How Does Physical and Psychological Recovery Vary Among Competitive and Recreational Athletes After Anterior Cruciate Ligament Reconstruction?

BACKGROUND: The recovery and rehabilitation journey after anterior cruciate ligament reconstruction (ACLR) surgery can be different for competitive and recreational athletes as their motivation and goals toward sports are different. HYPOTHESIS: Competitive athletes would present with better patient-reported outcomes and higher muscle strength compared with recreational athletes postsurgery. Second, competitive athletes would recover better (patient-reported outcome [PRO] measures and muscle strength) compared with recreational athletes at later stages. STUDY DESIGN: Cross-sectional laboratory-based study. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 245 patients with unilateral ACLR were categorized as competitive or recreational athletes and grouped into early (4-6.9 months) or late (7-10 months) stages of recovery. PRO were collected for psychological response (Tampa Scale Kinesiophobia; Anterior Cruciate Ligament-Return to Sport after Injury), perceived knee function (International Knee Documentation Committee subjective form [IKDC]), and quality of life (Knee injury and Osteoarthritis Outcome Score; Veteran Rand-12). Isokinetic, concentric knee extension strength was measured bilaterally with a multimodal dynamometer (System 4, Biodex Medical Systems) at a speed of 90° and 180°/s. RESULTS: Competitive athletes had significantly higher scores for IKDC (P = 0.03), and quadriceps peak torque at 90°/s (P = 0.01) and 180°/s (P < 0.01) compared with recreational athletes. Competitive athletes had higher quadriceps strength at 90°/s (P < 0.01) and 180°/s (P = 0.02) in the late group. Recreational athletes displayed higher sports participation in the late group. CONCLUSION: Outcomes of ACLR may differ based on preinjury athletic level. Whereas competitive athletes had higher knee and muscle function than recreational athletes, psychological measures were not different among groups. CLINICAL RELEVANCE: There is a need for more individualized care for patients with ACLR since there is variability among patient goals postsurgery. This information might help set realistic expectations for competitive and recreational athletes after surgery.

A Novel Intrinsic Foot Muscle Strength Dynamometer Demonstrates Moderate-To-Excellent Reliability and Validity.

Background: Intrinsic foot muscle (IFM) weakness can result in reduced foot function, making it crucial for clinicians to track IFM strength changes accurately. However, assessing IFM strength can be challenging for clinicians, as there is no clinically applicable direct measure of IFM strength that has been shown to be reliable and valid with the foot on the ground. Purpose: The purpose was to investigate the intra-rater and inter-rater reliability of a novel, budget-friendly IFM dynamometer and determine its agreement with a handheld dynamometer (HHD). The researchers also examined correlations of foot morphology and activity level to IFM strength. Study design: Descriptive Laboratory Study. Methods: Two assessors measured IFM strength of 34 healthy volunteers (4 male, 30 female; age=21.14±2.57, height=164.66 ±7.62 cm, mass=64.45±11.93 kg) on two occasions 6.62±0.78 days apart with the novel dynamometer to assess intra- and inter-rater reliability. The HHD was used to measure IFM in the first session in order to assess validity. Results: For the novel dynamometer, intra- and inter-rater reliability was moderate-to-excellent (ICC = 0.73 - 0.95), and the majority of the strength tests were within the 95% limits of agreement with the HHD. Wider foot morphology and a higher number of days walking over the prior seven days had small but significant correlations with IFM strength (dominant foot r = 0.34, non-dominant foot r = 0.39; r = -0.33, -0.39 respectively). Conclusion: This novel IFM dynamometer is a budget-friendly ($75) tool that was shown to be reliable and valid in a healthy population. Levels of evidence: Level 3©The Author(s).

Local microvascular tissue oxygenation of the intrinsic foot muscles in patients with diabetes: A cross-sectional case-comparison study.

BACKGROUND: Foot-related complications including impaired peripheral circulation and lower limb ulceration are severe consequences for those with diabetes mellitus. This study aimed to assess differences in tissue oxygenation and oxygen utilization of the plantar surface intrinsic foot muscles between diabetic participants and healthy comparisons following short foot exercise and a standard walking protocol. METHODS: Eighteen participants, 9 with diabetes and 9 healthy age- and sex-matched comparisons, completed two interventions in a randomized order. For the short foot exercise intervention, participants completed 5 sets of 15 intrinsic foot muscle contractions. For the walking intervention, participants completed a modified six-minute walk test. Tissue oxygenation variables including oxygenated hemoglobin, deoxygenated hemoglobin, and tissue saturation index were measured using near-infrared spectroscopy in quiet stance and during intrinsic foot muscle contraction cycles following each intervention. Means, standard deviations, 95 % confidence intervals, mean differences, and Cohen's d effect sizes were calculated for each tissue oxygenation variable. RESULTS: The results of this study indicated no significant group differences in quiet standing tissue oxygenation measures at baseline and following each intervention. Participants in the diabetic group had significantly less change in tissue saturation index during intrinsic foot muscle contractions compared to healthy participants after the short foot exercise intervention (ES= 4.00, P = .0002) and walking intervention (ES= 1.33, P = .015). CONCLUSIONS: By utilizing wireless NIRS and novel research methodology, this study was able to explore changes in plantar surface tissue oxygenation of the intrinsic foot muscles following a targeted short foot exercise intervention as well as a standard walking protocol in patients diagnosed with diabetes compared to age- and sex- matched individuals without diabetes. We identified that diabetic participants presented with less oxygen utilization during intrinsic foot muscle contractions performed following both exercise interventions compared to their healthy age- and sex- matched comparisons.

The Effects of Minimalist Shoes on Plantar Intrinsic Foot Muscle Size and Strength: A Systematic Review.

Minimalist shoes are proposed to prevent injury and enhance performance by strengthening intrinsic foot muscles, yet there is little consensus on the effectiveness of minimalist shoes in increasing muscle strength or size. This systematic review assesses using minimalist shoes as an intervention on changes in plantar intrinsic foot muscle size and strength. PubMed, CINHAL, Scopus, and SPORT Discus were systematically searched for articles from January 2000 to March 2022. Studies were included if they had an intervention of at least 2 weeks with a control group and examined the effect of minimalist shoes on plantar intrinsic foot strength or size (either volume, cross-sectional area, or thickness). Nine studies were included. There were significant increases and percent changes in foot muscle strength, volume, cross-sectional area, and thickness. Strength increased between 9-57%, and size increased between 7.05-10.6%. Minimalist shoes may effectively increase intrinsic foot muscle size and strength in healthy individuals, and they may also be more convenient than implementing time-intensive physical therapy programs. Future research is needed to explore using minimalist shoes as an intervention in clinical populations who would benefit from increased IFM strength and function. It will also be vital to improve upon IFM assessment methods.

Feasibility of a Novel Video Game-Based Electromyography Biofeedback System in Patients With Knee Osteoarthritis.

CONTEXT: A novel virtual game system Knee Biofeedback Rehabilitation Interface for game-based home therapy (KneeBright) was developed for strength training using integrated electromyography biofeedback of the quadriceps muscle to control the game. The study aimed to compare the KneeBright and electromyography biofeedback interface among patients with knee osteoarthritis. DESIGN: Controlled before and after design. METHODS: Nineteen patients with knee osteoarthritis took part in this laboratory-based study. Exercise sessions took place on 2 separate days. During session 1, participants used a conventional electromyography biofeedback system while performing 3 sets of lower body exercises with emphasis on maximal muscle activation, endurance, and precision. During session 2, participants used the KneeBright game to match the exercise sets in the first session. For both sessions, knee extension torque during the isometric muscle activation exercises and time to voluntary additional exercise were recorded. Patient engagement was assessed using the technology acceptance model and System Usability Score questionnaires. RESULTS: The peak knee extension torque produced during the control exercise session and the KneeBright exercise session were positively correlated. Knee extension torque generated during KneeBright game exercise sessions was increased by an average of 25% compared to the control sessions (2.14 vs 1.77 N·m/kg, P = .02). The mean technology acceptance model score for the KneeBright system was 3.4/5 and the mean System Usability Score was 79, both indicating positive patient engagement. CONCLUSIONS: Patients using the KneeBright game produced greater knee torque than patients using the conventional system, had positive levels of engagement, and exercised longer with the KneeBright game.

Evidence of Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-analysis.

OBJECTIVE: To critically assess the literature focused on strength training of the intrinsic foot muscles (IFM) and resulting improvements in foot function. DATA SOURCES: A search of electronic databases PubMed, CINHAL, Scopus, and SPORT Discus was completed between January 2000 to March 2022. STUDY SELECTION: Randomized control trials (RCTs) with an outcome of interest with at least two weeks of IFM exercise intervention were included. Outcomes of interest were broadly divided in to five categories of foot posture (navicular drop (ND) and Foot Posture Index (FPI)), balance, strength, patient-reported outcomes (PROs), sensory function, and motor performance. The PEDro scale was used to assess the methodological quality of included studies with two independent reviewers rating each study. Studies with a PEDro score greater than 4/10 were included. DATA EXTRACTION: Data from the included studies were extracted by two independent reviewers. These data included design, participant characteristics, inclusion and exclusion criteria, type of intervention, outcomes, and the primary results. Random effects meta-analysis was performed to analyze difference between intervention and control groups for each outcome when there were at least two studies. Standardized mean differences (SMD) describe effect size with a 95% confidence interval (SMD range). When the confidence interval crossed zero the effect was not significant. DATA SYNTHESIS: Thirteen studies were included and IFM exercise interventions were associated with decreasing ND (SMD range=0.37,1.83), and FPI (SMD range=1.03,1.69), improving balance (SMD range=0.18,1.86), strength (SMD range=0.06,1.52) and PROs for disability (SMD range=0.12,1.00) with pooled effect sizes favoring IFM intervention over control. There was no superiority of IFM exercises (SMD range=-0.15,0.66) seen in reducing pain. We could not perform meta-analysis for sensory function and motor performance as there was only study reporting each outcome, however, these results supported the use of IFM strength training. CONCLUSION: IFM strength training is helpful for patients in improving foot and ankle outcomes.

Clinical usage, application procedures, and perceived effectiveness of cupping therapy among healthcare professionals in the United States: A cross-sectional survey.

BACKGROUND: Despite its growing popularity since the mid-1900s, the application procedures and factors influencing the usage of cupping therapy among healthcare professionals in the United States remains unclear. Therefore, the purpose of this study was to investigate the clinical usage, application procedures, and perceived effectiveness of cupping therapy among healthcare professionals in the United States. MATERIALS AND METHODS: A convenience sample of 158 healthcare professionals (age: 29.36 ± 7.42 years) participated in this cross-sectional study (completion rate = 86.15%; n = 158/195). A custom web-based survey designed to assess respondents' clinical incorporation of cupping therapy, was disseminated through snowball sampling on various social media platforms. Descriptive statistics including means, standard deviations, and frequencies were calculated per survey item. RESULTS: Ninety-one percent of respondents reported working as an athletic trainer in either a secondary school (30%) or collegiate setting (48%). Dry cupping was the most commonly reported type of cupping therapy (99%), and 75% of respondents reported using both static and moving cupping techniques. Significant differences in cup application time and the amount of air extraction were noted between static and moving cupping. Cupping therapy was reported as most effective for treating muscle tightness, myofascial trigger points, and musculoskeletal pain. CONCLUSION: While the usage and application of cupping therapy may vary based on the type and style of cupping as well as the patient's condition, respondents reported cupping therapy to be an effective method for treating various musculoskeletal conditions.

Predicting Anterior Cruciate Ligament Reinjury From Return-to-Activity Assessments at 6 Months Postsurgery: A Prospective Cohort Study.

CONTEXT: Return-to-activity (RTA) assessments are commonly administered after anterior cruciate ligament reconstruction (ACLR) to manage the patient's postoperative progressions back to activity. To date, few data are available on the clinical utility of these assessments to predict patient outcomes such as secondary anterior cruciate ligament (ACL) injury once the athlete has returned to activity. OBJECTIVE: To identify the measures of patient function at 6 months post-ACLR that best predict RTA and second ACL injury at a minimum of 2 years after ACLR. DESIGN: Prospective cohort study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6 months post-ACLR. Of these, 192 (82.1%) completed follow-up at ≥2 years post-ACLR. MAIN OUTCOME MEASURE(S): The 6-month functional assessments consisted of patient-reported outcomes, isokinetic knee-flexor and -extensor strength, and single-legged hopping. We collected RTA and secondary ACL injury data at ≥2 years after ACLR. RESULTS: Of the patients who were able to RTA (n = 155), 44 (28.4%) had a subsequent ACL injury, 24 (15.5%) to the ipsilateral graft ACL and 20 (12.9%) to the contralateral ACL. A greater proportion of females had a secondary injury to the contralateral ACL (15/24, 62.5%), whereas a greater proportion of males reinjured the ipsilateral ACL graft (15/20, 75.0%; P = .017). Greater knee-extension symmetry at 6 months increased the probability of reinjury (B = 0.016, P = .048). Among patients with RTA at <8 months, every 1% increase in quadriceps strength symmetry at 6 months increased the risk of reinjury by 2.1% (B = 0.021, P = .05). Among patients with RTA at >8 months, every month that RTA was delayed reduced the risk of reinjury by 28.4% (B = -0.284, P = .042). Descriptive statistics of patient function stratified between the early and delayed RTA groups can be found in the Supplemental Table (available online at http://dx.doi.org/10.4085/1062-6050-0407.20.S1). CONCLUSIONS: Patients with more symmetric quadriceps strength at 6 months post-ACLR were more likely to experience another ACL rupture, especially those who returned to sport at <8 months after the index surgery. Clinicians should be cognizant that returning high-functioning patients to activity at <8 months post-ACLR may place them at an increased risk for reinjury.

Intrinsic foot muscle size and quality in a single leg weight bearing position across foot posture types in individuals with Patellofemoral Pain compared to healthy.

OBJECTIVE: To identify if any differences exist in IFM size and quality in single leg weight bearing position between healthy and PFP participants based on foot posture. DESIGN: Cross-sectional, matched case-comparison study SETTING: University Laboratory Setting PARTICIPANTS: 35 PFP (age:20.46 ± 3.79yrs, mass:73.28 ± 26.58 kg, height:170.80 ± 11.91 cm) and 35 healthy (age:20.40 ± 3.16yrs, mass:64.76 ± 11.52 kg, height:169.55 ± 9.10 cm) participants METHODS: After measuring Foot Posture Index (FPI), ultrasound images (USI) of Abductor Hallucis (AH), Flexor Digitorum Brevis (FDB) and Quadratus Plantae (QP) were taken in a single limb weight bearing position. Cross-sectional area (CSA) and echogenicity were measured on the USI. RESULTS: FPI was not different between groups (PFP:2.34 ± 3.76, Healthy:2.34 ± 3.10, 9 pronated and 26 non-pronated in both groups). AH CSA was smaller in PFP than healthy group (PFP:0.030 ± 0.01 cm (Smith et al., 2018)/kg, Healthy:0.042 ± 0.01 cm (Smith et al., 2018)/kg, P < 0.001) with a large effect (d = -1.20(-1.71, -0.69). There were no other significant group main effects or group-by-FP interactions in AH/FDB/QP CSA or echogenicity. CONCLUSION: AH CSA was smaller in PFP than healthy controls, but no difference in CSA or echogenicity of FDB/QP exist, as well as no difference in foot posture between groups. While single limb weight bearing, the PFP group presented with a smaller IFM which provides eccentric control of medial longitudinal arch, which may have implications up the chain during weight bearing functional tasks.

Differences in Gluteal and Quadriceps Muscle Activation During Weight-Bearing Exercises Between Female Subjects With and Without Patellofemoral Pain.

ABSTRACT: Glaviano, NR and Saliba, S. Differences in gluteal and quadriceps muscle activation during weight-bearing exercises between female subjects with and without patellofemoral pain. J Strength Cond Res 36(1): 55-62, 2022-Therapeutic exercises targeting gluteal and quadriceps muscles have been previously investigated; however, these studies have only been conducted on healthy individuals. Female subjects with patellofemoral pain (PFP) present with weakness in their gluteal and quadriceps muscles and commonly perform exercises that target these muscles. Therefore, the purpose of this study was to compare lower extremity muscle activity during 5 weight-bearing exercises between female subjects with and without PFP. Twenty female subjects with PFP and 20 healthy female subjects completed 5 weight-bearing tasks: a single-leg squat (SLS), lateral step-down, step-up task, step-down task, and lunge. Surface electromyography of the gluteus medius (GMed), gluteus maximus (GMax), vastus lateralis (VL), and vastus medialis oblique (VMO) were collected. Electromyography activity were normalized to maximal voluntary isometric contractions to represent each gluteal and quadriceps muscle as a percentage. Female subjects with PFP completed a SLS and step-up tasks with less GMed and GMax activity (p < 0.05) compared with those without PFP. Female subjects with PFP also had greater VMO activity (p < 0.05) during the step-up, step down, and lunge and VL activity (p < 0.05) during the step-up and SLS compared with healthy female subjects. Practitioners should be aware that there are differences in gluteal and quadriceps muscle activation between female subjects with and without PFP while performing weight-bearing exercises. These findings should influence both the selection of specific exercises and exercise progression when developing a treatment program that has the intended focus to address gluteal or quadriceps strength deficits in female subjects with PFP.

Effects of rehabilitation on joint-coupling in patients with chronic ankle instability.

Chronic ankle instability (CAI) is associated with kinematic changes in the lower extremity. Alterations in joint-coupling have been identified during gait in patients with CAI. Rehabilitation remains the gold-standard for clinical treatment of CAI but little is known on the effects of rehabilitation on joint-coupling variability. Wearable destabilisation devices have shown an increase in muscle activity during functional tasks and may be useful in rehabilitation. The purpose of this study is to analyse the joint-coupling variability during gait prior to and following a rehabilitation programme performed with and without destabilisation devices. Twenty-six individuals with CAI were randomly assigned to receive 4 weeks of comprehensive rehabilitation with or without destabilisation devices. A 3D motion capture system was used to collect kinematics during walking. A vector-coding analysis was used to assess the joint-coupling variability of knee and hip motion to ankle motion. The destabilisation device group had decreases in joint-coupling variability during periods of walking gait. This decrease in joint-coupling variability may represent a change in sensorimotor organisation following rehabilitation. This decrease is indicative of an adaptation to the rehabilitation using destabilisation devices and may indicate an improvement in sensorimotor function.

Running gait biomechanics in females with chronic ankle instability and ankle sprain copers.

Limited evidence exists comparing running biomechanics between individuals with chronic ankle instability (CAI) and those who fully recover (copers). The purpose of this study was to simultaneously analyse running gait kinematics, kinetics, and surface electromyography (sEMG) between ankle sprain copers and individuals with CAI. Twenty-six (13 CAI, 13 Coper) recreationally active females participated and ran shod on an instrumented treadmill at 2.68 m/s. We assessed lower extremity kinematics and kinetics and sEMG amplitude for the fibularis longus, tibialis anterior, medial gastrocnemius, and gluteus medius muscles. Ten consecutive strides from the beginning of the trial were analysed using statistical parametric mapping (SPM) independent t-test. The CAI group had significantly more ankle inversion during 0-6%, 42-53%, and 96-100% of the running stride cycle compared to the coper group. At initial contact (0%), the CAI group was in an inverted ankle position (5.9°±6.8°) and the coper group was in an everted ankle position (-3.2°±5.5°; p = 0.01, d = 1.5). There were no significant differences identified for any other outcome measures. Increased ankle inversion during the swing phase leading into the loading phase is concerning because the ankle is in an open packed position and inversion is a primary mechanism of injury for sustaining a lateral ankle sprain.

Quantification of Workload and Wellness Measures in a Women's Collegiate Volleyball Season.

The purpose of this paper was to quantify internal and external loads completed by collegiate volleyball athletes during a competitive season. Eleven players were sampled (using accelerometers and subjective wellness surveys) during the practice (n = 55) and game (n = 30) sessions over the 2019 season. Longitudinal data were evaluated for trends across the preseason, non-conference play, and conference play periods. Data were also analyzed with respect to positional groups. Longitudinal analysis of accelerometer data showed higher workload demand during practices than games. Positional group differences were most when evaluating jump count and height. Setters accrued over twice as many jumps in a practice than during a game and had similar overall jump counts in practice to attacking positions. Average team wellness values varied with time in the season, especially during times of congested travel. This is the first study to look at both game and practice workload and wellness measures in collegiate women's volleyball. The results suggest athlete monitoring can be used to understand the demands of volleyball and used in the future to enhance practice and recovery day design to optimize athlete well-being.

Does verbal encouragement change dynamic balance? The effect of verbal encouragement on Star Excursion Balance Test performance in chronic ankle Instability.

BACKGROUND: The Star Excursion Balance Test (SEBT) is commonly used for testing dynamic balance in chronic ankle instability (CAI) in both clinical and research settings. However, the effect of verbal encouragement (VE) on the SEBT performance is not known. OBJECTIVE: To investigate the effects of VE on maximum reach distance performance between CAI and healthy participants on the SEBT. METHOD: Thirty-four college-aged adults, 17 with CAI and 17 healthy controls, performed the SEBT in the anterior, posteromedial, and posterolateral reach directions. Independent variables (VE versus No-VE) and group (CAI versus healthy) were analyzed using Analysis of Variance (ANOVA) to determine whether VE and group affected reach performance. RESULTS: There was a significant group-by-condition interaction (p = 0.02) for the anterior as well as for the posteromedial reach (p = 0.04). There was no statistically significant interaction (p = 0.48) for the posterolateral reach. There were moderate to large effect sizes in the reach distances found in the No-VE condition between the CAI and healthy controls, but with VE, the range of effect sizes from No-VE to VE were diminished. CONCLUSION: There was a significant group by condition interaction for anterior and posteromedial reaches which shows that providing VE resulted in a greater increase in performance for participants with CAI compared to healthy controls. Psychological constraints need to be considered while performing and interpreting the results of the SEBT.

Quadriceps Oxygenation During Exercise in Patients With Anterior Cruciate Ligament Reconstruction.

CONTEXT: The causes of persistent muscle weakness after anterior cruciate ligament reconstruction (ACLR) are not well known. Changes in muscle oxygenation have been proposed as a possible mechanism. OBJECTIVE: To investigate changes in quadriceps muscle oxygenation during knee extension in ACLR-involved and ACLR-uninvolved limbs. DESIGN: Case-control study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 20 individuals: 10 patients with primary, unilateral ACLR (7 women, 3 men; age = 22.90 ± 3.45 years, height = 170.81 ± 7.93 cm, mass = 73.7 ± 15.1 kg) and 10 matched control individuals (7 women, 3 men; age = 21.50 ± 2.99 years, height = 170.4 ± 10.7 cm, mass = 68.86 ± 9.51 kg). INTERVENTION(S): Each participant completed a single data-collection session consisting of 5-second isometric contractions at 25%, 50%, and 75% of the volitional maximum followed by a 30-second maximal isometric knee-extension contraction. MAIN OUTCOME MEASURE(S): Oxygenated hemoglobin (O2Hb) measures in the reconstructed thigh were continuously recorded (versus the uninvolved contralateral limb as well as the nondominant thigh of healthy control individuals) using 3 wearable, wireless near-infrared spectroscopy units placed superficially to the vastus medialis, vastus lateralis, and rectus femoris muscles. Relative changes in oxygenation were ensemble averaged and plotted for each contraction intensity with associated 90% CIs. Statistical significance occurred where portions of the exercise trials with CIs on the O2Hb graph did not overlap. Effect sizes (Cohen d, 90% CI) were determined for statistical significance. RESULTS: We observed less relative change in O2Hb in patients with ACLR than in healthy control participants in the rectus femoris at 25% (d = 2.1; 90% CI = 1.5, 2.7), 50% (d = 2.8; 90% CI = 2.6, 2.9), and 75% (d = 2.0; 90% CI = 1.9, 2.2) and for the vastus medialis at 75% (d = 1.5; 90% CI = 1.4, 1.5) and 100% (d = 2.6; 90% CI = 2.5, 2.7). Less relative change in O2Hb was also noted for the vastus medialis in ACLR-involved versus ACLR-uninvolved limbs at 100% (d = 2.62; 90% CI = 2.54, 2.70). CONCLUSIONS: Quadriceps muscle oxygenation during exercise differed between patients with ACLR and healthy control individuals. However, not all portions of the quadriceps were affected uniformly across contraction intensities.

Effects of 4-week impairment-based rehabilitation on jump-landing biomechanics in chronic ankle instability patients.

OBJECTIVE: To determine effects of 4-weeks of impairment-based rehabilitation on lower extremity neuromechanics during jump-landing. DESIGN: Descriptive laboratory study. PARTICIPANTS: Twenty-six CAI subjects (age = 21.4 ± 3.1 sex=(M = 7,F = 19), height = 169.0 ± 8.8 cm, weight = 71.0 ± 13.8 kg) completed 15 jump-landing trials prior to and following 12 supervised rehabilitation sessions. MAIN OUTCOME MEASURES: Frontal and sagittal lower extremity kinematics and kinetics and sEMG amplitudes (anterior tibialis, peroneus brevis, peroneus longus, and medial gastrocnemius). Means and 90% confidence intervals (CIs) were calculated for 100 ms prior to and 200 ms following ground contact. Areas where pre- and post-rehabilitation CIs did not overlap were considered significantly different. Kinematic and kinetic peaks and kinematic excursion were compared with paired t-test (P ≤ 0.05). RESULTS: Following rehabilitation, CAI subjects exhibited less ankle (2.1° (0.8, 3.4), P < 0.01) and hip (2.0° (0.5, 3.7), P = 0.01) frontal plane excursion and lower peak hip abduction (2.5° (0.0, 5.0), P = 0.05). There was less ankle (5.0° (1.7, 8.3), P < 0.01) and knee (3.4° (0.8, 6.0), P = 0.01) sagittal plane excursion following rehabilitation. There was decreased peroneus longus activity from 9 ms to 135 ms post ground contact and decreased peak plantar flexion moment (0.08 N∗m/kg (0.01, 0.13), P = 0.02) following rehabilitation. CONCLUSION: Progressive impairment-based rehabilitation resulted in reductions in kinematic excursion and peroneus longus muscle activity, suggesting a more efficient landing strategy.

Visuomotor therapy modulates corticospinal excitability in patients following anterior cruciate ligament reconstruction: A randomized crossover trial.

BACKGROUND: Corticospinal adaptations have been observed following anterior cruciate ligament reconstruction around the time of returning to activity. These measures have been related to quadriceps strength deficits. Visuomotor therapy, combining motor control tasks with visual biofeedback, has been shown to increase corticospinal excitability. The purpose of this study was to assess the immediate changes of corticospinal excitability following a single session of visuomotor therapy in patients following anterior cruciate ligament reconstruction. METHODS: This was a single blinded, sham-controlled crossover study. Ten patients following ACLR (8 Female, 26.1(6.2) years) completed assessments of quadriceps strength at approximately 4- and 6-months following anterior cruciate ligament reconstruction. At 6-months, quadriceps motor evoked potentials were assessed at 80%, 90%, 100%, 110%, 120%, 130%, 140%, and 150% of the patient's active motor threshold. Patients were randomized to receive a single session of visuomotor therapy(active) or passive motion(sham). Quadriceps motor evoked potentials were reassessed for treatment effect. Following a one-week washout period, all patients received the crossover intervention. FINDINGS: Moderate to large increases in motor response following visuomotor therapy 90%(P = .008, r = 0.60), 110%(P = .038, r = 0.46), 120%(P = .021, r = 0.52), 130%(P = .021, r = 0.52), 140%(P = .008, r = 0.60) and 150%(P = .021, r = 0.52) of the active motor threshold were found. Moderate increases in motor response was observed following the passive motion at 80% of the active motor threshold(P = .028, r = 0.49). INTERPRETATION: A single session of visuomotor therapy was found to increase quadriceps corticospinal motor response greater than the response to sham therapy. Visuomotor therapy is a potential supplement to quadriceps rehabilitation programs when upregulation of corticospinal excitability is indicated.

Gait biofeedback and impairment-based rehabilitation for chronic ankle instability.

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment-based rehabilitation on gait biomechanics and patient-reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty-seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment-based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three-dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:-7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:-5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM-ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment-based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI.