THE MINIMUM CLINICALLY IMPORTANT DIFFERENCE ON THE VISA‐A AND LEFS FOR PATIENTS WITH INSERTIONAL ACHILLES TENDINOPATHY

Study Design

Cohort study of subjects with insertional Achilles tendinopathy (IAT).

Objectives

The purpose of this study was to establish the minimum clinically important difference (MCID) on the Victorian Institute of Sport Assessment ‐ Achilles Questionnaire (VISA‐A) and the Lower Extremity Functional Scale (LEFS) for patients with IAT.

Background

The VISA‐A and LEFS are two measures commonly utilized for patients with IAT. Previous authors have estimated the MCID for the VISA‐A, but a MCID has not been formally established. The MCID for the LEFS has been established for patients with lower extremity conditions in general, but it is not clear if this MCID is applicable to patients with IAT.

Methods

Fifteen subjects participating in a randomized controlled trial studying the effectiveness of intervention for IAT over a 12‐week period were included in this study. Subjects completed the VISA‐A and LEFS forms at baseline and 12 weeks after the initiation of treatment. All subjects also completed a 15‐point global rating of change (GROC) questionnaire at 12 weeks after the initiation of treatment. Subjects were classified as improved or stable based on their GROC scores.

Results

The area under the curve (AUC) for the VISA‐A was 0.97 and a MCID of 6.5 points was identified. The AUC for the LEFS was 0.97 and a MCID of 12 points was identified.

Conclusion

The VISA‐A and LEFS are both useful outcome measures to assess response in patients with IAT.

Level of Evidence

3     

COMPARISON OF ECCENTRIC AND CONCENTRIC EXERCISE INTERVENTIONS IN ADULTS WITH SUBACROMIAL IMPINGEMENT SYNDROME

Background

Researchers have demonstrated moderate evidence for the use of exercise in the treatment of subacromial impingement syndrome (SAIS). Recent evidence also supports eccentric exercise for patients with lower extremity and wrist tendinopathies. However, only a few investigators have examined the effects of eccentric exercise on patients with rotator cuff tendinopathy.

Purpose

To compare the effectiveness of an eccentric progressive resistance exercise (PRE) intervention to a concentric PRE intervention in adults with SAIS.

Study Design

Randomized Clinical Trial

Methods

Thirty‐four participants with SAIS were randomized into concentric (n = 16, mean age: 48.6 ± 14.6 years) and eccentric (n = 18, mean age: 50.1 ± 16.9 years) exercise groups. Supervised rotator cuff and scapular PRE''s were performed twice a week for eight weeks. A daily home program of shoulder stretching and active range of motion (AROM) exercises was performed by both groups. The outcome measures of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain‐free arm scapular plane elevation AROM, pain‐free shoulder abduction and external rotation (ER) strength were assessed at baseline, week five, and week eight of the study.

Results

Four separate 2x3 ANOVAs with repeated measures showed no significant difference in any outcome measure between the two groups over time. However, all participants made significant improvements in all outcome measures from baseline to week five (p <  0.0125). Significant improvements also were found from week five to week eight (p < 0.0125) for all outcome measures except scapular plane elevation AROM.

Conclusion

Both eccentric and concentric PRE programs resulted in improved function, AROM, and strength in patients with SAIS. However, no difference was found between the two exercise modes, suggesting that therapists may use exercises that utilize either exercise mode in their treatment of SAIS.

Level of evidence

Therapy, level 1b     

MUSCLE ACTIVITY DURING KNEE‐EXTENSION STRENGTHENING EXERCISE PERFORMED WITH ELASTIC TUBING AND ISOTONIC RESISTANCE

Background/Purpose:

While elastic resistance training, targeting the upper body is effective for strength training, the effect of elastic resistance training on lower body muscle activity remains questionable. The purpose of this study was to evaluate the EMG‐angle relationship of the quadriceps muscle during 10‐RM knee‐extensions performed with elastic tubing and an isotonic strength training machine.

Methods:

7 women and 9 men aged 28‐67 years (mean age 44 and 41 years, respectively) participated. Electromyographic (EMG) activity was recorded in 10 muscles during the concentric and eccentric contraction phase of a knee extension exercise performed with elastic tubing and in training machine and normalized to maximal voluntary isometric contraction (MVC) EMG (nEMG). Knee joint angle was measured during the exercises using electronic inclinometers (range of motion 0‐90°).

Results:

When comparing the machine and elastic resistance exercises there were no significant differences in peak EMG of the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM) during the concentric contraction phase. However, during the eccentric phase, peak EMG was significantly higher (p<0.01) in RF and VM when performing knee extensions using the training machine. In VL and VM the EMG‐angle pattern was different between the two training modalities (significant angle by exercise interaction). When using elastic resistance, the EMG‐angle pattern peaked towards full knee extension (0°), whereas angle at peak EMG occurred closer to knee flexion position (90°) during the machine exercise. Perceived loading (Borg CR10) was similar during knee extensions performed with elastic tubing (5.7±0.6) compared with knee extensions performed in training machine (5.9±0.5).

Conclusion:

Knee extensions performed with elastic tubing induces similar high (>70% nEMG) quadriceps muscle activity during the concentric contraction phase, but slightly lower during the eccentric contraction phase, as knee extensions performed using an isotonic training machine. During the concentric contraction phase the two different conditions displayed reciprocal EMG‐angle patterns during the range of motion.

Level of Evidence:

5     

RELATIONSHIP BETWEEN HIP STRENGTH AND TRUNK,HIP, AND KNEE KINEMATICS DURING A JUMP‐LANDING TASK IN INDIVIDUALS WITH PATELLOFEMORAL PAIN

Background/Purpose:

Decreased strength of the hip musculature and altered mechanics of the lower extremity have been identified in individuals with patellofemoral pain (PFP). The aim of this study was to determine if a relationship exists between hip muscle strength and transverse and frontal plane motion at the hip and knee, and ipsilateral trunk flexion during a jump‐landing task in individuals with PFP.

Methods:

Fifteen individuals (10 females, 5 males) with PFP participated in this investigation. A three‐dimensional motion analysis system was utilized to assess trunk, hip, and knee kinematics during a jump‐landing task. An isokinetic dynamometer was utilized to assess concentric and eccentric strength of the hip musculature. Simple correlation analyses were performed to determine the relationships between hip muscle strength and peak frontal and transverse plane hip and knee kinematics and ipsilateral trunk flexion.

Results:

Decreased eccentric strength of the hip external rotators and abductors was significantly correlated to increased frontal plane motion at the hip and trunk, respectively (P<0.05).

Conclusions:

Based on these findings, eccentric strengthening exercises for the hip musculature may be an important component for clinicians to include when rehabilitating individuals with PFP who display increased frontal plane motion at the hip and trunk.

Level of Evidence:

2b     

PREVALENCE OF MUSCULOSKELETAL PAIN AMONG SWIMMERS IN AN ELITE NATIONAL TOURNAMENT

Background

Professional swimmers are often affected by a high number of injuries due to their large amount of training. The occurrence of musculoskeletal pain during an important tournament has not been investigated.

Objective

The objective of the study was to assess the prevalence of musculoskeletal pain and its characteristics in professional swimmers. Secondary objectives included evaluating the swimmers’ injury history over the previous 12 months, and examining the association of the presence of pain with personal and training characteristics of the swimmers.

Design

Observational, cross‐sectional study

Method

Two‐hundred and fifty‐seven swimmers who participated in the Brazilian Swimming Championship were included in the study and answered a questionnaire about personal and training characteristics, presence of pain, and injuries in the previous 12 months. The relative risk of presence of pain was calculated for the following variables: gender, BMI, stroke specialty, swimmer''s position, strength training, practice of another physical activity, and previous injuries.

Results

The prevalence of musculoskeletal pain was about 20%, with 60% of swimmers reporting at least one injury in the previous 12 months. The shoulder was the most commonly affected region and tendinopathy was the most common type of previous injury. No significant relationships were found between the presence of pain and personal or training characteristics.

Conclusions

The results demonstrated that the prevalence of musculoskeletal pain in professional swimmers participating in the most important Brazilian national tournament was approximately 20%, while the majority of participants reported previous injuries in many areas.

Level of Evidence

2c     

THE EFFICACY OF TAPING FOR ROTATOR CUFF TENDINOPATHY: A SYSTEMATIC REVIEW AND META‐ANALYSIS

Background

Rotator cuff (RC) tendinopathy is a highly prevalent musculoskeletal disorder. Non‐elastic taping (NET) and kinesiology taping (KT) are common interventions used by physiotherapists. However, evidence regarding their efficacy is inconclusive.

Objective

To examine the current evidence on the clinical efficacy of taping, either NET or KT, for the treatment of individuals with RC tendinopathy.

Study Design

Systematic review and meta‐analysis

Methods

A literature search was conducted in four bibliographical databases to identify randomized controlled trials (RCT) that compared NET or KT to any other intervention or placebo for treatment of RC tendinopathy. Internal validity of RCTs was assessed with the Cochrane Risk of Bias tool. A qualitative or quantitative synthesis of evidence was performed.

Results

Ten trials were included in the present review on overall pain reduction or improvement in function. Most RCTs had a high risk of bias. There is inconclusive evidence for NET, either used alone or in conjunction with another intervention. Based on pooled results of two studies (n=72), KT used alone resulted in significant gain in pain free flexion (MD: 8.7 ° 95%CI 8.0 ° to 9.5 °) and in pain free abduction (MD: 10.3 ° 95%CI 9.1 ° to 11.4 °). Based on qualitative analyses, there is inconclusive evidence on the efficacy of KT when used alone or in conjunction with other interventions on overall pain reduction or improvement in function.

Conclusion

Although KT significantly improved pain free range of motion, there is insufficient evidence to formally conclude on the efficacy of KT or NET used alone or in conjunction with other interventions in patients with RC tendinopathy.

Level of Evidence

Therapy, level 1a     

GLENOHUMERAL ROTATIONAL RANGE OF MOTION DIFFERENCES BETWEEN FAST BOWLERS AND SPIN BOWLERS IN ELITE CRICKETERS

Background:

The shoulder, particularly the glenohumeral joint with its predominant reliance upon soft tissues for stability is prone to injury among the cricketers who bowl regularly. These shoulder injuries are more common in spin bowlers than fast bowlers. A decreased internal rotational difference and increased external rotational difference exist when comparing the dominant shoulder with non‐dominant shoulder between overarm cricketers and non‐throwing wicket keepers.

Purpose:

To compare the glenohumeral internal and external rotation range of motion differences between fast bowlers and spin bowlers.

Methods:

A cross‐sectional design was utilized for this study. Thirty‐five fast bowlers and 31 spin bowlers from an elite group were recruited based on the selection criteria. Glenohumeral passive internal and external rotational differences between dominant and non‐dominant shoulders were measured using a standardized mechanical inclinometer.

Results:

Independent t‐tests revealed a statistically significant difference for external rotational difference (p=0.005) between fast and spin bowlers and no such difference for internal rotational difference (p=0.549) between them at 0.05 level.

Conclusion:

External rotational difference is significantly different between fast bowlers and spin bowlers but not internal rotational difference.

Level of Evidence:

Level 4     

OFF‐SEASON TRAINING HABITS AND PRESEASON FUNCTIONAL TEST MEASURES OF DIVISION III COLLEGIATE ATHLETES: A DESCRIPTIVE REPORT

Purpose/Background:

Division III (D III) collegiate coaches are challenged to assess athletic readiness and condition their athletes during the preseason. However, there are few reports on off‐season training habits and normative data of functional assessment tests among D III athletes. The purpose of this study was to examine off‐season training habits of D III athletes and their relationships to the standing long jump (SLJ) and single‐leg hop (SLH) tests.

Methods:

One‐hundred and ninety‐three athletes (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to the start of their sports seasons. Athletes reported their off‐season training habits (weightlifting, cardiovascular exercise, plyometric exercise, and scrimmage) during the six weeks prior to the preseason. Athletes also performed three maximal effort SLJs and three SLHs.

Results:

Male athletes reported training more hours per exercise category than their female counterparts. Mean SLJ distances (normalized to height) were 0.79 ± 0.10 for females and 0.94 ± 0.12 for males. Mean SLH distances for female athletes'' right and left limbs were 0.66 (± 0.10) and 0.65 (± 0.10), respectively. Mean SLH distances for male athletes'' right and left limbs were 0.75 (± 0.13) and 0.75 (± 0.12), respectively. Several significant differences between off‐season training habits and functional test measures were found for both sexes: males [SLJ and weightlifting (p = 0.04); SLH and weightlifting (p = 0.04), plyometrics (p = 0.05)]; females [SLJ and plyometrics (p = 0.04); SLH and scrimmage (p = 0.02)].

Conclusion:

This study provides normative data for off‐season training habits and preseason functional test measures in a D III athlete population. Greater SLJ and SLH measures were associated with increased time during off‐season training.

Clinical Relevance:

The findings between functional tests and off‐season training activities may be useful for sports medicine professionals and strength coaches when designing their preseason training programs.

Level of Evidence:

4     

COMPARISON OF THE EFFECTS OF AN EIGHT‐WEEK PUSH‐UP PROGRAM USING STABLE VERSUS UNSTABLE SURFACES

Background and Purpose:

Recently, the trend among physical training and rehabilitation professionals is the use of resistance exercise on unstable equipment in order to increase the effort of the agonist and stabilizing muscles. It is unknown if performing exercises on unstable surfaces provides a greater training stimulus as compared to training on a stable training surface. Therefore, the purpose of this research was to compare the effect that push‐up training on stable and unstable surfaces had on strength performance in healthy young men.

Methods:

Thirty subjects with experience in resistance training participated in push‐up training two days per week for eight weeks on one of three different surfaces: the floor (Tp), the T‐Bow® (TBp) or the BOSU® (Bp).

Results:

Strength, as measured by one repetition maximum (1‐RM) and muscle endurance, as measured by number of pushups performed did not improve significantly (p>0.05) for any of the intervention groups.

Conclusions:

The addition of unstable surfaces in push‐up training does not provide greater improvement in muscular strength and endurance than push up training performed on a stable surface in young men.

Levels of Evidence:

3b     

ECCENTRIC AND CONCENTRIC JUMPING PERFORMANCE DURING AUGMENTED JUMPS WITH ELASTIC RESISTANCE: A META‐ANALYSIS

Introduction

The initial rapid eccentric contraction of a stretch‐shortening cycle (SSC) activity is typically reported to accentuate the subsequent concentric jump performance. Some researchers have rationalized that adding elastic resistance (ER) to explosive type activities (e.g. countermovement jumps and drop jumps) would increase excitatory stretch reflex activity and mechanical recoil characteristics of the musculotendinous tissues. The purpose of this meta‐analysis was to examine the available literature on jumping movements augmented with ER and to provide a quantitative summary on the effectiveness of this technique for enhancing acute eccentric and concentric jumping performance.

Methods

In a random‐effects model, the Hedges`s g effect size (ES) was used to calculate the biased corrected standardized mean difference between the augmented and similar non‐augmented jumps.

Results

The results demonstrated that augmented jumps provided a greater eccentric loading compared to free jumps (Hedges`s g ES = 0.237, p = 0.028). However the concentric performance was significantly impaired, particularly if the downward elastic force was used during concentric phase as well (ES = ‐2.440, p < 0.001). Interestingly, no performance decrement was observed in those studies, which released the bands at the beginning of the concentric phase (ES = 0.397, p = 0.429).

Discussion

The authors postulated that the excessive eccentric loading might trigger reflex inhibition, alter the muscle stiffness, increase downward hip displacement and dissipate mechanical recoil properties. These results suggest that the release of elastic force at the beginning of the concentric phase seems to be a critical point to avoid impairment of acute concentric performance in augmented jumps.

Level of Evidence

2a