Acute changes in sagittal plane kinematics while wearing a novel belt device during treadmill running.

Somatosensory feedback is used in walking retraining; however, its utility in running is less feasible due to the greater associated speeds. The purpose of this study was to examine the acute effects of wearing a novel running belt device on sagittal plane running kinematics. Ten healthy runners ran on a treadmill with and without the use of a running belt device within a repeated measures study design. Temporal-spatial characteristics and sagittal plane knee and ankle kinematics were recorded with three-dimensional motion analysis. Wilcoxon Signed-Rank Tests revealed significant decreases in centre of mass vertical displacement (z = -2.083, p = 0.003), tibial inclination at initial contact (z = -2.803, p = 0.003), and stance phase knee joint excursion (z = -2.701, p = 0.003), and greater knee flexion at initial contact (z = -2.803, p = 0.003) when the belt was donned. No differences were observed in step rate (z = -0.351, p = 0.363), foot inclination angle at initial contact (z = -2.090, p = 0.018), or peak knee flexion during stance (z = -1.172, p = 0.121). Findings suggest that donning a running belt can minimise specific high-risk biomechanical characteristics in runners with particular kinematic profiles.

INTERRATER AND TEST-RETEST RELIABILITY OF THE Y BALANCE TEST IN HEALTHY, EARLY ADOLESCENT FEMALE ATHLETES.

BACKGROUND: Adolescence is the stage of development marked by peak rates of skeletal growth resulting in impaired dynamic postural control and increased injury risk, especially in female athletes. Reliable tests of dynamic postural control are needed to help identify athletes with balance deficits and assess changes in limb function after injury. PURPOSE: To estimate the interrater and test-retest (intrarater) reliability of the Y-Balance Test in a group of early adolescent females over a one-month period when administered by novice raters. METHODS: Twenty-five early adolescent females (mean age 12.7 ± 0.6 years) participated. Two physical therapy student raters, randomly selected from a pool of five, simultaneously assessed each subject's performance on the Y-Balance Test and were blinded to each other's results. Twenty-one subjects returned for a second session (mean 32.3 ± 9.6 days) and were assessed by the same two raters, blinded to previous measurements. Maximum and normalized reach distances and composite scores of the right and left limbs were collected. Intraclass correlation coefficients (ICC) were calculated for between rater and between session agreement. Measurement error and minimal detectable change values were calculated for clinical interpretation. RESULTS: Interrater reliability was excellent for all reach directions and composite scores of the right limb (ICC 0.973-0.998) and left limb (ICC 0.960-0.999) except for the day 1 left anterior reach which was good (ICC 0.811). Test-retest reliability were moderate to excellent for the right limb (ICC 0.681- 0.908) and moderate to good for left limb (ICC 0.714 - 0.811). Minimal detectable change values for the right and left limbs ranged between 2.02-3.62% and 2.77-3.63%, respectively. CONCLUSIONS: The Y-Balance Test is a reliable tool to assess dynamic balance in early adolescent females and may be utilized in a clinical setting to monitor function over a one-month time interval. Between rater differences were mainly attributed to disparities in subjective test requirements and not quantitative measures of reach distance. LEVEL OF EVIDENCE: Level 2.

Anterior Cruciate Ligament Reconstruction Rehabilitation Clinical Practice Patterns: A Survey of the PRiSM Society.

BACKGROUND: Recovery after anterior cruciate ligament (ACL) reconstruction (ACLR) requires extensive postoperative rehabilitation. Although no ideal rehabilitation procedure exists, most experts recommend a fusion of time and strength and functional measures to guide decision making for activity progression during rehabilitation. This process is often directed by surgeon protocols; however, the adoption of contemporary rehabilitation recommendations among surgeons is unknown. PURPOSE: To understand the current landscape of surgeon practice as it relates to ACLR rehabilitation recommendations in adolescent athletes. STUDY DESIGN: Cross-sectional study. METHODS: An online survey was distributed among members of the Pediatric Research in Sports Medicine (PRiSM) Society in January 2017. The survey was designed to identify clinical practice patterns during 3 key transitional points of rehabilitation after ACLR: progression to jogging, modified sports activity, and unrestricted return to sports. RESULTS: Responses from 60 orthopaedic surgeons were analyzed. While 80% of surgeons agreed upon initiating jogging within a 1-month range (3-4 months postoperatively), similar levels of agreement were only captured when including a wider 4-month (4-8 months) and 6-month range (6-12 months) for modified sports activity and unrestricted return to sports, respectively. All respondents (100%) reported using knee strength as a determinant to progress to modified sports activity; however, the mode of testing varied, with most using manual muscle testing (60%), followed by isokinetic (28%) or isometric (12%) testing. Most surgeons (68%) reported using some form of functional testing to return to modified sports activity, but the mode of testing and required progression criteria varied considerably among all reported testing procedures. The use of patient-reported outcome measures was limited to 20% of the sample, and no respondents reported using fear or self-efficacy questionnaires. Upon completion of rehabilitation, 73% recommended injury prevention programs, and 50% recommended the use of a functional ACL brace. CONCLUSION: Rehabilitation progression practices in adolescent athletes are variable and become more inconsistent as the time from surgery increases. While the majority of the sample considered strength and functional testing important, the mode of testing and criteria thresholds for activity advancement varied considerably.

Rehabilitation Practice Patterns Following Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists.

BACKGROUND: Recovery from anterior cruciate ligament reconstruction (ACLR) requires an intensive course of postoperative rehabilitation. Although guidelines outlining evidence-based rehabilitation recommendations have been published, actual practice patterns of physical therapists are unknown. OBJECTIVES: To analyze the current landscape of clinical practice as it pertains to rehabilitation progression and the use of time and objective criteria in rehabilitation following ACLR. METHODS: In this cross-sectional study, an online survey was distributed to members of the Academy of Orthopaedic Physical Therapy, the American Academy of Sports Physical Therapy, and the Private Practice Section of the American Physical Therapy Association between January and March 2017. RESULTS: The study analyzed a sample of 1074 responses. Supervised physical therapy was reported to last 5 months or less by 56% of survey respondents. The most frequent time frames for activity progression were 3 to 4 months (58%) for jogging, 4 to 5 months (50%) for modified sports activity, and 9 to 12 months (40%) for unrestricted sports participation. More than 80% of respondents reported using strength and functional measures during rehabilitation. Of those physical therapists who assessed strength, 56% used manual muscle testing as their only means of strength testing. Single-limb hop testing (89%) was the most frequently reported measure used to allow patients to begin modified sports activity following ACLR. Performance criteria for strength and functional tests varied significantly across all phases of rehabilitation. The 45% of respondents who reported using patient-reported outcome measures indicated that just under 10% of those measures involved fear or athletic confidence scales. CONCLUSION: Considerable variation in practice exists among American Physical Therapy Association members regarding rehabilitation following ACLR. This variability in practice may contribute to suboptimal outcomes and confusion among practitioners and patients. J Orthop Sports Phys Ther 2018;48(10):801-811. Epub 22 May 2018. doi:10.2519/jospt.2018.8264.

Tarsometatarsal (Lisfranc) Joint Injury in an Athlete With Persistent Foot Pain.

The patient was a 20-year-old female ultimate frisbee player who felt a "pop" in her left foot with resultant pain and bruising along the plantar aspect of her midfoot. She was seen by an orthopaedic physician, who ordered standard radiographs that were found to be unremarkable. Although initial non-weight-bearing films were normal, these findings do not rule out tarsometatarsal joint injury. Following presentation to physical therapy 4 months after the initial injury, the patient was referred to a sports medicine physician. Weight-bearing radiographs and magnetic resonance imaging were ordered and confirmed a high-grade Lisfranc ligament tear. J Orthop Sports Phys Ther 2016;46(6):494. doi:10.2519/jospt.2016.0408.

Strength and functional performance recovery after anterior cruciate ligament reconstruction in preadolescent athletes.

BACKGROUND: In the skeletally immature population, the incidence of anterior cruciate ligament (ACL) injuries and ACL reconstructions appears to be increasing. Differences in surgical techniques, physiology, and emotional maturity may alter the rehabilitation progression and impact the outcomes when compared with adults. Reports of objective strength recovery and performance-based outcome measures after pediatric ACL reconstruction (ACLR) are limited. STUDY DESIGN: Retrospective case series. LEVEL OF EVIDENCE: Level 4. METHODS: All patients that underwent all-epiphyseal ACLR from January 2008 to August 2010 were identified. Isokinetic peak quadriceps/hamstring torque values and functional performance measures in unilateral hopping tasks were extracted and compared with the noninjured limb. A limb symmetry index (LSI) of ≥90% was considered satisfactory. RESULTS: Complete data were available for 16 patients (mean age, 12.28 years; range, 8.51-14.88 years). By a mean 7 months (range, 3.02-12.56 years) postoperatively, only 9 of 16 (56%) were able to achieve a satisfactory LSI for quadriceps strength. For hamstring strength, 15 of 16 (94%) were able to achieve satisfactory LSI. By a mean of 12 months (range, 5.39-24.39 months) postoperatively, only 6 of 16 subjects (38%) were able to achieve satisfactory performance on all functional hop tests. At a mean 15.42 months (range, 8.58-24.39 months) postsurgery, only 4 of 16 (25%) subjects were able to achieve an LSI of ≥90% on all testing parameters. CONCLUSION: For some pediatric patients, significant strength and functional deficits may be present at greater than 1 year after ACLR. This population may require more prolonged rehabilitation programs to allow for adequate recovery of strength and function because of unique characteristics of normal growth and development.