The Interruption of Rehabilitation Following Anterior Cruciate Ligament Reconstruction due to COVID-19 Restrictions: Association With Return-to-Sport Testing.

CONTEXT: Among many unanticipated changes, access to rehabilitation was disrupted during the onset of the COVID-19 pandemic. It is unclear how the timing of late-stage rehabilitation following anterior cruciate ligament with surgical reconstruction (ACLR) during the initial months of the pandemic affected outcomes. The purpose of this study was to compare physical performance outcome measures in patients following ACLR prior to and following COVID-19-related restrictions. DESIGN: Retrospective cohort study. METHODS: Data from patients who underwent return-to-sport testing following ACLR were analyzed based on date. December 2018 through March of 2020 (n = 66) was defined as the baseline period, and June through October 2020 (n = 27) was defined as the surveillance period. Outcome measures included single leg hop, triple hop, single leg vertical jump, and the lower-extremity functional test (LEFT). Linear mixed models were used to compare outcome measures before and after the onset of pandemic-related restrictions, clustered by sex and sport. A 1-way analysis of variance was performed to analyze the association between the number of virtual rehabilitation visits and outcome measures for subjects in the surveillance period. RESULTS: Subjects in the surveillance period performed significantly worse in the LEFT (+7.88 s; 95% confidence interval, 1.11 to 14.66; P = .02) and single leg vertical jump on the unaffected side (-4.32 cm; 95% confidence interval, -7.44 to -1.19, P < .01), and performed better with single leg vertical jump symmetry (+6.3%; 95% confidence interval, 1.0% to 11.5%; P = .02). There were no other statistically significant differences. There was no significant association between having virtual rehabilitation visits and any of the performance outcomes. CONCLUSIONS: There was a decline in physical performance outcome measures in patients following ACLR who did not attend regular in-person physical therapy sessions in the late-stage rehabilitation due to COVID-19-related restrictions. Other factors during this unique time period, such as access to training facilities or psychosocial stressors, may have also influenced outcomes.

Normative data on horizontal power, acceleration, and change-of-direction ability in amateur youth female soccer players.

BACKGROUND: Physical performance measures such as horizontal power, acceleration, and change-of-direction ability are related to performance in soccer, and may aid in talent selection, coaching decisions and the prescription of training programs. The purpose of this study was to describe the normative values of three performance tests in amateur female youth soccer players. METHODS: A cross-sectional descriptive study design was employed with 151 amateur female youth soccer players (age 14.20±1.13 years). Physical performance measures included the standing broad jump, 10-meter sprint, and Pro-Agility Test. Time since peak height velocity (PHV) was calculated to represent physical maturity status. Descriptive statistics were sought, and Pearson's correlation coefficients were used to identify correlations between variables. One-Way Analysis of Variance with a Tukey post-hoc test was used to calculate the relationship between categorical groups of chronological ages and years since PHV. Significance was set at P<0.05. RESULTS: Normative data for each physical performance measure are presented based on chronological age and physical maturity status for amateur female youth soccer players. Chronological age was significantly associated with improved performance in standing broad jump (R=0.558; 95% CI: 0.436, 0.658; P<0.01), 10-meter sprint time (R=-0.375; 95% CI: -0.495, -0.217; P<0.01), and Pro-Agility Test time (R=-0.424; 95% CI: -0.546, -0.284; P<0.01). Physical maturity status was also significantly associated with improved performance in standing broad jump (R=0.650; 95% CI: 0.426, 0.711; P<0.01), 10-meter sprint time (R=-0.430; 95% CI: -0.507, -0.232; P<0.01), and Pro-Agility Test time (R=-0.453; 95% CI: -0.554, -0.293; P<0.01). CONCLUSIONS: The normative data from this study demonstrates differences in physical performances across chronological ages and physical maturity status. Physical maturity status had a slightly stronger association for all performance measures than chronological age. The variance and range tended to increase across performance measures with increasing age.

Acute Effects of Ice Hockey on Hip Range of Motion, Strength, and Pelvic Tilt in Competitive Male Players.

BACKGROUND: Ice hockey players are at high risk for hip and groin injury. Several risk factors have been identified or proposed, including lower hip rotation range of motion (ROM), lower hip adductor strength, lower ratio of hip adductor to abductor strength, and lower pelvic tilt angle. It is not known how these risk factors change acutely with ice hockey participation. HYPOTHESIS: Acute exposure to ice hockey will result in a reduction in ROM, strength, and pelvic tilt angle in competitive male players. STUDY DESIGN: Controlled cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Risk factors for hip and groin injury, including isometric hip adductor strength at 0° of flexion, the ratio of hip adductor to abductor strength, total hip rotation passive ROM in supine, and the resting pelvic tilt angle, were assessed immediately before, immediately after, and 24 hours after an ice hockey exposure in 42 competitive male ice hockey players. Rating of perceived exertion (RPE) was collected to identify the intensity of the exposure. RESULTS: There was a significant decrease in total hip rotation ROM (-7.32°, P < 0.01 (-3.91, -10.70)) and hip adductor strength (-4.41 kg, P < 0.01 (-2.81, -6.00) immediately after the exposure, and a significant decrease in total hip rotation ROM (-18.54°, P < 0.01 (-14.35, -22.73)), hip adductor strength (-6.56 kg, P < 0.01 (-4.58, -8.61)), and the ratio of hip adductor to abductor strength (-0.12, P < 0.01 (-0.21, -0.45)) 24 hours after. There was no significant change in pelvic tilt found in this study immediately after or 24 hours after. There was a moderate relationship between changes in hip adductor strength and changes in the ratio of hip adductor to abductor strength (r = 0.433, P < 0.01). RPE was not significantly correlated to any of the changes observed. CONCLUSION: Risk factors for hip and groin injury in ice hockey players are modifiable after a single ice hockey exposure. CLINICAL RELEVANCE: The identified fluctuation of injury risk factors for hip and groin injury in ice hockey players has implications for injury risk profiling, rehabilitation, and return-to-competition decision-making.

Clinical Measures of Pelvic Tilt in Physical Therapy.

Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures. LEVEL OF EVIDENCE: 5.