A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain.

Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.

Assessing the Impact of COVID-19 on Amateur Runners' Performance: An Analysis through Monitoring Devices.

This retrospective study aimed to analyze the return to running of non-professional runners after experiencing asymptomatic or mild COVID-19. Participants aged 18-55 years who maintained a training load of ≥10 km/week for at least three months prior to diagnosis and utilized Garmin/Polar apps were included. From these devices, parameters such as pace, distance, total running time, cadence, and heart rate were collected at three intervals: pre-COVID, immediately post-COVID, and three months after diagnosis. The Wilcoxon signed rank test was used for analysis (significance was set at ≤0.05). Twenty-one participants (57.1% male; mean age 35.0 ± 9.8 years) were included. The results revealed a significant decrease in running duration and distance two weeks after diagnosis, without significant changes in other parameters. Three months after infection, no differences were observed compared to pre-infection data, indicating a return to the pre-disease training load. These findings underscore the transient impact of COVID-19 on training performance among non-professional runners with mild or asymptomatic symptoms, highlighting the importance of tailored strategies for resuming running after infection.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review.

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Clinical Presentation Differences Among Four Subtypes of Femoroacetabular Impingement: A Case-Control Study.

OBJECTIVE: The aims of this study were to assess the psychological, functional, and physical differences between patients with femoroacetabular impingement (FAI) syndrome and individuals who were asymptomatic (controls) to analyze clinical differences among 4 subtypes of FAI (cam type, cam type with labral tear, pincer type, and pincer type with labral tear), to calculate the correlations among the variables described, and to identify risk factors contributing to the hip function variance. METHODS: A case-control study was conducted at a hospital rehabilitation unit with a cohort of individuals who were asymptomatic (controls) and a cohort of patients with FAI. Sociodemographic characteristics, pain intensity, psychological health status, hip range of motion (RoM), hip isometric strength, and hip function were assessed. RESULTS: A total of 69 controls and 69 patients with FAI were analyzed. Although sociodemographic characteristics were comparable between samples, poorer hip RoM, strength, and psychological health were found for the cases. FAI subtypes showed no significant pain intensity, psychological health, or RoM differences (except for hip adduction), but hip strength differed among FAI subtypes. Multiple significant correlations between psychological health, pain intensity, RoM, strength, and hip function were found. The variance values of the International Hip Outcome Tool, Hip Outcome Score (HOS) for daily living activities, and HOS for sports activities were partially explained (47.6%, 36.0%, and 21.6%, respectively) on the basis of kinesiophobia, hip strength, self-efficacy, and anxiety. CONCLUSION: Patients with FAI showed poorer psychological health, hip RoM, and strength than individuals who were asymptomatic and had similar sociodemographic characteristics. FAI subtype influenced the patients' clinical presentations. Hip strength, kinesiophobia, anxiety, and self-efficacy should be targeted for improving hip function, as they have been demonstrated to be important contributors to hip disability. IMPACT: This study demonstrated that pain catastrophizing, hip strength, and hip adduction differed among FAI subtypes. However, hip function and pain intensity were comparable between FAI subtypes.

Effects of a dry-land strengthening exercise program with elastic bands following the Kabat D2 diagonal flexion pattern for the prevention of shoulder injuries in swimmers.

Background: During the repetitive execution of the swimming strokes, the muscles responsible for the internal rotations of the shoulders tend to become stronger compared to the muscles that oppose these movements. The aim of this study was to analyse the effect of a strengthening program for the shoulder rotator muscles using elastic band exercises in a diagonal Kabat pattern (D2 for flexion) in swimmers, to develop an effective, quick and easy-to-implement protocol for preventive training routines. Methods: A randomized controlled trial design was carried out. Internal and external rotation range of movement, isometric strength of the muscles responsible for internal and external rotation of the shoulder, scapular movements, was measured at the beginning of the study and after 8 weeks post-intervention. A total of 22 male swimmers participated in the study and were randomly assigned to either an experimental group (n = 11) or a control group (n = 11). The experimental group underwent a 8-week shoulder-strength program using elastic bands, while the control group focused on aquatic training. Results: The strength-training program resulted in an improvement in the isometric strength of the muscles responsible for external rotation and a better balance between the shoulder rotator muscles in the experimental group. However, these improvements have not been significant (p > 0.05). Conclusion: The strengthening exercise program showed minimal improvement in shoulder rotation strength and range of motion. These findings suggest that the prescribed shoulder-strengthening exercise could be a quick-beneficial dry-land training option to improve external rotation shoulder strength or range of motion, but more studies with larger sample sizes and more weeks of treatment are needed to determine the efficacy of this protocol.

Efficacy of a strength-based exercise program in patients with chronic tension type headache: a randomized controlled trial.

Background: Strength-based exercise is widely used to treat tension-type headache, but the evidence of its benefit is unclear. This study aims to analyze the efficacy of a strength-based exercise program in patients with chronic tension-type headaches. Methods: A randomized controlled trial with a 12-week strength-based exercise program, with chronic tension-type headache. The headache characteristics (which were the primary outcomes: frequency, duration, and intensity), cervical muscle thickness at rest or contraction of multifidus and longus-colli muscle, cervical range of motion, pain pressure threshold of temporalis, upper trapezius, masseter, tibialis muscle and median nerve, and cervical craniocervical flexion test were assessed at baseline and 12-weeks of follow-up in the intervention group (n = 20) and the control group (n = 20) was performed on 40 patients (85% women, aged 37.0 ± 13.3 years). Results: Between baseline and week-12 of follow-up the intervention group showed statistically significant differences compared to control group in the following primary outcomes: duration and intensity of headaches. In addition, the intervention group improved the thickness of deep cervical muscles, reduced the peripheral sensitization, and improved the strength of deep cervical flexors. Conclusion: A 12-week strength training of neck and shoulder region induced changes in pain intensity and duration, and physical-related factors in patients with TTH. Future interventions are needed to investigate if normalization of pain characteristics and physical factors can lead to an increase of headache-related impact.

Effects of combined treatment with transcranial and peripheral electromagnetic stimulation on performance and pain recovery from delayed onset muscle soreness induced by eccentric exercise in young athletes. A randomized clinical trial.

Background: There is a common interest in finding a common consensus in the approach of athletes suffering from DOMS with the aim of accelerating recovery and thereby enhancing performance. The objective of this study was to observe the effects of a paired-associative transcranial and peripheral electromagnetic stimulation on young athletes suffering from DOMS, induced by 1 h of eccentric and plyometric exercises. Methods: Forty-eight young athletes participated in this randomized control trial: 13 were assigned to the peripheral group (P); 12 were in the control group (Cont); 11 were assigned to the transcranial group (T) and 12 were included in the paired-associative group (Comb). The Visual Analogue Scale (VAS) of pain perception and the mechanical Pressure Pain Threshold (PPT) were the tools used to analyze the symptoms of DOMS. On the other hand, the Half Squat (HS) test evaluated with an accelerometer, and the 30 m sprint velocity (30-mSP) test were used to observe the evolution of the sports performance of the lower limbs. All evaluations were performed before and after the eccentric exercise session that caused DOMS, as well as at 24-48, and 72 h afterward. Results: The AS group improved the symptoms of the induced DOMS, since significant positive differences were observed in the VAS and PPT compared to the other groups (p < 0.001). In addition, the AS group showed a significant improvement in the HS and the 30-mSP tests (p < 0.001). Based on the results a treatment with both peripheral and transcranial electromagnetic stimulation improves recovery and performance in athletes at 72 h, although these data would need to be verified in future research with a larger sample size. Conclusion: Paired-associative electromagnetic stimulation improved DOMS symptomatology, velocity, and sports performance in the lower limbs.

Validity and reliability of a new hip flexor muscles flexibility assessment tool: The reactive hip flexor (RHF) test.

BACKGROUND: The modified Thomas test is the most used and most reliable test to assess the hip flexors' flexibility. However it does not evaluate the interaction of both legs. The objective of this study is to propose a new assessment tool for hip flexor flexibility, the Reactive Hip Flexion (RHF) Test. METHODS: An observational, intra-test, and test-retest study with repeated measures was carried out with the aim of assessing the validity and reliability of the RHF Test. The participants were males and females aged between 18 and 35 years old who had a training schedule of at least 2 days a week, without a musculoskeletal lower limb or lumbopelvic pathology. The reliability of the test was examined using the intraclass correlation coefficients (ICCs) by a two-way random model to establish inter-rater reliability and a two-way mixed model to assess intra-rater reliability. The precision was measured by the standard error of measurement (SEM). In addition, the minimum detectable change (MDC95%) was calculated. RESULTS: Twenty-six participants (52 hips) (47% female) completed the study. No correlations were observed between anthropometric variables and RHF peak force or active knee extension (AKE) measurements. There was an excellent intra-rater and inter-rater ICC in the hip flexors' reactive peak force and the AKE measurements, with a low SEM. CONCLUSIONS: This study demonstrated that the proposed RHF test technique is valid and reliable when used in healthy youth population.

Electromyographic Activity of the Pelvic Floor Muscles and Internal Oblique Muscles in Women during Running with Traditional and Minimalist Shoes: A Cross-Over Clinical Trial.

The study aimed to investigate the effects of footwear on the electromyographic (EMG) activity of pelvic floor muscles (PFMs) and internal oblique (IO) muscles during running at different speeds. The study also aimed to explore the correlation between EMG activity of PFMs and IO muscles and participants' morphological characteristics. Ten nulliparous female runners were included in the study. The participants ran for 90 s at speeds of 9, 11, and 13 km/h wearing both traditional and minimalist shoes. EMG outcomes were presented as a percentage of maximum voluntary contraction (%MVC). Comparative analysis was conducted using the Wilcoxon rank test. Correlational analysis was performed using the Rho-Spearman correlation coefficient. The %MVC for the IO muscles was significantly lower when using minimalist shoes compared to traditional shoes (p = 0.04). No statistically significant differences were found for the PFMs (p > 0.05). The study also observed large correlations between age and %MVC of the PFMs and IO muscles (rho = -0.64; p = 0.04). Minimalist shoes decreased the activity of IO muscles in female runners. However, no significant differences in EMG activity of PFMs were found when comparing traditional and minimalist footwear. The long-term effects of minimalist footwear on EMG activity of PFMs and IO muscles, as well as their relationship to morphological characteristics, require further investigation.

Effects of peripheral electromagnetic stimulation after an eccentric exercise-induced delayed-onset muscle soreness protocol in professional soccer players: a randomized controlled trial.

Introduction: To examine the effects of peripheral electromagnetic stimulation in male professional soccer players on markers of Delayed Onset Muscular Soreness (DOMS), induced by a protocol of exercise (60 min of eccentric and plyometric). Methods: A randomized controlled trial with fourty-five professional soccer players aged 22.33 ± 4.82 years participated in the study. Twenty-three participants were assigned to the experimental group with peripheral electromagnetic stimulation (5 stimulations of 5 s at 100 HZ with 55 s of rest for a total of 5 min of treatment) and the remaining 22 participants were assigned to the control group. Pain pressure threshold (PPT) of the vastus medialis, the Visual Analogue Scale-Fatigue (VAS-F), half squat (HS) test and the maximum voluntary contraction of the quadriceps were assessed. All evaluations were performed before and after 1 h of the eccentric exercise induced DOMS, as well as at post 24-48, and 72 h. Results: Group-by-time interaction was observed in PPT of the vastus medialis (p = 0.040) with a medium effect size (η2 p = 0.069). From 48 to 72 h the experimental group showed an increase of PPT compared to control group (p = 0.015). There was no group-by-time interaction for HS, quadriceps strength and VAS-F (p > 0.05). Discussion: Peripheral electromagnetic stimulation in male professional soccer players did not produce significant improvements in the power and strength of the lower limbs but decreased the peripheral sensitization of the vastus medialis after eccentric exercise protocol. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384050&isReview=true, Identifier: ACTRN12622000841774.

Associations between Fatty Acid Intake and Tension-Type Headache: A Cross-Sectional Study.

INTRODUCTION: Patients with tension-type headache (TTH) are characterized by recurrent pain that can become disabling. Identifying the dietary triggers of headaches has led to defining dietary strategies to prevent this disease. In fact, excessive dietary intake of Omega-6 (ω-6) fatty acids, or an ω-6: ω3 ≥ 5 ratio, typical of Western diets, has been associated with a higher prevalence of headaches. The objectives of the present study were to compare dietary fatty acid intake between participants with and without chronic TTH and to investigate the association between dietary fatty acid intake, pain characteristics, and quality of life in patients with chronic TTH. METHODS: An observational study was conducted, comparing healthy participants (n = 24) and participants diagnosed with chronic TTH for more than six months (n = 24). The variables analyzed were dietary fatty acid intake variables, the Headache Impact Test (HIT-6), and the characteristics of the headache episodes (intensity, frequency, and duration). RESULTS: The TTH group reported a significantly higher intake of saturated fatty acids (SFAs) but similar intakes of monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and ω-6: ω-3 ratio when compared to controls. Furthermore, in the TTH group, the Ω-6 fatty acid intake was associated with more intense headache episodes. In addition, the TTH group reported a significant impact of headaches on their activities of daily living according to the HIT-6. CONCLUSIONS: Higher intakes of SFAs and Ω-6 fatty acids were associated with more severe headache episodes in patients with TTH. Therefore, the characteristics of the diet, in particular the dietary fatty acid intake, should be considered when treating these patients.

Validity and Test-Retest Reliability of the Spanish Version of the International Hip Outcome Tool (iHOT-12Sv).

Objective: To develop a Spanish version of the international Hip Outcome Tool questionnaire (iHOT-12Sv) for assessing the psychometric characteristics (internal consistency, convergent validity, test−retest reliability, and floor and ceiling effects) of this version in physically active patients with hip pain. Methods: After conducting the translation and transcultural adaptation, a consecutive sample of patients with labral tear injury and/or femoroacetabular impingement (Pincer or Cam type) were recruited in a Spanish Hospital. Patients completed the iHOT-12Sv and the Spanish version of the iHOT-33 and the Hip Outcome Score (HOS). Internal consistency was calculated using Cronbach's alpha; convergent validity was evaluated using Spearman correlation coefficients (Rho) with iHOT-33 and HOS; test−retest reliability was examined using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable changes (MDC); and floor and ceiling effects were calculated as the percentage of patients who obtained the minimum and maximum score. Results: One hundred and fifty-three patients (64.7% males) participated in this study. Cronbach's alpha of 0.92 revealed the excellent internal consistency. In addition, the iHOT-12Sv demonstrated strong to very strong correlations with the HOS (Rho ranged from 0.741 to 0.827; p < 0.001) and the iHOT-33 (Rho = 0.932; p < 0.001), respectively; acceptable test-retest reliability (ICC = 0.86 to 0.94); SEM = 6.21 and MDC = 17.22; and no floor or ceiling effects were found. Conclusions: The iHOT-12Sv can be used as a valid and reliable tool for clinical evaluation of physically active patients with hip pathology. However, the full version is preferable for research purposes aiming to assess changes in hip function.

Relationship between Self-Efficacy and Headache Impact, Anxiety, and Physical Activity Levels in Patients with Chronic Tension-Type Headache: An Observational Study.

Background: Chronic tension-type headache is the primary headache with the highest prevalence. The present study is aimed at analyzing the associations between patient self-efficacy and headache impact with pain characteristics, kinesiophobia, anxiety sensitivity, and physical activity levels in subjects with chronic tension-type headache. Materials and Methods: An observational descriptive study was carried out. A total sample of 42 participants was recruited at university environment with diagnosis of tension-type headache. Headache characteristics (frequency, intensity, and duration), physical activity levels, pain related-self-efficacy, kinesiophobia, anxiety sensitivity, and headache impact were measured. Results: The HIT-6 (61.05 ± 6.38) score showed significant moderate positive correlations with the ASI-3 score (17.64 ± 16.22; r = 0.47) and moderate negative correlations with the self-efficacy in the domains of pain management (31.9 ± 10.28; r = -0.43) and coping with symptoms (53.81 ± 14.19; r = -0.47). ASI-3 score had a negative large correlation with self-efficacy in the domains of pain management (r = -0.59), physical function (53.36 ± 7.99; r = -0.55), and coping with symptoms (r = -0.68). Physical activity levels showed positive moderate correlations with the self-efficacy in the domain of physical function (r = 0.41). Linear regression models determined that the self-efficacy and anxiety sensitivity with showed a significant relationship with the HIT-6 score (R 2 = 0.262; p = 0.008) and with the ASI-3 score (R 2 = 0.565; p < 0.001). In addition, no correlations were found between pain intensity, duration or frecuency with psychosocial factors, or headache impact. Conclusions: The present study showed that patients with chronic tension-type headache had a great negative impact on daily tasks and physical activity levels, which were associated with higher anxiety levels and lower self-efficacy.

Deep Cervical Muscles and Functionality in Patients with Chronic Tension-Type Headache: An Observational Study.

Background and objectives: Chronic tension-type headache (TTH) is the type of headache with the highest prevalence. The involvement of musculoskeletal structures in TTH is supported by evidence in the scientific literature. Among these, deep cervical muscle strength appears to be related to the function of the cervical spine and the clinical characteristics of TTH. This study aimed to correlate anatomical, functional, and psychological variables in patients with TTH. Materials and methods: An observational descriptive study was carried out with 22 participants diagnosed with TTH for at least six months. The characteristics of headaches, including ultrasound-based deep neck flexor and extensor muscle thickness, range of motion (ROM), and pressure pain threshold (PPT), were recorded. We also conducted the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Craniocervical Flexion Test (CCFT). Results: Moderate-large negative correlations were found between the PVAQ and the muscle thickness of right deep flexors contracted (r = -0.52; p = 0.01), left multifidus contracted (r = -0.44; p = 0.04), right multifidus at rest (r = -0.48; p = 0.02), and right multifidus contracted (r = -0.45; p = 0.04). Moderate-large positive correlations were found between the CCFT score and the left cervical rotation ROM (r = 0.53; p = 0.01), right cervical rotation ROM (r = 0.48; p = 0.03), muscle thickness of left multifidus contracted (r = 0.50; p = 0.02), and muscle thickness of right multifidus at rest (r = 0.51; p = 0.02). The muscle thickness of the contracted right deep cervical flexors showed a moderate negative correlation with headache intensity (r = -0.464; p = 0.03). No correlations were found between PPT and the rest of the variables analyzed. Conclusions: In patients with TTH, a higher thickness of deep cervical muscles was associated with higher ROM and higher scores in the CCFT. In turn, the thickness of deep cervical muscles showed negative correlations with pain hypervigilance and headache intensity. These results contribute to a better understanding of the physical and psychosocial factors contributing to the development of TTH, which is useful for implementing appropriate prevention and treatment measures.

Training-induced changes in anterior pelvic tilt: potential implications for hamstring strain injuries management.

An association has been reported between dynamic anterior pelvic tilt (APT) and hamstring injuries; however, no research has examined if a training-based preventive intervention could alter APT. Therefore, the aim of the present study was to examine if a specific 6-week multimodal intervention, based on the theoretical influence of neighbouring joints and biomechanical interactions between muscles that are inserted to the pelvis, induced changes in APT, during walking gait, hamstring flexibility and trunk endurance. Thirty-five active healthy males volunteered for this single-blind controlled trial and were split into two groups based on baseline data: a control group (CG, n = 20, continued their normal physical activities), and an intervention group (IG, n = 15, performed the intervention programme for 18 sessions over 6 weeks). A significant (p = 0.001) decrease in the APT kinematics during gait, significant increase in the Active Knee Extension Test (p = 0.001), and a significant increase in trunk endurance performance for flexion (p = 0.001), extension (p = 0.001) and side bridge (p = 0.001) were observed, in IG after the 6-week programme, compared to CG.