Influence of Graft Type and Meniscal Involvement on Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction.

CONTEXT: The purpose of this study was to compare short-term clinical outcomes between meniscus procedures performed with anterior cruciate ligament reconstruction (ACLR), ACLR (ACLR-only), ACLR with meniscectomy/resection (ACLR-resect), and ACLR with meniscal repair (ACLR-repair) for bone patellar tendon bone grafts (BPTB) and hamstring tendon grafts, separately. DESIGN: This was a cross-sectional study conducted in a controlled laboratory setting as part of a large point-of-care collaborative research program. METHODS: This study included 314 participants (168 females; mean [SD]: age, 19.7 [4.8]) with primary unilateral ACLR with a BPTB or hamstring tendon. Patients were divided into 3 groups depending on meniscal procedure (ACLR-only, ACLR-resect, and ACLR-repair). Postsurgical testing included: isokinetic assessment of knee extension and flexion, single-leg hop tests, and patient-reported outcomes. Multivariate analysis of covariance compared differences between meniscal procedures on the battery of tests, and for each statistically significant variable an analysis of covariance assessed the effect of meniscal procedure within each graft type. Chi-square analysis assessed the influence of meniscal procedure on tests' pass rates defined as 90% of limb symmetry index. RESULTS: BPTB: ACLR-only had greater hamstring strength than ACLR-resect (P = .05) and ACLR-repair (P = .005). ACLR-only had the highest proportion of participants to pass the hamstring strength test (P = .02). Hamstring tendon: ACLR-only (P = .03) and ACLR-resect (P = .003) had higher International Knee Documentation Committee scale scores than ACLR-repair. There was a significant difference in the proportion of participants who scored >90% limb symmetry index on the timed hop test (P = .05). CONCLUSIONS: The influence of meniscal repair on clinical outcomes is dependent on the graft choice. Following an ACLR with BPTB and a meniscal procedure, hamstring function should be more closely monitored for optimal short-term recovery.

SHOULDER AND ELBOW INJURY RATES AND CHARACTERISTICS AMONG COLLEGIATE BASEBALL STUDENT-ATHLETES.

BACKGROUND: Recent research has focused on the epidemiology of shoulder and elbow injuries among high school and professional baseball players. Shoulder and elbow injury data has not been comprehensively reported among college baseball student-athletes. PURPOSE: The purpose of this study is to describe shoulder and elbow injury rates and their characteristics among collegiate baseball student-athletes in order to improve injury prevention. STUDY DESIGN: Descriptive Epidemiology Study. METHODS: Shoulder and elbow injury data were obtained from the NCAA Injury Surveillance System for baseball from 2004-2014. Incidence rate ratios and descriptive analyses described injury characteristics for the shoulder and elbow, separately. RESULTS: The injury rate for the shoulder was 4.02/10,000 athlete-exposures and for the elbow was 2.44/10,000 athlete-exposures. During the ten-year period, the injury rate of the shoulder has approximately decreased by 75% and of the elbow by approximately 50%. Injury rates were higher during competitions compared to practice for the shoulder (rate ratio, 1.81;95% CI, 1.51, 2.18) and elbow (rate ratio, 2.19;95% CI, 1.73, 2.78). Freshmen and juniors were most likely to sustain shoulder (F=40.6%, J = 29%) and elbow (F=33%, J=33.7%) injuries. Regarding shoulder injuries, surgery was required for 7.1%, and the outcome was season ending for 14.5%. More elbow injuries (17.5%) ended in surgery, and a greater proportion (28.9%) had season-ending injuries. CONCLUSION: In collegiate baseball, shoulder and elbow injury rates have decreased but still result in high morbidity. More granular analyses, especially during Division 1 competitions, are necessary for more specific interventions. While shoulder injuries are more common, elbow injuries result in a longer time to return to play and a higher proportion of surgical interventions. LEVEL OF EVIDENCE: Level 3.

Comparison of Thigh Muscle Strain Occurrence and Injury Patterns Between Male and Female High School Soccer Athletes.

CONTEXT: Thigh muscle strains are among the most common injuries in high school soccer for both males and females. Similar results have been reported among college soccer players, specifically for hamstring strains. In college soccer, males have a higher injury rate than women, although they share common injury characteristics. Currently, no studies exist comparing the injury rate or injury characteristics of thigh muscle strains between sexes playing high school soccer. OBJECTIVE: To compare thigh muscle strain injury rates and injury event characteristics among sexes participating in high school soccer. DESIGN: Descriptive epidemiology study. SETTING: A total of 100 nationally representative high schools that participated in the High School Sports-Related Injury Surveillance System, Reporting Information Online. PARTICIPANTS: High school soccer athletes who had a thigh muscle strain. MAIN OUTCOME MEASURES: Injury rates of thigh muscle strains were calculated between sexes. The occurrence of the following variables during a thigh muscle injury was compared between sexes: grade level, age, level of play, event type, time of practice, time of competition, basic injury mechanism, soccer activity, player position, field location, practice type, and time of season. RESULTS: Males had a lower injury rate of thigh muscle strains during competition than females (rate ratio = 0.66; 95% confidence interval, 0.47-0.93). No differences between sexes existed in the distribution of first-time or recurrent event characteristics. When combining sexes, recurrent strains (93%) occurred more frequently on the offensive side of the field than first-time strains (59%), P < .001. The majority of strains occurred among the varsity players (71%), during running activities (60%) and practices (58%). CONCLUSIONS: Males were less likely to sustain a thigh muscle strain during competitions, but no other differences existed between sexes. The events surrounding all thigh muscle strains may be described with some common properties. Consideration of these characteristics may assist in the development of preventive and rehabilitative programs as well as direct future research on thigh muscle strains among high school soccer players.

DRY NEEDLING INCREASES MUSCLE THICKNESS IN A SUBJECT WITH PERSISTENT MUSCLE DYSFUNCTION: A CASE REPORT.

BACKGROUND AND PURPOSE: Muscle dysfunction is very common following musculoskeletal injury. There is very little evidence to suggest that muscle function may be positively impacted by soft tissue interventions, such as dry needling. The purpose of this case report is to describe the immediate effect of dry needling on muscle thickness in a subject after shoulder surgery. CASE DESCRIPTION: A 22 year-old competitive gymnast presented seven months post shoulder surgery with significant impairments and functional limitations. Previous physical therapy focused on restoration of range of motion and strength using general exercise interventions, but the subject had persistent tightness and weakness of musculature of the shoulder complex. A subject-specific physical therapy program including manual physical therapy resulted in significant initial improvement, but lack of flexibility and weakness of the rotator cuff limited progress. Dry needling was used to address persistent myofascial trigger points. OUTCOMES: Immediately after dry needling the infraspinatus, the muscle's thickness was significantly improved as measured by rehabilitative ultrasound imaging. There was a corresponding increase in force production of external rotation at 90 degrees of abduction. DISCUSSION: Minimal research exists that validates the potential of dry needling on muscle function, as assessed by muscle thickness measured using rehabilitative ultrasound imaging. The results of this case report suggest that dry needling contributed to improvement in muscle thickness and strength in a subject with muscle dysfunction following an injury. LEVEL OF EVIDENCE: 4.

Days to Return to Participation After a Hamstrings Strain Among American Collegiate Soccer Players.

CONTEXT: Among US collegiate soccer players, the incidence rate and the event characteristics of hamstrings strains differ between sexes, but comparisons in the return-to-participation (RTP) time have not been reported. OBJECTIVE: To compare the RTP time between male and female collegiate soccer players and analyze the influence of event characteristics on the RTP time for each sex. DESIGN: Descriptive epidemiology study. SETTING: Data were collected from collegiate teams that voluntarily participated in the National Collegiate Athletic Association Injury Surveillance System. PATIENTS OR OTHER PARTICIPANTS: Collegiate soccer athletes who sustained 507 hamstrings strains (306 men, 201 women) during the 2004 through 2009 fall seasons. MAIN OUTCOME MEASURE(S): Nonparametric statistics were used to evaluate RTP time differences between sexes and among categories of each event characteristic (ie, time of season, practice or competition, player position). Negative binomial regression was used to model the RTP time for each sex. All analyses were performed separately for first-time and recurrent strains. RESULTS: We found no differences in the RTP time between sexes for first-time (median: men = 7.0 days, women = 6.0 days; P = .07) or recurrent (median: men = 11 days, women = 5.5 days; P = .06) hamstrings strains. For male players with first-time strains, RTP time was increased when the strain occurred during competition or the in-season/postseason and varied depending on the division of play. Among female players with first-time strains, we found no differences in RTP time within characteristics. For male players with recurrent hamstrings strains, the RTP time was longer when the injury occurred during the in-season/postseason. Among female players with recurrent strains, RTP time was longer for forwards than for midfielders or defenders. CONCLUSIONS: Although we found no differences in the RTP time after hamstrings strains in male and female collegiate soccer players, each sex had unique event characteristics that influenced RTP time.

Comparison of hamstring strain injury rates between male and female intercollegiate soccer athletes.

BACKGROUND: Hamstring strains are common among soccer athletes, and they have a high incidence of recurrence. Among American collegiate soccer players, men have an overall higher incidence rate of hamstring strains than women. PURPOSE: This research compares the hamstring strain injury rates in event and athlete characteristics between male and female college soccer athletes. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data describing partial and complete hamstring strains were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for men's and women's soccer from 2004 to 2009. Incidence rate ratios (IRRs) comparing the incidence of hamstring strains between the sexes as well as during games versus practices and the preseason versus the in-season were calculated. χ(2) tests were used to compare the occurrence of hamstring strains across different event and athlete characteristics. RESULTS: Men were 64% more likely than women to sustain a hamstring strain (IRR, 1.64; 95% CI, 1.37-1.96). Men had significantly higher rates of hamstring strains than women during both games (IRR, 2.42; 95% CI, 1.82-3.23) and practices (IRR, 1.34; 95% CI, 1.06-1.68). There were no differences between men and women in injury rates during the preseason, but men were significantly more likely to sustain a hamstring strain during the in-season (IRR, 1.98; 95% CI, 1.56-2.52). Men had a significantly higher proportion of recurrent hamstring strains compared with women (men, 22%; women, 12%; P = .003). There were no significant differences in the distribution of strains in event or athlete characteristics between men and women for first-time or recurrent hamstring strains. CONCLUSION: In collegiate soccer, men have significantly higher rates of hamstring strains than women, and regardless of the recurrence status, the event and athlete characteristics were similar for both sexes. Identifying common characteristics may assist in the targeted development of preventive and rehabilitative programs as well as continued research on hamstring strains among collegiate soccer players.

Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review.

STUDY DESIGN: Systematic review. BACKGROUND: Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of thoracic spine thrust manipulation for the treatment of individuals with mechanical neck pain. OBJECTIVE: The purpose of this systematic review was to determine the effects of thoracic spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain. METHODS: Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included "thoracic mobilization," "thoracic spine mobilization," "thoracic manipulation," and "thoracic spine manipulation." Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range of motion, and subjective function at all stated time intervals. RESULTS: Effect size point estimates for the pain change scores were significant for global assessment across all studies (range, 0.38-4.03) but not conclusively significant at the end range of active rotation (range, 0.02-1.79). Effect size point estimates were large among all range-of-motion change measures (range, 1.40-3.52), and the effect size point estimates of the change scores among the functional questionnaires (range, 0.47-3.64) also indicated a significant treatment effect. CONCLUSIONS: Thoracic spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable. LEVEL OF EVIDENCE: Therapy, level 1b-.

Sex differences in concussion symptoms of high school athletes.

CONTEXT: More than 1.6 million sport-related concussions occur every year in the United States, affecting greater than 5% of all high school athletes who participate in contact sports. As more females participate in sports, understanding possible differences in concussion symptoms between sexes becomes more important. OBJECTIVE: To compare symptoms, symptom resolution time, and time to return to sport between males and females with sport-related concussions. DESIGN: Descriptive epidemiology study. SETTING: Data were collected from 100 high schools via High School RIO (Reporting Information Online). PATIENTS OR OTHER PARTICIPANTS: Athletes from participating schools who sustained concussions while involved in interscholastic sports practice or competition in 9 sports (boys' football, soccer, basketball, wrestling, and baseball and girls' soccer, volleyball, basketball, and softball) during the 2005-2006 and 2006-2007 school years. A total of 812 sport concussions were reported (610 males, 202 females). MAIN OUTCOME MEASURE(S): Reported symptoms, symptom resolution time, and return-to-play time. RESULTS: No difference was found between the number of symptoms reported (P  =  .30). However, a difference was seen in the types of symptoms reported. In year 1, males reported amnesia (exact P  =  .03) and confusion/disorientation (exact P  =  .04) more frequently than did females. In year 2, males reported more amnesia (exact P  =  .002) and confusion/disorientation (exact P  =  .002) than did females, whereas females reported more drowsiness (exact P  =  .02) and sensitivity to noise (exact P  =  .002) than did males. No differences were observed for symptom resolution time (P  =  .40) or return-to-play time (P  =  .43) between sexes. CONCLUSIONS: The types of symptoms reported differed between sexes after sport-related concussion, but symptom resolution time and return-to-play timelines were similar.

Short-term effect of muscle energy technique on pain in individuals with non-specific lumbopelvic pain: a pilot study.

Muscle energy technique (MET) is a form of manual therapy frequently used to correct lumbopelvic pain (LPP), herein the patient voluntarily contracts specific muscles against the resistance of the clinician. Studies on MET regarding magnitude and duration of effectiveness are limited. This study was a randomized controlled trial in which 20 subjects with self-reported LPP were randomized into two groups (MET or control) after magnitude of pain was determined. MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods, while the control group received a sham treatment. Tests for current and worst pain, and pain with provocation were administered at baseline, immediately following intervention and 24 hours after intervention. Separate 2x3 ANOVAs were used to assess results as change scores. Visual analog score (VAS) for worst pain reported in the past 24 hours decreased for the MET group (4.3mm+/-19.9, p=.03) and increased for the sham (control) group (17.1mm+/-21.2, p=.03). Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours, thereby suggesting that MET may be useful to decrease LPP over 24 hours.

Arthrogenic muscle response of the quadriceps and hamstrings with chronic ankle instability.

CONTEXT: An arthrogenic muscle response (AMR) of the soleus and peroneal muscles has been previously demonstrated in individuals with chronic ankle instability (CAI), but the presence of AMR in muscles acting on joints proximal to unstable ankles has not been previously explored. OBJECTIVE: To determine if AMR is present in the quadriceps and hamstrings muscles of those with and without unilateral CAI. DESIGN: Case control. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty subjects with unilateral CAI (12 males, 8 females: age = 19.9 +/- 3.7 years; height = 170.3 +/- 15.6 cm; mass = 78.0 +/- 23.1 kg) and 21 controls (16 males, 5 females: age = 23.2 +/- 5.4 years; height = 173.9 +/- 12.7 cm; mass = 87.2 +/- 24.6 kg) with no previous ankle injuries. MAIN OUTCOME MEASURE(S): The central activation ratio (CAR), a measure of motoneuron pool excitability during maximal voluntary isometric contraction, for the hamstrings and quadriceps muscles was measured in both limbs using the superimposed burst technique. RESULTS: The CAI group demonstrated quadriceps CARs that were significantly larger in their involved limbs (.87 +/- .09), as compared with their uninvolved limbs (.84 +/- .08), whereas no significant side-to-side difference was seen in the control group (sham involved = .80 +/- .11, sham uninvolved = .81 +/- .11). When values from both the involved and uninvolved limbs were averaged, the hamstrings CAR was significantly lower for the CAI group (.94 +/- .03) than for the control group (.96 +/- .03). CONCLUSIONS: Arthrogenic inhibition of the hamstrings muscles bilaterally and facilitation of the quadriceps muscle ipsilateral to the involved limb were noted in subjects with unilateral CAI. Motoneuron pool excitability appears to be altered in muscles that act on joints proximal to the ankle in those with unilateral CAI.

Cryotherapy does not affect peroneal reaction following sudden inversion.

CONTEXT: If ankle joint cryotherapy impairs the ability of the ankle musculature to counteract potentially injurious forces, the ankle is left vulnerable to injury. OBJECTIVE: To compare peroneal reaction to sudden inversion following ankle joint cryotherapy. DESIGN: Repeated measures design with independent variables, treatment (cryotherapy and control), and time (baseline, immediately post treatment, 15 minutes post treatment, and 30 minutes post treatment). SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-seven healthy volunteers. INTERVENTION(S): An ice bag was secured to the lateral ankle joint for 20 minutes. MAIN OUTCOME MEASURES: The onset and average root mean square amplitude of EMG activity in the peroneal muscles was calculated following the release of a trap door mechanism causing inversion. RESULTS: There was no statistically significant change from baseline for peroneal reaction time or average peroneal muscle activity at any post treatment time. CONCLUSIONS: Cryotherapy does not affect peroneal muscle reaction following sudden inversion perturbation.

Training and equipment to prevent athletic head and neck injuries.

Due to the potential for catastrophic neurotraumas and cervical spine injuries in sport, the sports health care professional must take proper measures to prevent such injuries. Strength training of the cervical spine, teaching of proper sporting techniques, and use of protective sports equipment are three primary means of attempting to prevent neurotraumas and cervical spine injuries in sports. There are other avenues to assist in preventing these injuries, such as flexibility programs. The sports health care professional, therefore, must be knowledgeable of the needs of each individual athlete when developing prevention plans.

The relationship between self-reported and clinical measures and the number of days to return to sport following acute lateral ankle sprains.

STUDY DESIGN: This is a prospective observational study. OBJECTIVE: To determine the relationship of self-reported and clinical measures to the number of days to return to sport following acute lateral ankle sprains. BACKGROUND: In order to direct rehabilitation, injury classification schemes should include self-reported and clinical measures that help prognosticate the number of days to return to sport (DAYS). METHODS AND MEASURES: Twenty Division II college athletes (7 men, 13 women; mean age = 19.2 +/- 1.1 years) were assessed following an acute lateral ankle sprain and upon return to sport. Athletes were assessed by three self-reported measures: global function question, Short Form-36 Physical Function scale (SF36PF), visual analog pain scale, and four clinical measures: ankle active range of motion (AROM), ankle dorsiflexion strength, ankle plantar flexion strength, ambulation status. Simple regression, multiple regression, and effect sizes (ES) were used to analyze these data. RESULTS: The simple regression revealed a statistically significant relationship between DAYS and the global function question (r2 = .22), the SF36PF (r2 = .28), and the patient's ambulation status (r2 = .27). A multiple regression using these three variables in combination was also statistically significant (P = .015) and explained approximately one-third of the variance in DAYS, (r2 = .37). All dependent variables revealed large or moderate ES. CONCLUSION: Self-reported functional measures in conjunction with the athlete's ambulation status are important factors in predicting the number of days to return to sport following acute lateral ankle sprains. Further research using large sample sizes and other clinical and functional measures is necessary.