Signs of Inequitable Access: Users of Private Physiotherapy Services Do Not Reflect the Urban Population in Winnipeg, Manitoba.

Purpose: Both private and public funding cover outpatient physiotherapy (PT) in Canada. Knowledge is lacking in who does and does not access PT services, which limits the ability to identify health/access inequities created by current financing structures. This study characterizes the individuals accessing private PT in Winnipeg to better understand whether inequities exist, given the very limited publicly financed PT. Methods: Patients attending PT in 32 private businesses, sampled for geographic variation, completed a survey online or on paper. We compared the sample's demographic characteristics with Winnipeg population data using chi-square goodness-of-fit tests. Results: In total, 665 adults accessing PT participated. Respondents were older and had higher levels of income and education compared to Winnipeg census data (p < 0.001). Our sample included higher proportions of female and White individuals, and lower proportions of Indigenous persons, newcomers, and people from visible minorities (p < 0.001). Conclusions: There are signs that inequities exist in access to PT in Winnipeg; the cohort who access private PT services does not reflect the wider population, which suggests that some segments of the population are not receiving care.

Objectif : un financement tant public que privé couvre les services ambulatoires de physiothérapie au Canada. On ne sait pas qui y a accès ou non, ce qui limite la possibilité de déterminer les iniquités en matière de santé et d'accès attribuables aux structures actuelles de financement. La présente étude caractérise les personnes qui accèdent à des services de physiothérapie privés à Winnipeg, afin de mieux comprendre s'il existe des iniquités, compte tenu des services de physiothérapie très limités qui sont financés par le secteur public. Méthodologie : des patients recevant des services de physiothérapie dans 32 entreprises privées, échantillonnées d'après leur variation géographique, ont rempli un sondage en ligne ou sur papier. Les chercheurs ont comparé les caractéristiques démographiques de l'échantillon aux données populationnelles de Winnipeg au moyen de tests du chi carré pour la qualité de l'ajustement. Résultats : au total, 665 adultes qui avaient accès à des services de physiothérapie ont participé. Ils étaient plus âgés et avaient un revenu et une scolarisation supérieurs aux données du recensement de Winnipeg (p < 0,001). L'échantillon contenait une plus forte proportion de femmes et de personnes blanches, et une plus faible proportion de personnes autochtones, de nouveaux arrivants et de membres des minorités visibles (p < 0,001). Conclusions : il y a des signes d'iniquité d'accès aux services de physiothérapie à Winnipeg. La cohorte qui a accès aux services de physiothérapie privés ne reflète pas l'ensemble de la population, ce qui indique que certains segments de la population ne reçoivent pas de soins.

Anterior cruciate ligament injury: towards a gendered environmental approach.

BACKGROUND: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. OBJECTIVE: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. APPROACH: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. CONCLUSION: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment.

ATHLETE PERCEPTIONS AND PHYSICAL PERFORMANCE EFFECTS OF THE FIFA 11 + PROGRAM IN 9-11 YEAR-OLD FEMALE SOCCER PLAYERS: A CLUSTER RANDOMIZED TRIAL.

BACKGROUND: Strong evidence supports the use of the FIFA 11 + injury risk reduction warm-up program among soccer players, but few studies have investigated its impact on physical performance and movement control in athletes younger than 12 years of age, or the athletes' opinions of participating in the program. PURPOSE: The primary purpose of this study was to measure the impact of the FIFA 11 + program on movement control [Landing Error Scoring System (LESS) and Y-Balance test (YBT)], agility, vertical jump (VJ) height, and trunk muscle endurance compared to a standard warm-up in pre-teen female athletes over one indoor soccer season. A secondary purpose was to assess the athletes' tolerance and enjoyment of the program. STUDY DESIGN: Cluster randomized controlled trial. METHODS: All six teams in the U10 and U11 female divisions of a developmental-level soccer club were cluster randomized to the FIFA 11 + program intervention group or the control group. Participants in the control group continued with a coach-determined warm-up for the duration of a five-month indoor soccer season. Pre- and post-season participants underwent physical testing using the agility T-test, Belt Mat vertical jump (VJ), and static plank tests; and two measures of neuromuscular control (LESS, YBT). Following the soccer season, the athletes in the intervention group also completed a bespoke Tolerance and Enjoyment questionnaire. RESULTS: The 11 + group (n = 25) increased their mean static plank hold time by 26.1 ± 38.5 seconds compared to the control group (n = 18), who only increased by 2.1 ± 37.1 seconds (p = 0.047). For all athletes, there were improvements in mean LESS score (0.6 ± 1.3, p = 0.003), and T-test time (0.4 ± 0.7, p = 0.001); however, YBT scores worsened by approximately 2% from pre- to postseason. No differences were found for VJ. Athletes tolerated the program well, but the majority described the enjoyment of completing the program as moderately low. CONCLUSION: This study suggests that the 11 + program may improve some aspects of physical performance in 9-11 year-old female soccer players, but the low enthusiasm for the program could have longer term adherence implications. LEVEL OF EVIDENCE: 2b.

Functional fitness for dental hygiene students: Does it make them fit to sit?

Background: Static positioning and awkward postures put dental hygienists at risk for work-related musculoskeletal disorders. These disorders often appear during professional training programs. Ergonomics education has been shown to reduce the incidence of injuries, but fitness training to improve postural awareness and endurance is not typically included in dental hygiene curricula. This study assessed the effects of a 12-week functional fitness training program on ergonomic and postural knowledge, outcome expectations and self-efficacy related to exercise, and core stability in final-year dental hygiene students. Methods: Participants (n = 24) completed surveys and core stability tests and demonstrated postural movements before and after completing a mandatory weekly training program focusing on dynamic core stabilization, aerobic exercise, and postural awareness. Results: Participants improved static plank hold time and left leg forward lunge scores, with no significant changes in right lunge or stability push-up tests. Accuracy in demonstrating postural movements in response to verbal cues improved for 2 of 6 movements. Knowledge about injury risk factors and body mechanics was relatively high at pre-test and did not change post-test. Outcome expectations and self-efficacy were not significantly different from pre- to post-test. Conclusions: Functional fitness training resulted in increased core endurance and improved execution of some movement patterns associated with good body mechanics. Our study provides evidence for the inclusion of this type of conditioning program in the dental hygiene curriculum. Further research, including more sensitive tests of physical function as well as the transfer of knowledge and safe postures into clinically relevant situations, is warranted.

Contexte: Le positionnement statique et les mauvaises postures mettent les hygiénistes dentaires à risque de troubles musculosquelettiques liés au travail. Ces troubles surviennent souvent au cours des programmes de formation professionnelle. Il a été démontré que la formation en matière d'ergonomie réduit l'incidence des blessures, alors que le conditionnement physique effectué pour améliorer la prise de conscience posturale et l'endurance ne fait généralement pas partie du programme d'étude en hygiène dentaire. La présente recherche a évalué les effets d'un programme de conditionnement physique fonctionnel de 12 semaines sur les connaissances en matière de l'ergonomie et de la posture, des attentes de résultats, de la connaissance de ses propres capacités liées à l'exercice, ainsi que de la stabilité du tronc chez les étudiants de dernière année en hygiène dentaire. Méthodologie: Les participants (n = 24) ont rempli des sondages, effectué des tests de stabilité du tronc et démontré des mouvements posturaux avant et après avoir terminé une formation hebdomadaire obligatoire axée sur la stabilisation dynamique du tronc, les exercices aérobiques et la prise de conscience posturale. Résultats: Les participants ont amélioré leurs résultats de temps de planche statique et de l'exercice de fente avant de la jambe gauche et n'ont pas montré de changements significatifs dans leurs tests d'exercice de fente avant de la jambe droite ou de répulsions, des exercices de stabilisation du tronc. La précision des mouvements posturaux en réponse aux stimulations verbales s'est améliorée dans 2 des 6 mouvements. Les connaissances sur les facteurs de risque en matière des blessures et sur la mécanique du corps étaient relativement élevées au moment du test préliminaire et n'ont pas changé après le test. Les attentes de résultats et la connaissance de ses propres capacités n'étaient pas significativement différentes entre le test préliminaire et le post-test. Conclusions: Le conditionnement physique fonctionnel s'est traduit en une meilleure endurance du tronc et une performance améliorée de certaines séquences de mouvements associés à la bonne fonction mécanique du corps. Notre étude apporte des preuves qui appuient l'ajout de ce type de programme de conditionnement au programme d'hygiène dentaire. Il est justifié de faire des recherches plus poussées, y compris des évaluations plus sensibles de la fonction physique, ainsi que du transfert des connaissances et des postures sécuritaires aux situations cliniques pertin.

The Effect of Strength Training on the Jump-Landing Biomechanics of Young Female Athletes: Results of a Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of leg-focused strength training on the jump-landing mechanics of young female athletes. DESIGN: Single-blind, randomized controlled clinical trial. SETTING: University-based training program. PARTICIPANTS: Forty female athletes, 10 to 14 years old, were randomly allocated to intervention or active control. INTERVENTIONS: Twice weekly training was performed by the leg strengthening group [intervention group (IG); n = 19] and the active control group (CG; n = 17), for 12 weeks. Control group participants performed upper body strengthening exercises. MAIN OUTCOME MEASURE: Jump-landing performance was assessed by a blinded observer using the Landing Error Scoring System (LESS). RESULTS: There was no difference between the IG and CG postintervention (IG mean LESS score 6.0 ± SD 1.8 vs CG mean 6.1 ± SD 1.8; P = 0.85). CONCLUSIONS: Strength training of the legs does not seem to improve jump-landing abilities in young female athletes compared with active controls who strength-trained their arms. CLINICAL RELEVANCE: Leg strengthening may not provide an advantage over arm strengthening for improving jump-landing movement patterns in young female athletes. This has implications for the design of conditioning programs if injury prevention is a goal.

Reliability of measuring hip and knee power and movement velocity in active youth.

PURPOSE: The purpose of this study was to determine the reliability of measuring neuromuscular power and movement velocity of the hip and knee in young, active individuals using an isokinetic dynamometer. METHODS: Peak power, average power, and peak velocity (PV) data were recorded for the hip in the standing position and the knee in the sitting position in 52 youth aged 10 to 14 years on 2 occasions approximately 1 week apart. RESULTS: The PV measures demonstrated the best absolute reliability of all variables tested (coefficients of variation of the typical error [CV(TE)] = 5.0%-8.5%; standard errors of measurement = 18.1-21.1°/s). Hip flexion and knee extension peak power and average power exhibited acceptable reliability (CV(TE) = 8.7%-10.8%) compared with the other isokinetic tests (CV(TE) = 16.9%-32.8%). CONCLUSIONS: Peak velocity appears to be a reliable means of indirectly measuring neuromuscular power in active youth, whereas direct measurement of power is only reliable for certain movements.

Modifying spike jump landing biomechanics in female adolescent volleyball athletes using video and verbal feedback.

Landing awkwardly from a jump is a common mechanism of injury for the anterior cruciate ligament (ACL) of the knee. Augmented feedback, such as verbal or visual instruction, has been shown to cause an immediate, positive change in landing biomechanics in a laboratory setting. No data exist on the longer term effects of feedback on jump landing biomechanics in a sports-specific setting. The purpose of this study was to explore whether providing video and verbal feedback to adolescent (12-14 years old) female volleyball athletes would improve their landing technique. Trunk and lower extremity kinematic variables were measured in 19 participants before a feedback session was provided to the intervention group (IG). Follow-up kinematic measurements of the IG were taken immediately postintervention, and again after 2 and 4 weeks. Two-way repeated measures analysis of variance (ANOVA) was used to compare the IG with a control group (CG), who received no feedback. The IG (n = 10) demonstrated increased maximal hip and trunk flexion compared with the CG (n = 9) at week 4 (p ≤ 0.05). One-way repeated measures ANOVA was used to determine if changes were evident within the IG over time. Ankle dorsiflexion, right knee and hip flexion, and trunk flexion changed significantly (p ≤ 0.05) over the 4-week period. Augmented feedback appeared to produce a positive change in landing biomechanics in adolescent female volleyball athletes performing a sports-specific skill. Courtside video and verbal feedback may present a relatively simple, cost-effective method of introducing one component of a comprehensive ACL injury prevention program at a young age.