p= 0.003), and passive ER (women: 62.29∘± 13.74∘, men: 48.89∘± 7.09∘, p= 0.002) were, also, higher in women.

CONCLUSION

Gender difference in knee proprioception acuity was found in IR, which is the direction of rotation that anterior cruciate ligament (ACL) stabilize. Women's ranges of knee rotation are greater than men in both IR and ER.

Relation between peak knee flexion angle and knee ankle kinetics in single-leg jump landing from running: a pilot study on male handball players to prevent ACL injury

OBJECTIVES

The relationship between knee kinematics and knee-ankle kinetics during the landing phase of single leg jumping has been widely studied to identify proper strategies for preventing non-contact ACL injury. However, there is a lack of study on knee-ankle kinetics at peak knee flexion angle during jumping from running. Hence, the purpose of this study is to establish the relationship between peak knee flexion angle, knee extension moment, ankle plantar flexion moment and ground reaction force in handball players in order to protect ACL from excessive stress during single leg jumping. In addition, the study also clarifies the role of calf muscles in relieving part of ACL stresses with different knee flexion angles during landing.

METHODS

Fifteen active male elite handball players of Saudi Arabia have participated in this study (Age = 22.6 ± 3.5years, Height = 182 ± 3.7 cm, Weight = 87.5 ± 10.2 kg). The players performed three successful landings of single-leg jump following running a fixed distance of about 450cm. The data were collected using a 3D motion capture and analysis system (VICON).

RESULTS

Pearson product moment correlation coefficients showed that greater peak knee flexion angle is related significantly to both lesser knee extension moment (r = -.623, P = .013) and vertical component of ground reaction force (VGRF) (r = -.688, P = .005) in landing phase. Moreover, increasing the peak knee flexion angle in landing phase tends to increase the ankle plantar flexion moment significantly (r = .832, P = .000).

CONCLUSION

With an increase of the peak knee flexion angle during single leg jump landing from running, there would be less knee extension moment, low impact force and more plantar flexion moment. As such, the clinical implication of this study is that there may be a possible protective mechanism by increasing the knee flexion angle during landing phase, which tends to protect the ACL from vigorous strain and injuries.

Influence of increasing knee flexion angle on knee-ankle varus stress during single-leg jump landing

Objectives

The primary aim of this study was to identify the relationship between the peak knee flexion angle and knee-ankle varus stress in the landing phase of the single-leg jump during running.

Methods

Fifteen male handball players from the first Saudi Arabian handball team were incorporated in this study. Each player performed a single-leg jump-land after running a fixed distance of 450 cm. The data were measured using a 3D motion analysis system. The maximum knee flexion angle, knee varus angle, centre of pressure pathway in the medio-lateral direction, and ankle varus moment were measured.

Results

The Pearson Product Moment Correlation showed that a greater knee flexion angle was related to a greater lateral displacement of the centre of pressure (r = 0.794, P = 0.000), a greater ankle varus moment (r = 0.707, P = 0.003), and a greater knee varus angle (r = 0.753, P = 0.001). In addition, the greater ankle varus moment was related to the greater lateral displacement of the centre of pressure (r = 0.734, P = 0.002).

Conclusions

These findings may help physical therapists and conditioning professionals to understand the impact of increasing knee flexion angle on the lower limb joints. Such findings may help to develop training protocols for enhancing the lateral body reaction during the landing phase of the single-leg jump, which may protect the knee and ankle joints from excessive varus stresses.

Cardio respiratory response: Validation of new modifications of Bruce protocol for exercise testing and training in elite Saudi triathlon and soccer players

The Bruce protocol is the traditional method used to assess maximal fitness level, although it may have limitations, such as its short duration and large work rate increases, with very high levels of exertion that consist of speed/incline combinations. Modifications have been added to elicit similar maximal fitness achievements. The authors of this experimental trial have proposed a new treadmill protocol that allows optimal test duration in conjunction with peak oxygen consumption 'VO2max', and with appropriate patient comfort and safety during both exercise testing and training.

Subjects

Twenty-two elite Saudi players, comprising eleven Saudi triathlon athletes, and eleven Saudi elite soccer players, BMI, body fat mass percentage, body fat free mass percentage. cardiovascular parameter; including, absolute and relative "VO2max" as well as maximal heart rate "HR max", were assessed during a graded treadmill running modified protocol, using a Quark Cardio Pulmonary Exercise Testing Unit (CPET).

Results

Descriptive statistics were used to obtain the anthropometric characteristics, including comparisons between the means, independent sample T-test and a regression analysis, to test the association of the protocol duration and the corresponding, dependent variables.

Conclusions clinical relevance

It is often difficult to achieve a high cardiorespiratory response, VO2max, without an association to high values of HR max, and peak perceived exertion. This may lead to cardiovascular risk. Our new modifications can provide a practical, valid alternative protocol to be used comfortably both during exercise testing and training, rather than performance testing only, to achieve high VO2max with minimal cardiovascular stress.

Does proprioceptive acuity during active knee rotation in the transverse plane vary at different ranges?

BACKGROUND

Knee proprioception in the sagittal plane has been widely investigated in prospective studies, however limited information is known about proprioceptive acuity during active knee rotation and the way most commonly injured.

OBJECTIVE

To investigate whether proprioceptive acuity during active internal and external knee rotation varies at different ranges in the transverse plane.

METHODS

Healthy volunteers (N: 26) without previous injury or surgery of the knee joint participated in the study.Knee rotation proprioceptive acuity was measured using a custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable-difference (JND). Participants actively rotated the knee at different intervals(initial, mid, and terminal internal or external rotation range) to one of four movement blocks and the magnitude of the permitted motion was judged.

RESULTS

The means of the JND for proprioceptive acuity at initial internal rotation (0.80° ± 0.06) were significantly (p< 0.002) lower than for mid (1.62° ± 0.18), and terminal (2.08° ± 0.35) internal rotation. The means of the JND for proprioceptive acuity at initial external rotation (1.16° ± 0.10) were significantly (p< 0.04) lower than for mid (1.95° ± 0.30), and terminal (1.97° ± 0.24) internal rotation.

CONCLUSIONS

Participants perceived smaller differences between active internal and external rotation movements at initial rotation range than at the mid and terminal rotation range of movement. This suggests better proprioceptive acuity at the initial rotation range of movement in the transverse plane.

Prevalence causes and impact of work related musculoskeletal disorders among physical therapists

BACKGROUND

Physical therapists are particularly vulnerable to work-related musculoskeletal disorders (WRMDs).

OBJECTIVE

To evaluate the prevalence, causes and impact of WRMDs among physical therapists in the Kingdom of Saudi Arabia (KSA).

METHODS

A cross-sectional study of physical therapists using a valid and reliable questionnaire. A total of 690 completed surveys were returned (response rate = 69%). The T-test and Pearson's correlation were used to identify correlations between variables and the incidence of WRMDs.

RESULTS

Working hours/week and WRMDs were significantly correlated (p = 0.005). Lower back (46.5%) and neck (26.6%) pain were most commonly encountered. WRMDs were significantly correlated with altered work habits (p = 0.036) but not with body mass index (p = 0.297). The prevalence of WRMDs among physical therapists was 47.7% with a significant difference between full- and part-time practice (p = 0.023). Adjustable beds/plinths (20%) and splints (18%) were the most commonly used assistive devices.

CONCLUSIONS

Physical therapists are especially vulnerable to WRMDs with a prevalence of 47.7%. WRMDs are impacted by both work status and setting. Low back pain is the most common form of WRMDs (46.5%). Avoidance of poor work habits, increased ergonomic awareness and application of safety measures are essential to prevent WRMDs.

Association of postural balance and isometric muscle strength in early- and middle-school-age boys

OBJECTIVE

The purpose of this study was to evaluate the isometric muscle strength (IMS) and dynamic balance in early- and middle-school-age boys and to assess the strength of association between the dynamic balance scores and 6 different IMS indexes.

METHODS

This is a cross-sectional study of a convenience sample of 94 boys who were 6 to 10 years of age and classified into an early school age (6-8 years) group (n = 50) and a middle school age (8-10 years) group (n = 44). Balance was tested using a Biodex Balance System. Anteroposterior Stability Index, Mediolateral Stability Index, and Overall Stability Index were recorded. IMS of 11 muscle groups was measured with a handheld dynamometer and categorized into 6 different muscle strength indices.

RESULTS

The mean (SD) values of anteroposterior, mediolateral, and overall stability indexes observed for all study boys were 1.9 ± 1.0, 1.2 ± 0.7, and 2.5 ± 1.2 respectively. In the middle school age group, strong positive relationships were detected between the overall stability index and trunk, lower limb, anti-gravity, pro-gravity, and total strength indexes (r = -0.86/P < .001, r = -0.91/P < .001, r = -0.88/P < .001, r = -0.83/P < .001, and r = -0.84/P < .001 respectively), while no significant relationship was detected with the upper limb strength index (r = 0.159/P = .303). In the early school age group, moderate positive relationships were detected between the overall stability index and anti-gravity, lower limb, and total strength indexes (r = -0.404/P = .004, r = -0.356/P = .011, and r = -0.350/P = .013 respectively).

CONCLUSION

Dynamic balance did not appear to be mature by the age of 10 years. Better balance skills were recorded in the mediolateral direction than in the anteroposterior direction. In the middle school age group, the overall stability index had positive relationships with almost all examined muscle strength indexes excepting the upper limb strength index.

Proprioceptive acuity in active rotation movements in healthy knees

OBJECTIVES

To investigate the ability of asymptomatic participants to discriminate between active knee rotation movements of different magnitude and to determine whether proprioceptive acuity of active knee rotation differs between limbs (dominant and nondominant and right and left).

DESIGN

Cross-sectional study.

SETTING

Laboratory in an Australian university.

PARTICIPANTS

Healthy volunteers (N=30) without previous cruciate ligament injury or surgery, previous fracture of the lower limbs, or other lower-limb disorders in the last 3 months.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Knee rotation proprioceptive acuity was determined by using our custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable difference (JND). Participants actively rotated the knee (internal or external rotation) to 1 of 4 movement blocks and judged the magnitude of the permitted motion. Proprioceptive acuity scores, representing a participant's ability to detect small differences in magnitude of active knee rotation movements, were then calculated.

RESULTS

The means of the JND for proprioceptive acuity of internal rotation (1.37 degrees +/-.11 degrees ) were significantly (P=.04) lower than for external rotation (1.6 degrees +/-.14 degrees ) regardless of side (right, left) or dominance. No significant difference was found between the mean JND for left and right knee rotations (P=.84) or between the mean JND for dominant and nondominant knee rotation (P=.69).

CONCLUSIONS

Participants perceived smaller differences between active internal rotation movements than external rotation. No significant difference was found between the dominant and nondominant leg or between the left and right leg; therefore, clinicians can establish whether a proprioceptive deficit exists after unilateral injury and can use acuity of the uninjured knee as a normal status for rehabilitation.

Prognosis of conservatively managed anterior cruciate ligament injury: a systematic review

Anterior cruciate ligament (ACL) rupture is a common sporting injury, often managed surgically with patella-tendon or hamstrings-gracilis autograft. Some people who sustain the injury, request information about their prognosis if they choose to forgo surgery and opt for conservative management. Numerous studies provide data on the prognosis of conservatively managed ACL injuries. These studies have not been systematically reviewed. Thus, the aims of this systematic review are to describe the natural history and clinical course of function and proprioception in the conservatively managed ACL-deficient knee, and to identify prognostic factors. We searched MEDLINE, CINAHL, EMBASE, SportDiscus, PEDro and the Cochrane Central Register of Clinical Trials without language restrictions from the earliest record available up to July 2006. We also searched the Science Citation Index, and iteratively searched bibliographies for prospective studies of outcomes (>6 months follow-up) of conservatively managed complete ACL tears. Six criteria were used to assess the methodological quality of included studies. The main outcome measures were self-reported measures of knee function, activity level, performance in functional tasks and knee proprioception. Fifteen studies of variable methodological quality were included in the review. On average, patients with mixed or isolated ACL-deficient knees reported good knee function (87/100 Lysholm knee scale) at follow-up duration of 12-66 months. On average, functional performance assessed with the hop-for-distance test, was in the normal range. From pre-injury to follow-up there was a reduction in Tegner activity level of 21.3%. According to the methods used in the assessed studies, conservatively managed ACL-deficient knees have a good short- to mid-term prognosis in terms of self-reported knee function and functional performance. However, subjects reduced their activity levels on average by 21% following injury.

Design of a knee rotatory kinaesthetic device

The anterior cruciate ligament (ACL) constrains rotatory motion at the knee and is commonly injured during rotational movements in athletic activity. This densely innervated ligament is assumed to play a role in knee proprioception, however, no study has measured proprioception in a manner relevant to either the kinematics of the ligament or the mechanism of injury, partly because of a lack of suitable equipment. The aims of this technical note are to document the development of a novel knee rotatory kinaesthetic device, and to present details of its construction, reproducibility, accuracy and application. The purpose-built device allows rotational movements at the knee to occur with minimal frictional resistance and provides accurate limits to the magnitude of these movements. This allows analysis of subjects' ability to discriminate between movements of differing magnitudes and thus allows calculation of subjects' sensitivity to small differences in magnitude of active knee rotation. Measurements taken with the device had a high level of agreement with those of a calibrated digital inclinometer (ICC=0.99; 95% CI 0.88 to 0.99) with a mean error of 0.24 degrees . The device also demonstrated excellent reproducibility (Pearson's r=1.0). A single case study is presented to detail the clinical application of the device. This novel device allows subjects to perform active knee rotational movements in a closed kinetic chain with discrete, self-paced movement, enabling calculation of movement discrimination. The device is compact and portable enabling testing to be undertaken in remote settings enhancing its clinical applicability.