The Effect of Cryotherapy Application to the Knee Joint on Dynamic Postural Stability.

CONTEXT: Decreased postural balance is a primary risk factor for lower-limb injuries. Cryotherapy is commonly utilized by clinicians to provide local analgesia for minor acute knee joint musculoskeletal injuries during breaks in play or at halftime. Its effect on dynamic postural balance remains unclear. OBJECTIVE: To investigate the acute effects of a 15-minute knee joint cryotherapy application on dynamic postural balance, as assessed primarily via a clinically oriented outcome measure. DESIGN: Experimental study. SETTING: University biomechanics laboratory. PATIENTS OR PARTICIPANTS: A total of 28 elite-level college male field-sport athletes. INTERVENTION: Participants were tested on the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test both before and after a 15-minute knee joint cryotherapy application. MAIN OUTCOME MEASURE(S): Normalized reach distances, 3-dimensional knee joint kinematics, sagittal plane hip and ankle joint kinematics, as well as fractal dimension of the center-of-pressure path during the performance of the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test. RESULTS: There was a statistically significant decrease in reach distance scores achieved on anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test from precryotherapy to postcryotherapy (P < .05). None of the decreases in reach distance scores exceeded the reported smallest detectable difference values. No significant differences were observed in hip, knee, or ankle joint kinematics (P > .05). No significant change in fractal dimension was observed for any reach direction following cryotherapy application (P > .05). CONCLUSIONS: The results of the present study indicate that dynamic postural balance is unlikely to be adversely affected immediately following cryotherapy application to the knee joint.

Capturing concussion related changes in dynamic balance using the Quantified Y Balance Test - a case series of six elite rugby union players.

Concussion is one of the most common injuries reported across a myriad of sports. Recent evidence suggests that individuals may possess sensorimotor deficits beyond clinical recovery, predisposing them to further injury. This preliminary prospective case series aimed to determine if an inertial sensor instrumented Y balance test can capture changes in dynamic balance, regardless of apparent `clinical recovery', in six concussed elite rugby union players. The findings from this case series demonstrate that the inertial sensor-based measures can detect clinically meaningful changes in dynamic balance performance, not captured by the traditional clinical scoring methods, 48-hours post-injury and at the point of `clinical recovery' (return to play). Further research should investigate the role such instrumented dynamic balance assessments may play in the management of sports-related concussion.

Dynamic balance performance varies by position but not by age group in elite Rugby Union players - a normative study.

This cohort study aimed to provide normative Y Balance Test scores for an elite Rugby Union population, while investigating the effect player age groups (senior/under-20), playing positions (forwards/backs) and anthropometrics (height and body mass) had on performance.  Two-hundred and sixty-one elite male under-20 (n = 50) and senior (n = 211) players completed baseline Y Balance Test during the 2015/2016 season. One-way ANCOVA and post-hoc t-tests were used to investigate the effect playing position, player group, height and weight had on performance. The cohort was then stratified into groups (age group and/or playing position), and normative percentiles were presented. There was a statistically significant difference (p < 0.05) in Y Balance Test performance between playing positions, when controlling for age group. This difference did not remain when controlling for player body mass. Post-hoc analysis demonstrated that backs had a longer normalised reach distance, with medium-large and small-medium effect sizes for the under-20 and senior cohorts respectively. The one-way ANCOVA analysis suggests that this difference is likely due to the larger differences in player body mass between forward and back playing positions. The normative values presented in this paper may be used by clinicians and researchers to aid injury prevention and rehabilitation strategies.

Association of Dynamic Balance With Sports-Related Concussion: A Prospective Cohort Study.

BACKGROUND: Concussion is one of the most common sports-related injuries, with little understood about the modifiable and nonmodifiable risk factors. Researchers have yet to evaluate the association between modifiable sensorimotor function variables and concussive injury. PURPOSE: To investigate the association between dynamic balance performance, a discrete measure of sensorimotor function, and concussive injuries. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A total of 109 elite male rugby union players were baseline tested in dynamic balance performance while wearing an inertial sensor and prospectively followed during the 2016-2017 rugby union season. The sample entropy of the inertial sensor gyroscope magnitude signal was derived to provide a discrete measure of dynamic balance performance. Logistic regression modeling was then used to investigate the association among the novel digital biomarker of balance performance, known risk factors of concussion (concussion history, age, and playing position), and subsequent concussive injury. RESULTS: Participant demographic data (mean ± SD) were as follows: age, 22.6 ± 3.6 years; height, 185 ± 6.5 cm; weight, 98.9 ± 12.5 kg; body mass index, 28.9 ± 2.9 kg/m2; and leg length, 98.8 ± 5.5 cm. Of the 109 players, 44 (40.3%) had a history of concussion, while 21 (19.3%) sustained a concussion during the follow-up period. The receiver operating characteristic analysis for the anterior sample entropy demonstrated a statistically significant area under the curve (0.64; 95% CI, 0.52-0.76; P < .05), with the cutoff score of anterior sample entropy ≥1.2, which maximized the sensitivity (76.2%) and specificity (53.4%) for identifying individuals who subsequently sustained a concussion. Players with suboptimal balance performance at baseline were at a 2.81-greater odds (95% CI, 1.02-7.74) of sustaining a concussion during the rugby union season than were those with optimal balance performance, even when controlling for concussion history. CONCLUSION: Rugby union players who possess poorer dynamic balance performance, as measured by a wearable inertial sensor during the Y balance test, have a 3-times-higher relative risk of sustaining a sports-related concussion, even when controlling for history of concussion. These findings have important implications for research and clinical practice, as it identifies a potential modifiable risk factor. Further research is required to investigate this association in a large cohort consisting of males and females across a range of sports.

Fitness Profiles of Elite Adolescent Irish Rugby Union Players.

Wood, DJ, Coughlan, GF, and Delahunt, E. Fitness profiles of elite adolescent Irish rugby union players. J Strength Cond Res 32(1): 105-112, 2018-Rugby unions throughout the world are implementing player development models to prepare young players to meet the demands of professional rugby union. An example of this is the Irish Rugby Football Union Long Term Player Development model. The purpose of this study was to provide normative data relating to the physical fitness of elite adolescent Irish rugby union players and determine the differences in the physical capacities between players in the forward and back units as well as to provide descriptive data for the position categorizations within these units for this unique population. Players in the forward unit were significantly taller and heavier than players in the back unit (1.85 ± 0.06 m and 96.88 ± 9.00 kg vs. 1.79 ± 0.05 m and 81.97 ± 7.09 kg, respectively). Forwards (38.37 ± 4.00 cm) had a significantly lower countermovement jump height than backs (41.31 ± 4.44 cm). Forwards had a significantly lower triple hop for the distance score on their right (5.78 ± 0.52 m) and left (5.78 ± 0.55 m) legs compared with backs (6.26 ± 0.42 m and 6.33 ± 0.45 m, respectively). Forwards (1.85 ± 0.07 seconds) had a significantly higher 10-m sprint time than backs (1.77 ± 0.06 seconds). Furthermore, forwards (675.90 ± 82.46 m) had a significantly lower 150-m shuttle test score than backs (711.71 ± 27.46 m). The results of this study provide normative data for players who currently possess underage international potential and could be used by strength and conditioning coaches to guide the selection of players through talent identification processes.

Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test.

OBJECTIVES: The Y Balance Test is one of the most commonly used dynamic balance assessments, providing an insight into the integration of the sensorimotor subsystems. In recent times, there has been an increase in interest surrounding it's use in various clinical populations demonstrating alterations in motor function. Therefore, it is important to examine the effect physiological influences such as fatigue play in dynamic postural control, and establish a timeframe for its recovery. DESIGN: Descriptive laboratory study. METHODS: Twenty male and female (age 23.75±4.79years, height 174.12±8.45cm, mass 69.32±8.76kg) partaking in competitive sport, completed the Y Balance Test protocol at 0, 10 and 20min, prior to a modified 60s Wingate fatiguing protocol. Post-fatigue assessments were then completed at 0, 10 and 20 min post-fatiguing intervention. RESULTS: Intraclass correlation coefficients demonstrated excellent intra-session reliability (0.976-0.982) across the three pre-fatigue YBT tests. Post-hoc paired sample t-tests demonstrated that all three reach directions demonstrated statistically significant differences between pre-fatigue and the first post-fatigue measurement (anterior; p=0.019, posteromedial; p=0.019 & posterolateral; p=0.003). The anterior reach direction returned to pre-fatigue levels within 10min (p=0.632). The posteromedial reach direction returned to pre-fatigue levels within 20min (p=0.236), while the posterolateral direction maintained a statistically significant difference at 20min (p=0.023). CONCLUSIONS: Maximal anaerobic fatigue has a negative effect on normalised Y balance test scores in all three directions. Following the fatiguing protocol, dynamic postural control returns to pre-fatigue levels for the anterior (<10min), posteromedial (<20min) and posterolateral (>20min).

Challenging concussed athletes: the future of balance assessment in concussion.

The assessment and management of sports-related concussion has become a contentious issue in the field of sports medicine. The current consensus in concussion evaluation involves the use of a subjective examination, supported by multifactorial assessment batteries designed to target the various components of cerebral function. Balance assessment forms an important component of this multifactorial assessment, as it can provide an insight into the function of the sensorimotor subsystems post-concussion. In recent times, there has been a call to develop objective clinical assessments that can aid in the assessment and monitoring of concussion. However, traditional static balance assessments are derived from neurologically impaired populations, are subjective in nature, do not adequately challenge high functioning athletes and may not be capable of detecting subtle balance disturbances following a concussive event. In this review, we provide an overview of the importance of assessing motor function following a concussion, and the challenges facing clinicians in its assessment and monitoring. Additionally, we discuss the limitations of the current clinical methods employed in balance assessment, the role of technology in improving the objectivity of traditional assessments, and the potential role inexpensive portable technology may play in providing objective measures of more challenging dynamic tasks.

Inertial Sensor Technology Can Capture Changes in Dynamic Balance Control during the Y Balance Test.

INTRODUCTION: The Y Balance Test (YBT) is one of the most commonly utilised clinical dynamic balance assessments. Research has demonstrated the utility of the YBT in identifying balance deficits in individuals following lower limb injury. However, quantifying dynamic balance based on reach distances alone fails to provide potentially important information related to the quality of movement control and choice of movement strategy during the reaching action. The addition of an inertial sensor to capture more detailed motion data may allow for the inexpensive, accessible quantification of dynamic balance control during the YBT reach excursions. As such, the aim of this study was to compare baseline and fatigued dynamic balance control, using reach distances and 95EV (95% ellipsoid volume), and evaluate the ability of 95EV to capture alterations in dynamic balance control, which are not detected by YBT reach distances. METHODS: As part of this descriptive laboratory study, 15 healthy participants completed repeated YBTs at 20, 10, and 0 min prior to and following a modified 60-s Wingate test that was used to introduce a short-term reduction in dynamic balance capability. Dynamic balance was assessed using the standard normalised reach distance method, while dynamic balance control during the reach attempts was simultaneously measured by means of the 95EV derived from an inertial sensor, worn at the level of the 4th lumbar vertebra. RESULTS: Intraclass correlation coefficients for the inertial sensor-derived measures ranged from 0.76 to 0.92, demonstrating strong intrasession test-retest reliability. Statistically significant alterations (p < 0.05) in both reach distance and the inertial sensor-derived 95EV measure were observed immediately post-fatigue. However, reach distance deficits returned to baseline levels within 10 min, while 95EV remained significantly increased (p < 0.05) beyond 20 min for all 3 reach distances. CONCLUSION: These findings demonstrate the ability of an inertial sensor-derived measure to quantify alterations in dynamic balance control, which are not captured by traditional reach distances alone. This suggests that the addition of an inertial sensor to the YBT may provide clinicians and researchers with an accessible means to capture subtle alterations in motor function in the clinical setting.

Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint.

CONTEXT: Decreased postural stability is a primary risk factor for lower limb musculoskeletal injuries. During athletic competitions, cryotherapy may be applied during short breaks in play or during half-time; however, its effects on postural stability remain unclear. OBJECTIVE: To investigate the acute effects of a 15-minute ankle-joint cryotherapy application on dynamic postural stability. DESIGN: Controlled laboratory study. SETTING: University biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 29 elite-level collegiate male field-sport athletes (age = 20.8 ± 1.12 years, height = 1.80 ± 0.06 m, mass = 81.89 ± 8.59 kg) participated. INTERVENTION(S): Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Star Excursion Balance Test before and after a 15-minute ankle-joint cryotherapy application. MAIN OUTCOME MEASURE(S): Normalized reach distances; sagittal-plane kinematics of the hip, knee, and ankle joints; and associated mean velocity of the center-of-pressure path during performance of the ANT, PL, and PM reach directions of the Star Excursion Balance Test. RESULTS: We observed a decrease in reach-distance scores for the ANT, PL, and PM reach directions from precryotherapy to postcryotherapy (P < .05). No differences were observed in hip-, knee-, or ankle-joint sagittal-plane kinematics (P > .05). We noted a decrease in mean velocity of the center-of-pressure path from precryotherapy to postcryotherapy (P < .05) in all reach directions. CONCLUSIONS: Dynamic postural stability was adversely affected immediately after cryotherapy to the ankle joint.

Star Excursion Balance Test performance and application in elite junior rugby union players.

OBJECTIVES: To evaluate performance on selected reach directions of the Start Excursion Balance Test (SEBT) in an elite underage rugby union population, and determine if differences exist between the forward and back position units. This information may have implications for the application of this test in player injury prevention and management. DESIGN: Descriptive study. SETTING: Gymnasium at an elite junior rugby union screening camp. PARTICIPANTS: 102 healthy male elite rugby union players (age = 17.9 ± 1.1 years, height = 1.83 ± 0.07 m, body mass = 90.5 ± 11.3 kg). MAIN OUTCOME MEASURES: Participants were assessed on the Anterior (A), Posterior-medial (PM), and Posterior-lateral (PL) reach directions of the SEBT. RESULTS: Normative data for SEBT performance in the A, PM and PL reach directions were established for an elite junior rugby union population. No significant differences in dynamic postural stability were observed between the forward and back position units. CONCLUSIONS: This study provides normative SEBT data on an elite junior rugby union population, which enables clinicians to compare player dynamic postural stability and has implications for use in the prevention and management of player injuries.

Normative adductor squeeze test values in elite junior rugby union players.

OBJECTIVE: To establish normative adductor squeeze test (AST) values in elite junior rugby union players and investigate if differences existed between field position units and categorizations. DESIGN: Cross-sectional study. SETTING: National underage screening camp. PARTICIPANTS: One hundred four healthy players attending an under-19 and under-18 national musculoskeletal and fitness screening camp. Players had no history of surgery, no self-reported history of groin or pelvic pain in either limb and no other lower limb injury in the past 3 months, and no pain reported during the testing procedure. MAIN OUTCOME MEASURES: The AST in 3 positions of hip flexion (0, 45, and 90 degrees), position unit, and categorizations. RESULTS: The highest AST values were observed at 45 degrees of hip flexion in all field position categories. No differences were observed between position units and categorizations. CONCLUSIONS: Normative AST values in an elite junior rugby union population were established in this investigation. Clinically, the sports medicine professional may use these results in making decisions on the management of both symptomatic and asymptomatic players.

Concussion history and reporting rates in elite Irish rugby union players.

OBJECTIVES: To determine the self-reported, seasonal rates of concussion and the reporting practices among Irish rugby union players. DESIGN: Descriptive epidemiology study. SETTING: The study was conducted at the training grounds of four professional Irish rugby union clubs. PARTICIPANTS: One hundred seventy-two players (24.97 ± 4.11 years of age, 13.49 ± 5.79 years playing experience) gave consent to participate. MAIN OUTCOME MEASURES: Number of concussions reported during the 2010-2011 season, reasons for not reporting, and positions of concussed players. RESULTS: Forty-five percent of players reported at least one concussion during the 2010-2011 season, but only 46.6% of these presented to medical staff. The reasons for not reporting their concussions included, not thinking the injury was serious enough, and not wanting to be removed from the game. The relative proportion of concussions was higher for backs than forwards; however, the severity of injury was greater for forwards. Scrum-halves (12.0%) and flankers (10.9%) accounted for the majority of concussions reported. CONCLUSIONS: The self-reported rate of concussion in elite rugby union players in Ireland is higher than reported in other countries or other sports. Many concussions remain unreported and, therefore, unmanaged. However, recent changes in concussion management guidelines by the International Rugby Board may impact future reporting practices of players.

Kinematic analysis of selected reach directions of the Star Excursion Balance Test compared with the Y-Balance Test.

CONTEXT: The Star Excursion Balance Test (SEBT) and the Y-Balance Test (YBT) have 3 common reach directions: anterior (ANT), posteromedial (PM), and posterolateral (PL). Previous research has indicated that reach-distance performance on the ANT reach direction of the SEBT differs from that on the YBT. Kinematic patterns associated with the ANT reach direction of the SEBT and YBT need to be investigated to fully understand this difference, along with the PM and PL reach directions, to deduce any kinematic discrepancies between the 2 balance tests. OBJECTIVE: To compare and contrast the kinematic patterns associated with test performance on the reach directions common to the SEBT and YBT. DESIGN: Controlled laboratory study. SETTING: University laboratory. PARTICIPANTS: 15 healthy male (age 23.33 ± 2.02 y, height 1.77 ± 0.04 m, body mass 80.00 ± 9.03 kg) and 14 healthy female (age 21.14 ± 1.66 y, height 1.63 ± 0.06 m, body mass 59.58 ± 7.61 kg) volunteers. INTERVENTION: Each participant performed 3 trials of the ANT, PM, and PL reach directions of the SEBT and YBT on their dominant leg. MAIN OUTCOME MEASURES: Sagittal-plane lower-limb kinematic profiles were recorded using a 3-D motion-analysis system. Reach distances were also recorded for each reach direction. RESULTS: A significant main effect (P < .05) was observed for test condition with participants reaching farther on the ANT reach direction of the SEBT compared with the YBT. While reaching in the ANT direction participants were characterized by a more flexed position of the hip joint at the point of maximum reach on the YBT (27.94° ± 13.84°) compared with the SEBT (20.37° ± 18.64°). CONCLUSIONS: Based on these observed results, the authors conclude that test performance on the SEBT and YBT differ in terms of dynamic neuro-muscular demands, as evidenced by differences in reach distances achieved in the ANT reach direction and associated test kinematic profile.

Return to play in elite rugby union: application of global positioning system technology in return-to-running programs.

UNLABELLED: Global positioning systems (GPS) are widely used in sport settings to evaluate the physical demands on players in training and competition. The use of these systems in the design and implementation of rehabilitation and return-to-running programs has not yet been elucidated. OBJECTIVE: To demonstrate the application of GPS technology in the management of return to play in elite-club Rugby Union. DESIGN: Case series. SETTING: Professional Rugby Union club team. PARTICIPANTS: 8 elite Rugby Union players (age 27.86 ± 4.78 y, height 1.85 ± 0.08 m, weight 99.14 ± 9.96 kg). INTERVENTION: Players wore GPS devices for the entire duration of a club game. MAIN OUTCOME MEASURES: Variables of locomotion speed and distance were measured. RESULTS: Differences in physical demands between playing positions were observed for all variables. CONCLUSIONS: An analysis of the position-specific physical demands measured by GPS provides key information regarding the level and volume of loads sustained by a player in a game environment. Using this information, sports-medicine practitioners can develop rehabilitation and return-to-running protocols specific to the player position to optimize safe return to play.

A comparison between performance on selected directions of the star excursion balance test and the Y balance test.

CONTEXT: The Star Excursion Balance Test (SEBT) is a widely accepted method of assessing dynamic postural stability. The Y Balance Test (YBT) is a commercially available device for measuring balance that uses 3 (anterior, posteromedial, and posterolateral) of the 8 SEBT directions and has been advocated as a method for assessing dynamic balance. To date, no studies have compared reach performance in these tests in a healthy population. OBJECTIVE: To determine whether any differences exist between reach distance performance for the anterior, posteromedial, and posterolateral directions of the SEBT and the YBT. DESIGN: Descriptive laboratory study. SETTING: University motion analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 20 healthy active male participants (age = 22.50 ± 3.05 years, height = 1.78 ± 0.82 m, weight = 79.48 ± 11.32 kg, body mass index = 24.96 ± 2.56 kg/m²). INTERVENTION(S): Participants carried out 3 trials in each reach direction on each leg on the SEBT and the YBT a minimum of 1 week apart. MAIN OUTCOME MEASURE(S): The means of the 3 trials in each direction on each leg on both tests were calculated. Data were collected after 4 practice trials in each direction. Paired t tests and Bland-Altman plots were used to compare reach distances between the SEBT and the YBT. RESULTS: Participants reached farther in the anterior direction on the SEBT than on the YBT. No differences were observed in the posteromedial and posterolateral directions. CONCLUSIONS: Differing postural-control strategies may be used to complete these tasks. This finding has implications for the implementation and interpretation of these dynamic balance tests.

Increased aerobic fitness after neuromuscular electrical stimulation training in adults with spinal cord injury.

OBJECTIVES: To evaluate the efficacy of a novel neuromuscular electrical stimulation (NMES) system for improving aerobic fitness in individuals with spinal cord injury (SCI). It was hypothesized that training with this NMES system would increase peak oxygen consumption (Vo(2)peak) and peak heart rate (HRpeak) in a sedentary adult SCI population. DESIGN: Prospective cohort study. SETTING: All testing took place at a university human performance laboratory. PARTICIPANTS: Volunteer participants with SCI (N=16; T4-11 American Spinal Injury Association Impairment Scale grades A and B) were recruited from the national SCI outpatient and outreach service databases. All completed the training program, but results from 2 participants were excluded because posttraining tests were invalid. Therefore, 14 participants (11 men, 3 women) completed the program and testing. INTERVENTIONS: Four electrodes (175cm(2)) were placed bilaterally on the quadriceps and hamstrings muscle groups, and subtetanic contractions were elicited using an NMES device. Training was undertaken unsupervised at home for 1 hour, 5d/wk for 8 weeks. MAIN OUTCOME MEASURES: An incremental treadmill wheelchair propulsion exercise test with simultaneous cardiopulmonary gas exchange analysis was used to determine Vo(2)peak and HRpeak. RESULTS: A statistically significant increase in Vo(2)peak (P=.001) and HRpeak (P=.032) between baseline and follow-up was observed. CONCLUSIONS: This novel form of NMES is an effective method of improving aerobic fitness in an SCI population. Results are comparable to those with current functional electrical stimulation exercise systems.

Intrarater reliability of the adductor squeeze test in gaelic games athletes.

CONTEXT: Groin pain is commonly experienced by athletes involved in field-based sports and is particularly prevalent in Gaelic Games athletes. The adductor squeeze test is commonly used in the assessment of groin pain and injuries. To date, no evidence in the literature provides the reliability of the adductor squeeze test using a sphygmomanometer in assessing the adductor muscle integrity of Gaelic Games athletes. Given the high proportion of groin pain encountered in Gaelic Games athletes, establishing the reliability of the adductor squeeze test will allow clinicians to monitor injury responses and to assess return-to-play criteria. OBJECTIVE: To evaluate the intrarater reliability of a commercially available sphygmomanometer for measuring adductor squeeze values in Gaelic Games athletes and to determine if different squeeze values are associated with the 3 commonly used test positions. DESIGN: Descriptive laboratory study. SETTING: University clinical skills laboratory. PATIENTS OR OTHER PARTICIPANTS: Eighteen male Gaelic Games athletes without any previous or current history of groin or pelvic pain. INTERVENTION(S): Each participant performed the adductor squeeze test in 3 positions of hip joint flexion (0°, 45°, and 90°) on 2 test days separated by at least 1 week. MAIN OUTCOME MEASURE(S): Adductor squeeze test values (mm Hg) quantified by a commercially available sphygmomanometer. RESULTS: Intrarater reliability intraclass correlation values ranged from 0.89 to 0.92 (intraclass correlation coefficients were 0°, 0.89; 45°, 0.92; and 90°, 0.90). The highest squeeze values were recorded in the 45° of hip flexion test position, and these values differed from those demonstrated in the 0° and 90° hip flexion test positions (P < .05). CONCLUSIONS: A commercially available sphygmomanometer is a reliable device for measuring adductor squeeze test values.

Physical game demands in elite rugby union: a global positioning system analysis and possible implications for rehabilitation.

STUDY DESIGN: Descriptive. OBJECTIVES: To evaluate the physical demands of an international Rugby Union-level game using a global positioning system (GPS). BACKGROUND: Elite Rugby Union teams currently employ the latest technology to monitor and evaluate physical demands of training and games on their players. METHODS: GPS data from 2 players, a back and a forward, were collected during an international Rugby Union game. Locomotion speed, total body load, and body load sustained in tackles and scrums were analyzed. RESULTS: Players completed an average distance of 6715 m and spent the major portion of the game standing or walking, interspersed with medium- and high-intensity running activities. The back performed a higher number of high-intensity sprints and reached a greater maximal speed. Body load data revealed that high levels of gravitational force are sustained in tackling and scrum tasks. CONCLUSION: The current study provides a detailed GPS analysis of the physical demands of international Rugby Union players. These data, when combined with game video footage, may assist sports medicine professionals in understanding the demands of the game and mechanism of injury, as well as improving injury rehabilitation.

The thigh adductor squeeze test: 45° of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values.

The thigh adductor squeeze test is commonly used in the diagnosis of groin injuries. Currently no reports exist in the published literature which, detail the level of activation of the adductor musculature during the test as well as concomitant pressure values. Thus the aim of the present study was to investigate adductor muscle activity and concomitant pressure values during the performance of the thigh adductor squeeze test at 0°, 45°, and 90° of hip flexion. Eighteen Gaelic games athletes without any history of groin injury participated. Each participant performed 3 repetitions of the thigh adductor squeeze test in the three positions of 0°, 45°, and 90° of hip flexion. Adductor musculature surface electromyographic activity (bilateral) and pressure values quantified using a commercially available sphygmomanometer were recorded for each test. The greatest pressure values were observed in the 45° of hip flexion test position (0°: 202.50 ± 57.28 mmHg; 45°: 236.76 ± 47.29 mmHg; 90°: 186.11 ± 44.01 mmHg; P < 0.05). Similarly, the greatest amount of adductor muscle activity was observed in the 45° of hip flexion test position (P < 0.05). The combined results of the present study suggest that the 45° of hip flexion test position is the optimal thigh adductor squeeze test position for eliciting adductor muscle activity and maximum pressure values.

Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis.

OBJECTIVE: To examine whether people with recurrent ankle sprain, have specific physical and sensorimotor deficits. DESIGN: A systematic review of journal articles in English using electronic databases to September 2009. Included articles compared physical or sensorimotor measures in people with recurrent (≥2) ankle sprains and uninjured controls. MAIN OUTCOME GROUPS: Outcome measures were grouped into: physical characteristics, strength, postural stability, proprioception, response to perturbation, biomechanics and functional tests. A meta-analysis was undertaken where comparable results within an outcome group were inconsistent. RESULTS: Fifty-five articles met the inclusion criteria. Compared with healthy controls, people with recurrent sprains demonstrated radiographic changes in the talus, changes in foot position during gait and prolonged time to stabilisation after a jump. There were no differences in ankle range of motion or functional test performance. Pooled results showed greater postural sway when standing with eyes closed (SMD=0.9, 95% CI 0.4 to 1.4) or on unstable surfaces (0.5, 0.1 to 1.0) and decreased concentric inversion strength (1.1, 0.2 to 2.1) but no difference in evertor strength, inversion joint position sense or peroneal latency in response to a perturbation. CONCLUSION: There are specific impairments in people with recurrent ankle sprain but not necessarily in areas commonly investigated.