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

OBJECTIVE: To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES: A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS: Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS: Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS: The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

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

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

Can Therapeutic Exercises Improve Proprioception in Chronic Ankle Instability? A Systematic Review and Network Meta-analysis.

OBJECTIVE: To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI). DATA SOURCES: Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021. STUDY SELECTION: Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included. DATA EXTRACTION: Data were extracted by 2 independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the Physiotherapy Evidence Database scale. DATA SYNTHESIS: The end trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense in multiple directions was evaluated. RESULTS: Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the network meta-analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking [SUCRA]=74.6%). The next 2 were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively. CONCLUSIONS: Foot and ankle muscle strengthening exercise may have a good effect when used to improve joint position sense in individuals with CAI. The more complex balance exercise intervention becomes, the less effective the proprioceptive outcome.

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

ABSTRACT: Tan, J, Shi, X, Witchalls, J, Waddington, G, Lun Fu, AC, Wu, S, Tirosh, O, Wu, X, and Han, J. Effects of pre-exercise acute vibration training on symptoms of exercise-induced muscle damage: a systematic review and meta-analysis. J Strength Cond Res 36(8): 2339-2348, 2022-Exercise-induced muscle damage (EIMD) normally occurs after unaccustomed high-intensity eccentric exercises. Symptoms of EIMD include delayed-onset muscle soreness (DOMS), tenderness, stiffness, swelling, reduced strength, and increased creatine kinase (CK) levels in the blood. Vibration training (VT) may be useful as a pre-exercise intervention in attenuating EIMD on the basis of tonic vibration reflex (TVR) through a more efficient distribution of contractile stress over muscle fibers. The objective of this meta-analysis is to examine the effects of acute VT on symptoms of EIMD when performed as the pre-exercise intervention. Randomized controlled trials (RCTs) published in the 8 databases of Cochrane Library, PubMed, Embase, Web of Science, EBSCO, China National Knowledge Infrastructure, Airiti Library and WanFang Data from 1966 (the earliest available time) to January 2019 were searched. A total of 2,324 records were identified and 448 articles were screened with the title and abstract. Two investigators identified eligible studies, extracted data, and assessed the risk of bias independently. Review Manager 5.3 designed by Cochrane was used for the current meta-analysis. Six RCTs involving 180 subjects were included in the analysis. A low-to-moderate methodological quality of the included studies was revealed using the physiotherapy evidence database scale. The results showed that acute VT was superior to the control group for the reduction of DOMS on pain visual analogue scale at 24, 48 hours and pressure pain threshold at 24 hours. In addition, superior effects of acute VT were also found on the indirect markers of muscle damage including CK at 24, 72 hours, and lactate dehydrogenase at 24 hours. The current meta-analysis has collated the evidence to demonstrate that receiving acute VT before unaccustomed high-intensity eccentric exercises may be effective in attenuating markers of muscle damage and the development of DOMS when compared with a control group. The possible mechanisms of this effect could be attributed to an improved synchronization of muscle fiber caused by TVR, which could result in even distribution of exterior loads and eventually attenuate disruptions of muscle fibers. In addition, increased blood flow may also be helpful to prevent accumulation of metabolic substances and attenuate subsequent symptoms of EIMD. Vibration training may be used as a pre-exercise intervention to alleviate symptoms of EIMD caused by unaccustomed high-intensity eccentric exercise. Because of the limited quantity and quality of included studies, more high-quality studies are required to ascertain the effect of VT on symptoms of EIMD.

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

BACKGROUND: Neck pain is common in dancers, especially female dancers, and the injury pattern varies in different genres of dance. Among dancesport performers, intensive neck left rotation is required in female International Standard dancers, but it is unknown whether neck pain is associated with neck rotation range of motion and proprioception. OBJECTIVES: To explore the associations between neck pain, cervical rotation range of motion, and proprioception in female International Standard dancers. METHODS: Twelve dancers with dance-related neck pain (age 19.9±1.9 yrs) volunteered, matched with 12 not reporting neck pain (age 22.2±2.4 yrs). A 100-mm visual analog scale (VAS) was used to record neck pain. Active rotation range of motion (AROM) of the cervical spine was measured using a tape measure. A cervical rotation reposition test that used a head-mounted laser projector on a linear scale was employed to measure the cervical spine proprioception, and the absolute error (AE) and variable error (VE) were calculated as proprioceptive acuity scores. RESULTS: Nine of 12 participants in the group with neck pain declared left side pain, with 2 reporting pain on both sides. The group with neck pain had significantly lower left rotation AROM (p<0.05). For proprioceptive acuity, mixed model ANOVA only showed that repositioning of the right side of the neck is more accurate and consistent than that of the left (both AE and VE p<0.05). Linear regression analysis indicated that left rotation AROM was significantly influenced by left neck pain (t=3.061, p=0.006, adjusted R2 = 0.267, and Durbin-Watson value = 1.776). CONCLUSIONS: Most participants in the group with neck pain showed left side pain, associated with decreased left rotation AROM. Early screening on cervical rotation mobility may be necessary to reduce future dance-related injury after the onset of neck pain. Proprioceptive acuity of the left side neck was significantly impaired compared with that of the right, indicating future proprioceptive intervention on the left side neck.

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

PURPOSE: Previous research has found hemispheric asymmetries in the utilization of proprioceptive information. It is undetermined, however, if there is any change in asymmetry in proprioceptive function when external stimulation, such as vibration, is presented. The present study was to investigate the immediate effects of vibration stimulation (VS) on bilateral ankle proprioception. MATERIALS AND METHODS: Forty-six recreational male basketball players were included. Proprioception was assessed by using the active movement extent discrimination apparatus (AMEDA) in standing, and vibration was provided by using a vibrating form roller on the peroneal or gastrocnemius muscles. RESULTS: When participants were divided into high score and low score groups, according to the median of the baseline proprioceptive performance, VS (irrespective of whether vibrating the peroneal or gastrocnemius muscles) significantly improved left non-dominant ankle proprioception in the low proprioceptive performer group (p = 0.019), while significantly deteriorated right dominant ankle proprioception in the high proprioceptive performer group (p = 0.011). CONCLUSIONS: The results found that external stimuli reversely affect proprioception in better and worse performing groups. This suggests that there are differences in the processing of external stimulus signals on different bilateral hemispheres and in different groups (high score vs low score groups), which may be related to hemispheric asymmetry and stochastic resonance. Therefore, it is necessary to explore more specific interventions in the future.

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

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

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

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

Chronic Ankle Instability and Neuromuscular Performance in Prerecruitment Infantry Soldiers.

CONTEXT: Ankle instability can describe various impairments, including perceived instability (PI), mechanical instability (MI), and recurrent sprains (RSs), alone or combined. OBJECTIVE: To examine the prevalence of 8 ankle impairment subgroups and their effect on neuromuscular performance in prerecruitment combat soldiers. DESIGN: Cross-sectional study. SETTING: Military infantry basic training base. PATIENTS OR OTHER PARTICIPANTS: A total of 364 infantry male combat soldiers entering basic training (aged 18-21 years). MAIN OUTCOME MEASURE(S): Participants were assessed for PI (via the Cumberland Ankle Instability Tool), MI (using the Anterior Drawer Test and Medial Talar Tilt Test), and RSs (based on history) of their dominant and nondominant legs. Injuries were categorized in 8 subgroups: PI, RSs, PI + RSs, MI, PI + MI, MI + RSs, PI + MI + RSs, and none. Participants were screened for neuromuscular performance (dynamic postural balance, proprioceptive ability, hopping agility, and triceps surae muscle strength) during the first week of military basic training. RESULTS: For the dominant and nondominant legs, RSs were reported by 18.4% (n = 67) and 20.3% (n = 74) of the participants, respectively; PI was reported by 27.1% (n = 99) and 28.5% (n = 104) of the participants, respectively; and MI was seen in 9.9% (n = 36) and 8.5% (n = 31) of the participants, respectively. A 1-way analysis of variance showed differences in the mean proprioceptive ability scores (assessed using the Active Movement Extent Discrimination Apparatus) of all subgroups with impairments in both the dominant and nondominant legs (F = 6.943, η2 = 0.081, P < .001 and F = 7.871, η2 = 0.091, P < .001, respectively). Finally, differences were found in the mean muscle strength of subgroups with impairment in the nondominant leg (F = 4.884, η2 = 0.056, P = .001). CONCLUSIONS: A high prevalence of ankle impairments was identified among participants who exhibited reduced abilities in most neuromuscular assessments compared with those who did not have impairments. Moreover, participants with 1 impairment (PI, MI, or RSs) exhibited different neuromuscular performance deficits than those with >1 impairment.

Evaluation of the relative contribution of peripheral and focal vision to proprioceptive differentiation of underfoot inversion angles in young elite athletes.

Different visual conditions during proprioceptive testing have the potential to mask clinically meaningful differences in proprioceptive acuity, and must be understood in order to improve testing accuracy. This study compared the proprioceptive acuity achieved in estimating underfoot surface angles when looking ahead vs looking down during an active stepping task. 40 athletes from national development squads (23 male, 17 female, M age = 16 yr.) judged the inversion angle of a footplate when stepping onto and across it. 19 participants were permitted to briefly look down and see the footplate before stepping onto it, while 21 looked ahead and saw the footplate only in peripheral vision as they walked across. Looking down before stepping contributed to higher proprioceptive acuity scores. These results indicate that during a stepping task, a short opportunity to assess ground angle with focal vision supports the peripheral sensory receptors in proprioceptive acuity to a greater extent than peripheral vision alone.

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

Objectives: Medial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical to reducing operational burden. Therefore, this study aimed to build a decision-making model to predict the individual risk of MTSS within officer cadets and test the external validity of the model on a separate military population. Design: Prospective cohort study. Methods: This study collected a suite of key variables previously established for predicting MTSS. Data were obtained from 107 cadets (34 women and 73 men). A follow-up survey was conducted at 3 months to determine MTSS diagnoses. Six ensemble learning algorithms were deployed and trained five times on random stratified samples of 75% of the dataset. The resultant algorithms were tested on the remaining 25% of the dataset, with models then compared for accuracy. The most accurate new algorithm was tested on an unrelated data sample of 123 Australian Navy recruits to establish external validity of the model. Results: Calibrated random forest modelling was the most accurate in identifying a diagnosis of MTSS; (area under curve (AUC)=98%, classification accuracy (CA)=96%). External validation on a sample of Navy recruits resulted in comparable accuracy; (AUC=95%, CA=94%). When the model was tested on the combined datasets, similar accuracy was achieved; (AUC=92%, CA=91%). Conclusion: This model is highly accurate in predicting those who will develop MTSS. The model provides important preventive capacity which should be trialled as a risk management intervention.

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

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

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

OBJECTIVE: Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI. METHODS: Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale. RESULTS: Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI. CONCLUSIONS: The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.

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

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

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

Background: Lower limb somatosensation and proprioception are important for maintaining balance. Research has shown that compression garments or exposure to textured surfaces, can enhance somatosensation however, little is known about the effect of combined compression and texture on somatosensory acuity in the lower limb. This study aimed to assess the effects of combined compression socks with a plantar textured sole, on lower limb somatosensory acuity. Methods: Thirty participants completed a somatosensory acuity task (active movement extent discrimination apparatus; AMEDA) under three conditions: barefoot (control condition), standard knee-high compression sock (compression sock), and knee-high compression sock with internal rubber nodules situated on the sole (textured-compression sock). Somatosensory acuity was assessed between the different sock conditions for the (i) entire group, (ii) high performers, and (iii) low performers. It was hypothesized that low performers would see gains wearing either sock, but the greatest improvement would be in the textured-compression sock condition. Results: AMEDA scores were not significantly different between conditions when the entire group was analyzed (p = 0.078). The low performers showed an improvement in somatosensory acuity when wearing the compression sock (p = 0.037) and the textured compression sock (p = 0.024), when compared to barefoot, but there was no difference between the two sock conditions (p > 0.05). The high performers did not show any improvement (p > 0.05 for all). Conclusion: These findings demonstrate that additional sensory feedback may be beneficial to individuals with lower baseline somatosensory acuity but is unlikely to provide benefit for those with higher somatosensory acuity.

Developing a multivariate prediction model of falls among older community-dwelling adults using measures of neuromuscular control and proprioceptive acuity: A pilot study.

OBJECTIVE: To examine whether measures of neuromuscular control and proprioceptive acuity were predictive of falls in an older community-dwelling population and to develop a multivariate prediction model. METHODS: Fifty-eight adults aged above 60 living independently in the community were recruited for a prospective falls study. On entry, they undertook a Sensory Organisation Test (SOT) and an Active Movement Extent Discrimination Assessment (AMEDA) and completed a short fall risk questionnaire. Participants were monitored for falls over the subsequent 12 months. Prior to analysis, falls were classified into three categories based on the difficulty of the activity being undertaken and the demands of the environment in which the fall occurred. Logistic regression was used to predict the probability of a fall. RESULTS: For falls occurring under the least challenging circumstances, the model fitted using the AMEDA score and two of the questions from the fall risk questionnaire, related to balance and confidence, achieved a specificity of 87% and sensitivity of 83%. Falls occurring in more challenging circumstances could not be predicted with any accuracy based on the variables recorded at inception. CONCLUSIONS: This study highlights the importance of considering the heterogeneous nature of falls. Poorer proprioceptive acuity appears to play a role in falls occurring where neither the environment nor the activity is challenging, but not in falls occurring in other circumstances. Falls in the least-challenging circumstances affected 15% of participants, but this group was considerably more likely to have multiple falls, increasing their vulnerability to adverse consequences.

Intrinsic functional deficits associated with increased risk of ankle injuries: a systematic review with meta-analysis.

BACKGROUND: A history of ankle injury is known to be associated with an increased risk of future injuries. Prevention of a first-time injury to an ankle will also prevent subsequent re-injury; yet these participants are often overlooked in reports of preventive testing. Determining the functional deficits which promote injury risk in all ankles, through studies inclusive of previously injured and never injured ankles, will enable training to be directed at improving known deficits in all sports participants. OBJECTIVE: To review studies investigating the measurement of intrinsic functions in healthy ankles and assess their predictive value for injury. METHOD: Systematic review and meta-analysis of journal articles from selected electronic databases. Using all papers that included sufficient data for extraction in any paradigm, the authors pooled results for measures of strength, postural control, proprioception, muscle reaction time in response to perturbation, range of movement and ligament stability. RESULTS: Thirteen papers were found with adequate data reporting to allow calculation of pooled standardised mean difference (SMD) or pooled RR. The following are all associated with an increased risk of ankle injury: higher postural sway (SMD=0.693, 95% CI=0.151 to 1.235, p=0.012), being in the lower postural stability group (RR=2.06, 95% CI=1.364 to 3.111, p=0.001), lower inversion proprioception (0.573, 0.244 to 0.902, <0.001), higher concentric plantar flexion strength at faster speeds (0.372, 0.092 to 0.652, 0.009) and lower eccentric eversion strength at slower speeds (0.337, 0.117 to 0.557, 0.003). CONCLUSION: There is a set of intrinsic functional and structural ankle deficits associated with significantly increased risk of ankle injury. These findings will enable clinicians and sports trainers to measure and train specific deficits in sports people for the prevention of ankle injury.

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

AIMS: To examine the relationship between ankle proprioception and the ability to maintain balance with increased magnitudes of unexpected perturbations; and to compare the participants' ability to maintain balance following perturbations when starting from static and dynamic positions. METHODS: Sixty physical education students (average 24.6 years) were tested for proprioception ability (AUC scores) and balance challenges presented on a perturbation treadmill. The degree at which participants lost postural balance was recorded in seven starting positions: standing-eyes-open (SO), standing-eyes-closed (SC), tandem-dominant (TD), tandem non-dominant, (TND) single-leg lateral side perturbation (SLP), single-leg medial side perturbation (SMP), and walking. Perturbation scores were analysed divided by tertiles. Multidimensional Unfolding SPSS Statistics 25 (PREFSCAL) was used to examine the relationships between data sets. RESULTS: AUC scores of both dominant and non-dominant legs were significantly correlated with SO (r = 0.316; r = 0.445), SC (r = 0.364; r = 0.413), TD (r = 0.346; r = 0.308), and walking (r = 0.265; r = 0.439), respectively. In the dominant-leg, AUC scores of individuals with below-median SO scores were significantly worse compared to those with median SO scores (p = .046). In the non-dominant leg, individuals with above-median SC had significantly better AUC scores compared to those with lower-than-median SC (p = .008). Those with median and above-median SO and walking achieved better AUC scores than those with below-median (SO: p = .049, p = .004; walking: p = .016, p < .001, respectively). In dimension I, the SLP and SMP were located opposite one another; in dimension II, the TD and TND were located at the upper side, whereas SC, SO and walking were at the lowest side. CONCLUSIONS: AUC scores were significantly correlated with the level at which postural balance was lost, whereby the better the proprioception ability, the better the ability to maintain balance. As such, the ability to maintain balance is harder in tandem positions than in standing and walking positions. This ability differed when perturbations were to the lateral or medial sides.

Establishing the incidence and prevalence of injury and illness in Australian sailing athletes over a full year of training and competition to help determine prevention priorities.

OBJECTIVES: To investigate the prevalence, incidence rate (IR) and burden of health problems (injuries and illnesses) in Australian Olympic class and State Sailing Pathway Program (SSPP) athletes over 12-months of training and competition. DESIGN: Descriptive epidemiological study. METHODS: Ninety-two Australian Sailing and SSPP athletes were prospectively followed during the 2019-2020 season. Medical attention injuries and illnesses were prospectively recorded, and further sub-categorised according to time loss. The IR and burden were calculated per 365 athlete-days, with differences in IR between sexes compared using negative binomial generated rate ratios. RESULTS: Three hundred and forty-nine injuries were reported in 53 athletes (57.6 %), with 14.3 % resulting in time loss. Injury IR was 3.71 (95%CI = 3.33-4.12) injuries per 365 athlete-days, with no difference observed between sex (IRR = 1.64; 95%CI = 0.81-3.34). Shoulder injuries were found to have the greatest burden. Fifty-four illnesses were reported in 27 athletes (29.3 %), with 39.0 % resulting in time loss. Respiratory infection (n = 22, 40.7 %) was the most common illness reported. Illness IR was 0.57 (95%CI = 0.43-0.75) illnesses per 365 athlete days, with females found to have a 3.6 fold increase in illness compared to males (IRR = 3.6; 95%CI = 2.0-6.7). CONCLUSIONS: The majority of health problems reported in sailing athletes did not result in time loss. There were no differences in the injury IR between sexes, however females had a 3.6-fold increase in reported illness. These results can inform future strategies to reduce key health problems in sailors. Future research investigating whether performance is impacted by the high rate of non-time loss health problems is warranted.

Daily surveillance of falls is feasible and reveals a high incidence of falls among older adults.

OBJECTIVE: To ensure accurate data capture for a fall study through a system of daily contact with participants. METHODS: Fifty-eight adults older than 60 years of age and living independently in the community in Canberra, Australia, were recruited for a prospective fall study. We adopted a system of daily contact with study participants for at least 12 months, either by email or by text, asking whether they had suffered a fall in the previous 24 h. At the final testing session, we asked participants whether they had experienced a fall during the previous twelve months. RESULTS: We found no evidence that the daily reporting regime led to excess participant attrition. Only three participants withdrew over the course of the study, and the burden of responding was not cited as a factor in any of these cases. Of the 55 participants who completed the full twelve-month study period, 38 (69%) experienced at least one fall. We also identified inconsistencies between recall of falls occurring during the last twelve months of the study and the contemporaneously recorded data. CONCLUSIONS: Previous studies have found that increasing the reporting demands on fall study participants will lead to higher attrition. This study demonstrates that it is possible to maintain participant engagement and minimise attrition with appropriate design of reporting procedures. We confirm existing evidence regarding the unreliability of retrospective recall of falls. The study highlights the importance of comprehensive and accurate data capture and points to the possibility of under-reporting of fall incidence.