Plasma-Induced Changes in the Metabolome Following Vistula Tart Cherry Consumption.

Evidence suggests that tart cherry (TC) supplementation has beneficial effects on health indices and recovery following strenuous exercise. However, little is known about the mechanisms and how TC might modulate the human metabolome. The aim of this study was to evaluate the influence of an acute high- and low-dose of Vistula TC supplementation on the metabolomic profile in humans. In a randomised, double-blind, placebo controlled, cross-over design, 12 healthy participants (nine male and three female; mean ± SD age, stature, and mass were 29 ± 7 years old, 1.75 ± 0.1 m, and 77.3 ± 10.5 kg, respectively) visited the laboratory on three separate occasions (high dose; HI, low dose; LO, or placebo), separated by at least seven days. After an overnight fast, a baseline venous blood sample was taken, followed by consumption of a standardised breakfast and dose conditions (HI, LO, or placebo). Subsequent blood draws were taken 1, 2, 3, 5, and 8 h post consumption. Following sample preparation, an untargeted metabolomics approach was adopted, and the extracts analysed by LCMS/MS. When all time points were collated, a principal component analysis showed a significant difference between the conditions (p < 0.05), such that the placebo trial had homogeneity, and HI showed greater heterogeneity. In a sub-group analysis, cyanidine-3-O-glucoside (C3G), cyanidine-3-O-rutinoside (C3R), and vanillic acid (VA) were detected in plasma and showed significant differences (p < 0.05) following acute consumption of Vistula TC, compared to the placebo group. These results provide evidence that phenolics are bioavailable in plasma and induce shifts in the metabolome following acute Vistula TC consumption. These data could be used to inform future intervention studies where changes in physiological outcomes could be influenced by metabolomic shifts following acute supplementation.

Kinematic, Kinetic, and Temporal Metrics Associated With Golf Proficiency.

ABSTRACT: McHugh, MP, O'Mahoney, CA, Orishimo, KF, Kremenic, IJ, and Nicholas, SJ. Kinematic, kinetic, and temporal metrics associated with golf proficiency. J Strength Cond Res 38(3): 599-606, 2024-The biomechanics of the golf swing have been studied extensively, but the literature is unclear on which metrics are indicative of proficiency. The purpose of this study was to determine which metrics identified golf proficiency. It was hypothesized that discrete kinematic, kinetic, and temporal metrics would vary depending on proficiency and that combinations of metrics from each category would explain specific proficiency metrics. Kinematic, kinetic, and temporal metrics and their sequencing were collected for shots performed with a driver in 33 male golfers categorized as proficient, average, or unskilled (based on a combination of handicap, ball velocity, and driving distance). Kinematic data were collected with high-speed motion analysis, and ground reaction forces (GRF) were collected from dual force plates. Proficient golfers had greater x-factor at ball impact and greater trunk deceleration before ball impact compared with average ( p < 0.05) and unskilled ( p < 0.01) golfers. Unskilled golfers had lower x-factor at the top of the back swing and lower peak x-factor, and they took longer to reach peak trunk velocity and peak lead foot GRF compared with average ( p < 0.05) and proficient ( p < 0.05) golfers. A combination of 2 kinematic metrics (x-factor at ball impact and peak pelvis velocity), 1 kinetic metric (peak lead foot GRF), and 2 timing metrics (the timing of peak trunk and arm velocity) explained 85% of the variability in ball velocity. The finding that x-factor at ball impact and trunk deceleration identified golf proficiency points to the potential for axial trunk rotation training to improve performance.

Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study.

BACKGROUND: The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined. HYPOTHESIS: PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores. RESULTS: Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity. CONCLUSION: Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.

Lower extremity kinematic and kinetic factors associated with bat speed at ball contact during the baseball swing.

The purpose of this study was to determine which biomechanical variables measured during the baseball swing are associated with linear bat speed at ball contact (bat speed). Twenty collegiate baseball players hit a baseball from a tee into a net. Kinematics were recorded with a motion capture system sampling at 500 Hz and kinetics were measured by force plates under each foot sampling at 1000 Hz. Associations between bat speed, individual joint and segment kinematics, joint moments and ground reaction forces (GRF) were assessed using Pearson correlations and stepwise linear regression. Average bat speed was 30 ± 2 m/s. Lead foot peak vertical (159 ± 29% BW, r = 0.622, P = 0.001), posterior (-57 ± 12% BW, r = -0.574, P = 0.008) and resultant (170 ± 30% BW, r = 0.662, P = 0.001) GRF were all correlated with bat speed. No combination of factors strengthened the relationship to bat speed beyond these individual variables. These results illustrate the role of the lead leg in generating and transferring ground reaction forces through the kinetic chain in order to accelerate the bat. Training to improve bat speed should include both general lower extremity strengthening exercises and sport-specific hitting drills to improve lower extremity force production following lead foot contact.

Does High Medial Elbow Stress During Pitching Compromise the Dynamic Stabilizers of The Elbow?

Background: The flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) are thought to provide dynamic stability to the medial elbow, with a lesser contribution from the pronator teres (PT). Hypothesis/Purpose: The purpose of this study was to determine if baseball pitchers with higher valgus elbow torque experience greater FCU and FDS strength loss. Study Design: Controlled Laboratory Study. Methods: A pilot study was performed to determine if middle and ring finger flexion strength tests preferentially activated the FCU and FDS versus the PT (10 men age 36±12 yr). EMG amplitudes, expressed as percent of maximal voluntary contraction (MVC) were compared between tests and muscles. In a field study of college baseball pitchers, middle finger, ring finger and grip strength were tested prior to, immediately after, and one day after 14 pitching performances in 10 pitchers (21±2 yr). Elbow valgus torque was measured from an inertial measurement unit, housed in a compression sleeve and pitchers were categorized as having high or low valgus torque. Results: For the pilot study EMG activations were 74% FDS, 66% FCU and 35% PT for the middle finger test (muscle effect p=0.032) and 93% FCU, 61% FDS and 23% PT for the ring finger test (muscle effect p=0.005). In the field study, pitchers with high valgus torque showed marked post-game middle finger fatigue (88% of baseline) and incomplete recovery the following day (95%), while pitchers with low valgus torque showed no strength loss (107% post game, 106% a day later; group x time p=0.022). Results were similar for ring finger strength (high torque: 94% post game 96% a day later; low torque: 114% post game 107% a day later; group x time p=0.048). By contrast, grip strength was not different between pitchers with high versus low valgus torque (p=0.143). Conclusion: High medial elbow stress during pitching fatigues the dynamic stabilizers of the medial elbow. Level of Evidence: Level 3©The Author(s).

Adductor Strains in Athletes.

Acute adductor injuries are a common occurrence in sport. The overall incidence of adductor strains across 25 college sports was 1.29 injuries per 1000 exposures, with men's soccer (3.15) and men's hockey (2.47) having the highest incidences. As with most muscle strains there is a high rate of recurrence for adductor strains; 18% in professional soccer and 24% in professional hockey. Effective treatment, with successful return to play, and avoidance of reinjury, can be achieved with a proper understanding of the anatomy, a thorough clinical exam yielding an accurate diagnosis, and an evidence-based treatment approach, including return to play progression.

Role of Pelvis and Trunk Biomechanics in Generating Ball Velocity in Baseball Pitching.

ABSTRACT: Orishimo, KF, Kremenic, IJ, Mullaney, MJ, Fukunaga, T, Serio, N, and McHugh, MP. Role of pelvis and trunk biomechanics in generating ball velocity in baseball pitching. J Strength Cond Res 37(3): 623-628, 2023-The purpose of this study was to determine the impact of pelvis rotation velocity, trunk rotation velocity, and hip-shoulder separation on ball velocity during baseball pitching. Fastball pitching kinematics were recorded in 29 male pitchers (age 17 ± 2 years, 23 high school, 6 college). Pelvis and trunk angular velocities and hip-shoulder separation were calculated and averaged for the 3 fastest pitches. Associations between peak pelvis velocity, peak trunk velocity, hip-shoulder separation at foot contact, and ball velocity were assessed using Pearson correlation coefficients and multiple regression. The average ball velocity was 33.5 ± 2.8 m·s -1 . The average hip-shoulder separation at foot contact was 50 ± 12°. The peak pelvis velocity (596 ± 88°·s -1 ) occurred at 12 ± 11% of the time from stride foot contact to ball release, with the peak trunk velocity (959 ± 120°·s -1 ) occurring at 36 ± 11%. Peak trunk velocity was predictive of ball velocity ( p = 0.002), with 25% of the variability in ball velocity explained. No combination of factors further explained ball velocity. Hip-shoulder separation at foot contact (17%, p = 0.027), peak pelvis velocity (23%, p = 0.008), and the timing of peak pelvis velocity (16%, p = 0.031) individually predicted peak trunk velocity. The combination of peak pelvis velocity, hip-shoulder separation at foot contact, and the timing of peak trunk velocity explained 55% of the variability in trunk rotation velocity ( p < 0.001). These data highlight the importance of interactions between pelvis and trunk for maximizing velocity in pitching. Training to improve pelvis-trunk axial dissociation may increase maximal trunk rotation velocity and thereby increase ball velocity without increasing training load on the shoulder and elbow.

Use of a Non-Pharmacological Pain Relief Kit to Reduce Opioid Use Following Orthopedic Surgery: A Prospective Randomized Study.

Introduction: Opioid prescription to treat pain among orthopedic surgery patients remains common practice in the United States but overprescribing opioids can lead to abuse. The purpose of this study was to determine the effect of a multimodal non-pharmacological 'pain relief kit' on pain, function, and opioid consumption in individuals recovering from orthopedic surgery. Hypothesis: Patients provided with the pain relief kit would consume less opioid medication, report lower pain levels, and have better functional outcome scores than the control group. Level of Evidence: 2b. Methods: Fifty-three subjects (18 women, 35 men) having orthopedic surgery were randomly assigned to either receive the Pain Relief Kit (treatment) or control group. At the first postoperative physical therapy visit (within 1 week of surgery) the treatment group was provided elastic resistance bands, kinesiology tape, Biofreeze, and a hot/cold pack as part of the Pain Relief Kit. Patients completed the SF-36 and either the DASH or LEFS questionnaires consistent with their surgery at baseline and four weeks post-op. Both groups reported daily pain (Visual Analogue Scale), opioid use, and over the counter medication use. The treatment group also recorded daily kit modality use. Results: There was no significant difference in total opioid use between the treatment (108±252 milligram morphine equivalents) and control groups (132±158 MME; p=0.696). Opioid use and pain declined from week one to four with no difference between groups (p<0.001). Outcome scores and SF-36 scores improved from week one to four with no difference between groups (p<0.001). Conclusion: A non-pharmacological pain relief kit did not have an effect on opioid use in this patient population nor did it improve pain relief or function compared to controls.

Predictive value of magnetic resonance imaging in outcomes of nonsurgical treatment of lateral epicondylitis.

BACKGROUND: The diagnosis of lateral epicondylitis is typically made on the basis of clinical history and examination. However, magnetic resonance imaging (MRI) is often used to supplement evaluation of the patient with a painful elbow and can identify extensor carpi radialis brevis (ECRB) tendon tears. The objective of this study was to determine if ECRB tear size on MRI could be used as a prognostic indicator for patients with recalcitrant lateral epicondylitis and partial ECRB tears. METHODS: Forty-one patients with recalcitrant lateral epicondylitis and a partial ECRB tear on MRI were identified (22 men and 19 women; age: 49 ± 8 years; height: 165 ± 36 mm; weight: 73 ± 18 kg). Patients were divided into two groups based on whether they underwent surgery or not. Nonsurgical treatment was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire, and surgery was considered a failure of nonsurgical treatment. Nonsurgical treatment was variable and included a mixture of physical therapy, rest, injection therapy, and splinting. RESULTS: Of the 41 patients, 5 patients opted for immediate surgery and 36 patients were treated nonsurgically. Of those 36 patients, 11 patients had symptom relief, 19 patients had subsequent surgery, and 6 patients chose not to have surgery despite continued symptoms. Tear size on MRI did not differ significantly between the patients who had symptom relief with nonsurgical treatment and the other patients (7.7 ± 4.3 mm vs. 9.7 ± 2.5 mm, P = .07). DISCUSSION: Only 11 of 41 patients (27%) with recalcitrant lateral epicondylitis and ECRB tear had symptom relief with nonsurgical treatment. However, ECRB tendon defect size on MRI did not predict success or failure of nonsurgical treatment.

"Precovery" versus recovery: Understanding the role of cherry juice in exercise recovery.

Cherry juice has become a standard component of athlete recovery strategies. This review covers the history of cherry juice as a recovery drink to give context to its current use. Fifteen studies were identified that included a measure of muscle function, soreness, or inflammation on the days following exercise and had an exercise insult sufficient to assess the effectiveness of the tart cherry intervention. Eight studies used a concentrated juice, three used a juice from fresh-frozen cherries, two used a tart cherry concentrate gel, and two used a tart cherry powder. The effective juice dose was specific to the type of drink (fresh-frozen versus concentrate) but dose-response studies are lacking, and thus, the optimal dose for any specific type of cherry juice is not known. Timing of the dosing regimen is a critical factor. Studies have uniformly shown that muscle function will recover faster on the days after exercise if juice is provided for several days prior to exercise. Effects on soreness or systemic inflammation are more equivocal. The available evidence does not support a regimen that begins on the day of exercise or post-exercise. Tart cherry powder did not enhance any metric of recovery on the days after exercise. In conclusion, the term recovery implies an intervention that is introduced after an exercise insult. The term "precovery" may be preferable to describe interventions that should be introduced on the days prior to exercise to facilitate recovery on the days after exercise. The evidence supports cherry juice as a precovery intervention across a range of athletic activities.

Importance of Transverse Plane Flexibility for Proficiency in Golf.

ABSTRACT: McHugh, MP, O'Mahoney, CA, Orishimo, KF, Kremenic, IJ, and Nicholas, SJ. Importance of transverse plane flexibility for proficiency in golf. J Strength Cond Res 36(2): e49-e54, 2022-The extent to which the flexibility requirements for golf proficiency vary between the planes of motion has not been examined. The purpose of this study was to compare flexibility between proficient and average golfers with the hypothesis that proficient golfers have greater transverse plane flexibility than average golfers, with no differences in the sagittal and frontal planes. Twenty-five male golfers were categorized as proficient (handicap ≤5, n = 13) or average (handicap 10-20, n = 12). Fourteen flexibility tests were performed (4 shoulder tests, 4 trunk tests, and 6 hip tests) with tests in all 3 planes of motion for each body segment. In addition, trunk motion, pelvic motion, and hip motion during the golf swing were assessed with high-speed motion analysis. Ball speed and shot distance were recorded with a golf simulator. Proficient golfers had significantly better flexibility than average golfers in the transverse plane (shoulder p = 0.021, trunk p = 0.003, and hip p < 0.0001), with no differences in the sagittal plane or frontal plane (plane of motion by golf proficiency p = 0.0001). Transverse plane hip flexibility accounted for 48% of the variability in ball speed (p < 0.0001) and 45% of the variability in total distance (p = 0.001). During the golf swing, proficient golfers had greater separation between the pelvis and the trunk (x-factor) than average golfers (p = 0.002). In conclusion, transverse plane flexibility in the trunk and hips is an important requirement for golf proficiency. Sagittal plane flexibility and frontal plane flexibility were unrelated to proficiency. Developing and maintaining trunk and hip rotation flexibility is important for optimizing performance.

Electromyographic analysis of select eccentric-focused rotator cuff exercises.

BACKGROUND: Eccentric-focused rotator cuff exercises are clinically useful in rehabilitation; however, to what extent these exercises activate shoulder musculature is unknown. PURPOSE: Investigate peak electromyographic (EMG) activity of shoulder musculature during eccentric-focused rotator cuff exercises to inform clinical decision-making. METHODS: Surface EMG activity was measured in 15 healthy subjects from 5 muscles of the dominant shoulder: supraspinatus, infraspinatus, upper trapezius, lower trapezius, and middle deltoid. Subjects performed 5 exercises: short-to-long scaption, sit-to-stand scaption, standing external rotation (ER), sidelying ER, and sidelying horizontal adduction. The effects of exercise and muscle on peak EMG activity were analyzed using two-way repeated-measures ANOVA and followed with post-hoc pairwise comparisons. RESULTS: Significant exercise-by-muscle interaction effect was found (p < .001). Short-to-long and sit-to-stand scaption elicited higher activity in supraspinatus and middle deltoid compared to other exercises (p < .05); however, no effect of muscle was found for these exercises (p > .05). Infraspinatus and lower trapezius demonstrated higher activity compared to other muscles during standing ER, sidelying ER, and sidelying horizontal adduction (p < .05). CONCLUSION: Eccentric-focused exercises sufficiently activate the rotator cuff and is effective for use in rehabilitation. Caution must be taken as some exercises do not target specific musculature.

The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise.

Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.

Resisted adduction sit-up test (RASUT) as a screening tool for pelvic versus hip pathology.

Groin pain is a common symptom in hip and pelvic pathology and differentiating between the two remains a challenge. The purpose of this study was to examine whether a test combining resisted adduction with a sit-up (RASUT) differentiates between pelvic and hip pathology. The RASUT was performed on 160 patients with complaints of hip or groin pain who subsequently had their diagnosis confirmed by magnetic resonance imaging (MRI) or surgery. Patients were categorized as having pelvic pathology (athletic pubalgia or other) or hip pathology (intra-articular or other). Athletic pubalgia was defined as any condition involving the disruption of the pubic aponeurotic plate. Sensitivity, specificity, positive predictive accuracy, negative predictive accuracy and diagnostic odds ratios were computed. Seventy-one patients had pelvic pathology (40 athletic pubalgia), 81 had hip pathology and 8 had both. The RASUT was effective in differentiating pelvic from hip pathology; 50 of 77 patients with a positive RASUT had pelvic pathology versus 29 of 83 patients with a negative test (P < 0.001). RASUT was diagnostic for athletic pubalgia (diagnostic odds ratio 6.08, P < 0.001); 35 of 45 patients with athletic pubalgia had a positive RASUT (78% sensitivity) and 73 of 83 patients with a negative RASUT did not have athletic pubalgia (88% negative predictive accuracy). The RASUT can be used to differentiate pelvic from hip pathology and to identify patients without athletic pubalgia. This is a valuable screening tool in the armamentarium of the sports medicine clinician.

Accelerated Muscle Recovery in Baseball Pitchers Using Phase Change Material Cooling.

PURPOSE: The purpose of this study was to document recovery after a pitching performance and determine whether prolonged postgame phase change material (PCM) cooling of the shoulder and forearm accelerates recovery. METHODS: Strength, soreness, and serum creatine kinase (CK) activity were assessed before and on the 2 d after pitching performances in 16 college pitchers. Pitchers were randomized to receive either postgame PCM cooling packs on the shoulder and forearm or no cooling (control). PCM packs were applied inside compression shirts and delivered cooling at a constant temperature of 15°C for 3 h. Strength was assessed for shoulder internal rotation (IR), external rotation (ER), empty can (EC) test, and grip. RESULTS: Total pitch count was 60 ± 16 for 23 PCM cooling games and 62 ± 17 for 24 control games (P = 0.679). On the days after pitching, IR strength (P = 0.006) and grip strength (P = 0.036) were higher in the PCM cooling group versus control. One day after pitching, IR strength was 95% ± 14% of baseline with PCM cooling versus 83% ± 13% for control (P = 0.008, effect size d = 0.91) and 107% ± 9% versus 95% ± 10% for grip strength (P = 0.022, effect size d = 1.29). There was a trend for greater ER strength with PCM cooling (P = 0.091, effect size d = 0.51). The EC strength was not impaired after pitching (P = 0.147) and was therefore unaffected by PCM cooling (P = 0.168). Elevations in soreness and CK were not different between treatments (treatment-time CK P = 0.139, shoulder soreness P = 0.885, forearm soreness P = 0.206). CONCLUSION: This is one of the first studies to document impairments in muscle function on the days after baseball pitching, and the first study showing a novel cryotherapy intervention that accelerates recovery of muscle function in baseball pitchers after a game.

Prolonging the duration of cooling does not enhance recovery following a marathon.

Runners commonly utilize cryotherapy as part of their recovery strategy. Cryotherapy has been ineffective in mitigating signs and symptoms of muscle damage following marathon running and is limited by its duration of application. Phase change material (PCM) packs can prolong the duration of cooling. This study aimed to test the efficacy of prolonging the duration of cooling using PCM on perceptual recovery, neuromuscular function, and blood markers following a marathon run. Thirty participants completed a marathon run and were randomized to receive three hours of 15°C PCM treatment covering the quadriceps or recover without an intervention (control). Quadriceps soreness, strength, countermovement jump (CMJ) height, creatine kinase (CK), and high sensitivity C-reactive protein (hsCRP) were recorded at baseline, 24, 48, and 72 hours after the marathon. Following the marathon, strength decreased in both groups (P < .0001), with no difference between groups. Compared to baseline, strength was reduced 24 (P = .004) and 48 hours after the marathon (P = .008) in the control group, but only 24 hours (P = .028) in the PCM group. Soreness increased (P < .0001) and CMJ height decreased (P < .0001) in both groups, with no difference between groups. Compared to baseline, CMJ height was not reduced on any days in the PCM group but was reduced in the control group 24 (P < .0001) and 48 hours (P = .003) after the marathon. CK and hsCRP increased in both groups (P < .0001). Although the marathon run induced significant muscle damage, prolonging the duration of cooling using PCM did not accelerate the resolution of any dependent variables.

ASSESSMENT OF HUMERAL TORSION BY PALPATION IN BASEBALL PITCHERS: A VALIDATION STUDY.

BACKGROUND/PURPOSE: Greater humeral retroversion has been associated with shoulder and elbow injuries. Methods for measuring torsion include radiography, computed tomography (CT) and sonography (US) which may be costly or unavailable. A palpation method might be a reliable alternative to imaging techniques. The purpose of the current study was to examine the construct validity of the palpation technique for humeral torsion by (1) determining if a side-to-side difference in humeral torsion (HT) could be detected in a cohort of baseball pitchers using the palpation technique and (2) compare the side-to-side difference in HT obtained through the palpation method to the US method. HYPOTHESIS: Clinical assessment of HT by palpation is reliable and is as accurate as sonographic HT measurements among overhead athletes. METHODS: Twenty collegiate and high school pitchers were assessed. Bilateral shoulder passive external rotation (ER) and internal rotation (IR) range of motion were measured. Humeral torsion was indirectly measured using sonographic and palpatory methods. Paired t-tests were used to determine HT side-to-side difference measured by US versus palpation. Pearson's correlation coefficient (r) was used to determine the relationship between HT side-to-side difference detected by palpation and US, and relationships among IR and ER of the shoulder and HT side to-side difference measurements. RESULTS: There was significantly greater HT in dominant versus nondominant arm assessed by both palpation (5°±5, p=0.0004) and ultrasound (9°±11, p=0.0007). There was a positive correlation between both methods of HT measurement (r = 0.522, p=0.018). Palpation significantly underestimated HT as compared to US measurements (difference 4°±9, p=0.048). Difference in IR between shoulders correlated with HT measured by palpation (r=-0.651, p=0.002) and US (r=0.569, p=0.009). Increased ER in the dominant versus nondominant arm correlated with the side-to-side difference in HT measured by both palpation (r = 0.509, p=0.02) and US (r = 0.602, p=0.005). CONCLUSION: Greater HT on the dominant versus nondominant shoulder via palpation indicated this method can be used to assess HT in pitchers. HT assessed by palpation correlated with HT assessed by US. However, the magnitude of side-to-side difference in HT was smaller with palpation compared to US, and the two techniques should not be used interchangeably. Nevertheless, assessment of HT via palpation is a reliable and practical method and its use should be encouraged. LEVEL OF EVIDENCE: Level 3, measurement study.

Don't Lose Your Cool With Cryotherapy: The Application of Phase Change Material for Prolonged Cooling in Athletic Recovery and Beyond.

Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of 3-6 h with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.

MAPPING TENDERNESS TO PALPATION PREDICTS RETURN TO PLAY FOLLOWING ACUTE HAMSTRING STRAIN.

INTRODUCTION/PURPOSE: Currently there is little evidence supporting the use of objective tests, measures, or imaging to help predict time to return to sport (RTS) following a hamstring strain. The purpose of this study is to investigate the predictive value of tenderness to palpation (TTP) as measured by area and location following hamstring strain. STUDY DESIGN: Case Series. METHODS: Nineteen male athletes (age 28 ± 9 yr) who sustained an acute hamstring strain underwent hamstring tenderness mapping on initial evaluation. The length and width of tenderness of the hamstring was identified with manual palpation, outlined in pen, and was then calculated as a percentage of the length and width of the posterior thigh. All patients underwent the same hamstring rehabilitation protocol with remapping performed at specific stages in rehabilitation. The association between mapping tenderness indices and RTS was assessed by linear regression. RESULTS: The average length of the area of tenderness was 22 ± 12% with an average RTS of 43 ± 36 days. The length of the area of tenderness measured on initial evaluation was a strong predictor of RTS (R2 = 0.58, p<0.001; y = 2.3x - 6.2). Area of injury (R2 = 0.36, p = 0.006) and age (R2 = 0.27, p = 0.024) were also related to RTS, while width of injury (R2 = 0.006, p = 0.75) and location of injury were not (proximal-distal p = 0.62, medial-lateral p = 0.64). Adding age with length of injury into a multiple regression analysis improved the prediction of RTS (R2 = 0.73). The relationship between RTS and length of tenderness was relatively unchanged when the additional mapping indices taken during the course of rehabilitation were added to the analysis (R2 = 0.61, p<0.001; y = 2.3x - 4.4). This indicates that the regression equation can be used to estimate RTS regardless of when in the post injury/rehabilitation process the mapping is performed. CONCLUSIONS: The length of the area of tenderness to palpation of the injured hamstring muscle was highly predictive of RTS time. Based on the regression equation a patient with a length of tenderness of 10% would have an estimated RTS time of 17 days, while a tenderness length of 30% would be estimated to return in 63 days. This hamstring mapping technique described was predictive of the RTS and may be a useful clinical tool. LEVEL OF EVIDENCE: IIb.

Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise.

PURPOSE: The aim of this investigation was twofold: (1) to examine the effect of prolonged phase change material (PCM) cooling following eccentric exercise of the quadriceps on indices of muscle damage, and (2) to elucidate whether application of PCM cooling blunted the acute adaptive response to eccentric exercise, known as the repeated bout effect (RBE). METHODS: Twenty-six males (25 ± 6 years) performed an initial bout (B1) of 120 eccentric quadriceps contractions on each leg at 90% of their isometric strength and were then randomized to receive PCM packs frozen at 15 °C (treatment) or melted packs (control) worn directly on the skin under shorts for 6 h. The protocol was repeated 14 days later (B2) with all participants receiving the control condition. RESULTS: PCM cooling provided protection against strength loss in B1 (P = 0.005) with no difference in strength between treatment groups in B2 (P = 0.172; bout by treatment by time P = 0.008). PCM cooling reduced soreness in B1 (P = 0.009) with no difference between treatment groups in B2 (P = 0.061). Soreness was overall lower following B2 than B1 (P < 0.001). CK was elevated in B1 (P < 0.0001) and reduced in B2 (P < 0.001) with no difference between treatments. The damage protocol did not elevate hsCRP in B1, with no difference between treatments or between bouts. CONCLUSIONS: This work provides further evidence that PCM cooling enhances recovery of strength and reduces soreness following eccentric exercise. Importantly, these data show for the first time that prolonged PCM cooling does not compromise the adaptive response associated with the RBE.