Abstract Objectives To determine the immediate effects of applied forearm Kinesio taping on maximal grip strength and force sense of healthy collegiate athletes. Design Single group, repeated measures study. Setting Clinical sports medicine laboratory at a university hospital. Participants Twenty-one healthy collegiate athletes voluntarily participated in this study. All subjects were male (average height: 181.24 ± 7.60 cm; average body weight: 72.86 ± 7.03 kg; average age: 20.86 ± 2.59 years). Main Outcome Measures First, maximal grip strength of the dominant hand was assessed by hand-held dynamometer. Then, 50% of maximal grip strength was established as the reference value of force sense. Absolute and related force sense errors and maximal grip strength were measured under three conditions: (1) without taping; (2) with placebo taping; and (3) with Kinesio taping. Results Results revealed no significant differences in maximal grip strength between the three conditions ( p = 0.936). Both related and absolute force sense errors in grip strength measurements significantly increased the accuracy of the results under the three conditions (related force sense errors: p < 0.05; absolute force sense errors: p < 0.05). Conclusion Forearm Kinesio taping may enhance either related or absolute force sense in healthy collegiate athletes. However, Kinesio taping did not result in changes in maximal grip strength in healthy subjects.
Abstract Objective To assess the learning effect, test–retest reliability and measurement error associated with the SEBT. Design Repeated-measures study. Setting Controlled university laboratory environment. Participants Twenty-two healthy recreational athletes (11 male age 22.3 ± 3.7 years, 11 female age 22.8 ± 3.1 years). Main Outcome Measures Repeated-measures ANOVA assessed learning affects. Intraclass correlations coefficients, standard error of measurement and smallest detectable difference values were calculated to assess reliability and measurement error. Results Results showed that excursion distances stabilised after four trials, therefore trials five to seven were analysed for reliability. Test–retest reliability for all reach directions was high, with intraclass correlation coefficients ranging from 0.84 to 0.92. 95% confidence intervals, standard error of measurement and smallest detectable difference ranged from 77.84 to 94.00, 2.21–2.94% and 6.13–8.15%, respectively. Conclusion These statistics will allow clinicians to evaluate whether changes in SEBT scores are due to change in an individual’s performance or random error. The findings of this study show that the SEBT is a reliable measure of lower limb function in healthy recreational athletes. Changes in normalised scores of at least 6–8% are needed to feel confident that a real change in SEBT performance has occurred.
Abstract Objective Demonstrate implementation, safety and feasibility of multimodal, impairment-based physical therapy (PT) combining vestibular/oculomotor and cervical rehabilitation with sub-symptom threshold exercise for the treatment of patients with post-concussion syndrome (PCS). Setting University hospital outpatient sports medicine facility. Participants Twenty-five patients (12–20 years old) meeting World Health Organization criteria for PCS following sport-related concussion referred for supervised PT consisting of sub-symptom cardiovascular exercise, vestibular/oculomotor and cervical spine rehabilitation. Design Retrospective cohort. Main measures Post-Concussion Symptom Scale (PCSS) total score, maximum symptom-free heart rate (SFHR) during graded exercise testing (GXT), GXT duration, balance error scoring system (BESS) score, and number of adverse events. Results Patients demonstrated a statistically significant decreasing trend (p < 0.01) for total PCSS scores (pre-PT M = 18.2 (SD = 14.2), post-PT M = 9.1 (SD = 10.8), n = 25). Maximum SFHR achieved on GXT increased 23% (p < 0.01, n = 14), and BESS errors decreased 52% (p < 0.01, n = 13). Two patients reported mild symptom exacerbation with aerobic exercise at home, attenuated by adjustment of the home exercise program. Conclusions Multimodal, impairment-based PT is safe and associated with diminishing PCS symptoms. This establishes feasibility for future clinical trials to determine viable treatment approaches to reduce symptoms and improve function while avoiding negative repercussions of physical inactivity and premature return to full activity.
Patellofemoral pain (PFP) is one of the most prevalent conditions within sports medicine, orthopaedic and general practice settings. Long-term treatment outcomes are poor, with estimates that more than 50% of people with the condition will report symptoms beyond 5 years following diagnosis. Additionally, emerging evidence indicates that PFP may be on a continuum with patellofemoral osteoarthritis. Consensus of world leading clinicians and academics highlights the potential benefit of delivering tailored interventions, specific to an individual's needs, to improve patient outcome. This clinical masterclass aims to develop the reader's understanding of PFP aetiology, inform clinical assessment and increase knowledge regarding individually tailored treatment approaches. It offers practical application guidance, and additional resources, that can positively impact clinical practice.
Abstract Objective This study examined the difference in the isokinetic knee performance in healthy subjects with and without the Kinesio tape application onto the skin surface overlying the vastus medialis. Design A cross-sectional experimental study. Setting Clinical setting. Participants 30 healthy participants. Main outcome measures Maximal concentric knee extension and flexion at three angular velocities (60, 120 and 180°/s) were measured with an isokinetic dynamometer. Normalized peak torque, normalized total work done and time to peak torque of knee extension and flexion were compared by repeated measures ANOVA. Results There was no significant main effect in ANOVA in normalized peak torque and normalized total work done between taping conditions and angular velocities. Conversely, participants demonstrated significant shorter time to peak extension torque with the tape condition ( p = 0.03). Pair-wise comparisons indicated that such time reduction (36–101 ms) occurred at all three angular velocities ( p < 0.01). Conclusion This investigation demonstrated the application of Kinesio tape did not alter the muscle peak torque generation and total work done but shortened the time to generate peak torque. This finding may contribute to the rationale in injury prevention and rehabilitation in athletes with Kinesio taping.
Abstract Objectives To evaluate frontal and sagittal plane ankle kinematics between subjects with chronic ankle instability (CAI) and healthy controls while walking and jogging shod on a treadmill. Design Cross-sectional study. Setting Motion analysis laboratory. Participants Fifteen subjects with self-reported CAI and 13 healthy subjects volunteered. Main outcome measures Sagittal and frontal plane ankle kinematics were calculated throughout the gait cycle. For each speed, the means and associated 90% confidence intervals (CIs) were calculated in each plane across the entire gait cycle and increments in which the CI bands for the groups did not cross each other for at least 3 consecutive percentage points of the gait cycle were identified. Results At various increments while both walking and jogging, CAI subjects were found to be more plantar flexed compared to controls. In the frontal plane, CAI subjects were found to be more inverted at three different increments while jogging only. Conclusions While shod, kinematic differences were observed between groups. The alterations may indicate that while shod, CAI subjects may adjust their gait in order to successfully accomplish the given task.
Abstract Objectives The purpose of this study was to determine the effect of an internal and external attentional focus on single leg hop jump distance and knee kinematics in patients after ACL reconstruction (ACLR). Design Experimental. Setting Outpatient physical therapy facility. Participants Sixteen patients after ACLR. Main Outcome Measures Patients received either an instruction with an internal focus or an external focus before performing a single leg hop jump. The jump distance, knee valgus angle at initial contact, peak knee valgus angle, knee flexion angle at initial contact, peak knee flexion angle, total ROM and time to peak angles for the injured and non-injured legs were recorded. A repeated measures MANOVA was used to determine significance between the experimental conditions with the primary outcome measures as dependent variables. Results The external focus group had significant larger knee flexion angles at initial contact, peak knee flexion, total ROM and time to peak knee flexion for the injured legs. Conclusions This study demonstrates the applicability of using an external focus during rehabilitation of patients after ACLR to enhance safer movement patterns compared to an internal focus of attention and subsequently may help to reduce second ACL injury risk.
To evaluate the kinematic, kinetic and electromyographic (EMG) immediate effects of foot orthoses (FOs) during walking, maximal single-leg side jump landing (SIDE) and unilateral drop landing on even (DROP), inclined and unstable (FOAM) surfaces in individuals with chronic ankle instability (CAI). Cohort study. Biomechanics laboratory. 26 healthy individuals with CAI. Ankle and knee angles/moments and lower-limb EMG of the gluteus medius, vastus medialis, vastus lateralis, biceps femoris, gastrocnemis medialis, gastrocnemius lateralis, peroneus longus and tibialis anterior muscles. The main results are that with FOs, individuals with CAI exhibited decreased tibialis anterior muscle activity from 19 to 38% and 39–99% of the landing phase during the DROP task. They also exhibited increased biceps femoris muscle activity from 56 to 65% of the preactivation phase during walking. No significant ankle and knee joints angles and moments difference was observed when wearing FOs in any of the experimental tasks. The results of this study suggest that the biomechanical effects of FOs are task-dependent and only affect EMG activity. They will help clinicians and researchers to better understand FOs’ role in treatment and prevention of CAI.
In National Collegiate Athletic Association Division I swimmers, we examined the differences in thoracic spine rotation in swimmers with and without scapular dyskinesis and the relationship between thoracic spine rotation and shoulder pain/dysfunction according to the Kerlan-Jobe Orthopaedic Clinic (KJOC) score. Cross-sectional. Laboratory-based. 34 NCAA Division I swimmers (13 males, 21 females). Self-reported upper extremity function and pain assessed with the KJOC questionnaire, thoracic spine range of motion, presence of scapular dyskinesis. Dyskinesis was present in 15 of 34 (44%) subjects. Thoracic rotation averaged 136.7° and KJOC averaged 87.7 with no differences between swimmers with or without dyskinesis. We observed no correlation between KJOC-identified shoulder pain/dysfunction and thoracic rotation. In our cohort of NCAA Division 1 swimmers, no differences were found between swimmers with or without scapular dyskinesis and extent of thoracic rotation. We found no correlation between thoracic rotation and the amount of self-reported pain and dysfunction experienced in the upper extremity. The presence of scapular dyskinesis in nearly half of our subjects indicates that swimmers need to be assessed for this abnormality. If observed, rehabilitation should address the dyskinesis and improve thoracic rotation in an attempt to alleviate further upper extremity pain and dysfunction.
To report physical characteristics of lower-limb strength, endurance, range of motion, balance, and pain during adductor squeeze in elite female Australian Football (AF) players, and to examine the effect of limb dominance, previous AF experience, age, and previous level of sports participation on these characteristics. Cross-sectional study. Three elite AF clubs. Eighty-five female players. All were aged ≥18, contracted for the 2018 season, and participated in pre-season training. The physical characteristic assessments included; pain on adductor squeeze, weight-bearing lunge, side bridge, isometric hip abduction and adduction strength, and the modified star excursion balance test. The adductor squeeze had low pain scores, with 93% of players scoring ≤2 on the numerical rating scale. Other assessment results were (mean ± SD): 10.8 ± 2.7 cm for weight-bearing lunge, 95 ± 39s for side bridge, 1.85 ± 0.23 and 1.85 ± 0.36Nm/kg for hip abduction and adduction strength respectively, and 92 ± 8% for the modified star excursion balance test. There was no clinically relevant effect of limb dominance, previous AF experience, age, or previous level of sports on physical characteristics. Physical characteristics for five assessments are reported. These data can be used for comparison purposes in the screening and clinical management of elite female AF players.
Round shoulder posture (RSP) may exaggerate symptoms of subacromial impingement. The effects of kinesiology taping with exercise on posture, pain, and functional performance were investigated in subjects with impingement and RSP. This study was a single-blinded randomized controlled trial. An outpatient rehabilitation clinic in a university hospital. Thirty-four subjects with subacromial impingement and RSP. Kinesiology taping with and without tension was applied 2 times per week for 4 weeks. Both groups also performed strengthening and stretching exercises 3 times per week for 4 weeks. The pain level, shoulder angle and self-reported score were evaluated at pre-intervention, 2-week post-intervention and 4-week post-intervention time points. Functional performance improved after intervention in both groups (p = 0.027). A greater decrease in pain level was related to better functional performance of the shoulder in both groups ( = −0.760 and −0.674; p < 0.010). Moderate correlations were found for posture and functional performance of the shoulder in the intervention group (0.48). Four weeks of strengthening and stretching exercises with or without kinesiology taping improved functional performance in subjects with impingement and RSP. Improvement in clinical symptoms was related to better performance of posture.
To examine the immediate effects of prolonged patellar tendon vibration on quadriceps strength in anterior cruciate ligament reconstructed (ACLR) knees with bone-patellar tendon-bone (BTB) grafts and non-BTB grafts, and healthy control knees. Pretest-posttest design. Laboratory. Young adult participants were stratified into one of three groups: non-BTB graft (n = 25), BTB graft (n = 26), and controls without ACLR (n = 21). Maximum voluntary isometric contraction (MVIC) knee extension torque was measured at baseline and following a 20-min vibration intervention applied locally to the patellar tendon. Our findings suggest there was no difference in the effects of vibration on knee extension torque between the three groups. Knee extension torque significantly increased (effect size = 0.52 [0.18 to 0.81]) from baseline to post-vibration across all three groups (0.30 ± 0.26 Nm/kg, 21.8 ± 20.0%). Both ACLR groups demonstrated significantly lower knee extension torque compared the control group. The vibration intervention had a net excitatory effect on quadriceps strength in all three groups and there were no differences in the magnitude of change between the three groups. Vibration could become a useful tool for enhancing quadriceps strength in ACLR and healthy knees.
To investigate whether relationships between kinesiophobia, lower extremity function, and patient-reported function differ by self-reported physical activity engagement after ACL reconstruction (ACLR). Cross-sectional. Laboratory. Seventy-seven patients with a primary, unilateral ACLR. Kinesiophobia (TSK-17) was the primary outcome. Lower extremity function included quadriceps and hamstrings strength, fatigue, and hop performance. Patient-reported function included regional function (IKDC, KOOS subscales) and physical activity engagement (Godin Leisure-Time Exercise). Patients were evaluated together, then stratified by LOW and HIGH physical activity. Correlations and multiple regression analyses identified relationships between kinesiophobia and outcome measures. Greater kinesiophobia was associated with lesser hamstrings strength, hop performance, and patient-reported function. Greater hamstrings fatigue and lesser KOOS explained greater kinesiophobia in patients reporting LOW physical activity. Lesser triple hop symmetry, crossover hop distance, and IKDC explained greater kinesiophobia in patients reporting HIGH physical activity. Greater kinesiophobia associated with worse outcomes after ACLR. Relationships differed by self-reported physical activity engagement. Interventions that improve the ability to perform knee-related activities of daily living may be appropriate to minimize the impact of fear in less active patients, while those targeting hop performance and knee-related sport activities may be better suited for more active patients.
To systematically identify, appraise, and examine evidence regarding the effects of therapeutic tape on pain and function in individuals with lateral epicondylalgia (LE). Five electronic databases were systematically searched up to March 2018. Full-text, peer-reviewed, English-language studies were included if they had an LE population, a standalone tape condition, and an outcome related to pain or function. Eight out of 2022 screened studies were included. Three studies demonstrated immediate (i.e. within 1 h) improvements in pain and pain-free grip strength following diamond deloading rigid tape. One study reported immediate improvements in proprioception following transverse rigid tape. The immediate effects of longitudinal kinesiotape were inconsistent. One study reported improvements in pain and pain-free grip strength, while another study reported no effect on pain, strength, or muscle activity. Two studies examined short-term (i.e. within six weeks) kinesiotape application. One study reported two weeks of longitudinal kinesiotape improved pain and maximum grip strength. The other study reported one week of diamond kinesiotape improved patient-reported pain and function, but not maximum grip strength. In individuals with LE, diamond deloading rigid tape may immediately improve pain and strength. There is conflicting evidence regarding kinesiotape effects in both immediate and short-term timeframes.
Side-to-side asymmetry of lower-limb motor-performance is associated with increased noncontact injury risk in agility-sports. Side-to-side symmetry-analyses using single-leg balance and hop tests has not been reported for community-level adult netball players. The purpose of this study was to perform preseason side-to-side symmetry-analyses using eyes-closed-balance (ECB), triple-hop-for-distance (THD), single-hop-for-distance (SHD), and vertical-hop (VH) tests. Cross-sectional; Community-level adult netball club. Twenty-three female players (age 28.7 ± 6.2yr; height 171.6 ± 7.0 cm; mass 68.2 ± 9.8 kg). Right-left group-level comparisons (paired -test) and individual-level comparisons (absolute-asymmetry (%)). A limb symmetry index was calculated for each test and a clinically-significant absolute-asymmetry defined as >10%. Clinically-significant absolute-asymmetry prevalence (%) was computed for each test. There were no right-left significant differences for any test. Maximum absolute-asymmetries for the ECB, THD, SHD, and VH were 93.3%, 15.2%, 16.7%, and 60.3%, respectively. The prevalence of clinically-significant absolute-asymmetries for the ECB, THD, SHD, and VH was 91.3%, 8.7%, 8.7%, and 52.2%, respectively. Group-level comparisons with statistical tests fail to expose the extent of clinically-significant absolute-asymmetries. Most players demonstrated preseason clinically-significant absolute-asymmetries for the ECB and VH tests. Preseason clinically-significant absolute-asymmetries that may predispose increased lower-limb noncontact injury risk are widespread in a community-level adult netball club.
To examine the feasibility of recommended education and exercise supplemented by a hopping intervention implemented based on self-reported pain over 12 weeks for recreational runners with Achilles tendinopathy. Single cohort feasibility study. One private physiotherapy clinic in Melbourne, Australia. Fifteen male recreational runners with midportion Achilles tendinopathy. Recruitment and adherence measures, adverse events, intervention acceptability and treatment effect trends were measured at baseline, 4 and 12 weeks. Recruitment (100%), retention (87%) and follow-up (93%) rates were high. Exercise adherence was 70% (SD = 12.7) but fidelity was 50% (SD = 13.9). Three participants suffered adverse events (undertaking activities contrary to advice). Participants reported the education package, perceived benefit, and feedback frequency as intervention enablers; while the onerous time commitment was regarded a barrier. At 12 weeks, five participants were satisfied and eight very satisfied, while VISA-A had improved 24 ± 20.65 points (μ2 = 0.740). A randomised control trial including recommended education and exercise with a pain-guided hopping intervention as treatment for recreational runners with midportion Achilles tendinopathy may be warranted, once strategies to improve adherence and reduce adverse events are addressed.
Chronic ankle instability (CAI) is reported after ankle sprain. Our aim was to assess differences in mechanical pain sensitivity of lower extremity nerve trunks and physical performance between amateur soccer players with and without CAI. A cross-sectional case-control study. Amateur soccer teams. Fifty-five male soccer players, 28 with and 27 without CAI participated. The perceived instability was assessed with the Cumberland Ankle Instability Tool (CAIT). Pressure pain thresholds (PPTs) on the common peroneal and tibialis nerve trunks, vertical jump, lateral step-down test and joint position sense of the knee were assessed by a blinded assessor. Soccer players with CAI showed lower PPTs over the common peroneal nerve than those without CAI (between-groups mean difference: 1.0 ± 0.8 kg/cm , P 0.310]) were found. PPT over the common peroneal nerve exhibited a significant moderate correlation with the CAIT score (r = 0.528, P < 0.001). Amateur soccer players with CAI have higher pressure pain sensitivity over the common peroneal nerve but exhibit similar physical performance to amateur soccer players without CAI.
To investigate factors associated with injury in amateur male and female rugby union players. A prospective cohort study. Amateur rugby clubs in Ireland. Male (n = 113) and female (n = 24) amateur rugby union players from 5 of the top 58 amateur clubs in Ireland. Pre-season testing included physical tests assessing hamstring flexibility, dorsiflexion range of movement, adductor muscle strength and foot position. Wellness questionnaires assessed sleep quality (PSQI), coping skills (ACSI-28) and support levels (PASS-Q). Players were monitored throughout the season for injury. The time-loss match injury incidence rate was 48.2/1000 player hours for males and 45.2/1000 player hours for females. Two risk profiles emerged involving; ‘age + navicular drop + training pitch surface’ (53%) and ‘age + navicular drop + groin strength’ (16%). An inverse relationship between groin strength and groin injury was found for the ‘backs’ players (−0.307, < 0.05). Using the PSQI, 61% of players had poor sleep quality, however no relationship between the wellness questionnaires and injury was found. Two injury risk profiles emerged, associated with subsequent injury occurrence. Using these risk profiles, individualized prevention strategies may be designed regarding deficits in groin muscle strength and identifying foot alignment.
In this study we describe the first analysis of the relationship between acute-to-chronic valgus workload ratio (ACVR) and injury in baseball. Observational study. Competitive, team sport. Eighteen, elite male baseball players (aged 17.0 ± 0.7 year, height 185 ± 5.7 cm, and mass 85.2 ± 7.6 kg) competing at the varsity level participated in this six-month study. Each player wore the motusTHROW™ sleeve and sensor during pre-season training and the entire 2017 regular season. ACVR and injury. Overall there were a total of ten injuries recorded throughout the 2017 season amongst those wearing the sleeves, including six throwing-related injuries. Over 159 days of throwing, a total of 171,703 throws, and 1307 exposures were captured with the motusTHROW™ sensors. Five of the six throwing-related injuries occurred when athletes had an ACVR greater than 1.27, which marks the 75th percentile across all observations. Results from logistic regression suggested that ACVR was significantly related to injury occurrence (p < .05). This resulted in an odds ratio of 15.2 and a risk ratio of 14.9, meaning that ACVR ratios above 1.27 were 14.9 times more likely to result in injury than ACVR ratios below 1.27. Logistic regression reveals a significant relationship between ACVR and injury occurrence such that high ACVRs may increase injury risk.