Personal and situational factors that influence coaches' ability to care.

The purpose of this study was to explore how personal and situational factors may influence sport coaches' caring practices. 130 youth sport coaches completed an online survey including perceptions of caring, emotional intelligence, and leadership behaviours. Additionally, coaches were prompted to consider a situation when it was easy or hard to care while also identifying influencing factors. Results revealed coaches' awareness of others' emotions, coaches' ability to use their emotions, and coaches' lower use of autocratic behaviours significantly predicted their perceptions of caring on their teams. Open-ended findings revealed that having a core value/philosophy centred on caring, maintaining a collaborative and welcoming culture, engaging in relationship building, using empathy and listening skills, possessing personal experiences/expertise, encountering advantageous situations, or having positive athlete behaviour made it easier to care. It was more difficult for coaches to care when they experienced poor athlete or parent behaviour, unhelpful situational factors, lack of team culture, differing opinions among staff, or personal factors. These findings provide coaches insight into factors that may influence their ability to care.

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.

The effect of body weight reduction using a lower body positive pressure treadmill on plantar pressure measures while running.

OBJECTIVE: To evaluate the effects of body weight reduction at 10% intervals on pressure distribution variables across regions of the foot while running. STUDY DESIGN: Crossover Study Design. SETTING: Laboratory. PARTICIPANTS: 12 recreational runners. MAIN OUTCOME MEASURES: Pressure-time integral, peak pressure, instance of peak pressure, contact area, contact time and center of pressure (COP) location at initial contact across four foot regions were measured while participants ran at self-selected speed on the Lower Body Positive Pressure Treadmill (LBPPT) at 100%, 90%, 80%, 70% and 60% of their body weight (%BW). RESULTS: As the %BW decreased, there were corresponding significant decreases in the pressure-time integral and peak pressures in all four regions of the foot. Significant differences within foot region and %BW for the other variables were infrequent. There was a significant anterior shift of the COP location at initial contact as the %BW decreased. CONCLUSION: LBPPT is useful for reducing the pressure across the entire foot. Additionally, the anterior translation of the COP location at initial contact with reduced %BW may provide an additional gait retraining tool for prevention and treatment of running injuries as reducing %BW moves the runner away from a rearfoot strike pattern.

The Use of an Optical Measurement System to Monitor Sports Performance.

The purpose of this study was to compare ground contact time between an optical measurement system and a force platform. Participants in this study included six collegiate level athletes who performed drop jumps and sprint strike steps for a total of 15 repetitions each. Ground contact data was simultaneously collected from an optical measurement system and a force platform, at a sampling frequency of 1000 Hz. Data was then analyzed with Pearson's correlation and paired sample t-tests. The measures from the optical measurement system were found to be significantly higher (p < 0.001) than measures from the force platform in both conditions. Although significantly different, the extremely large relationships (0.979, 0.993) found between the two devices suggest the optical sensor is able to detect similar changes in performance to that of a force platform. Practitioners may continue to utilize optical sensors to monitor performance as it may provide a superior user-friendly alternative to more traditional based monitoring procedures, but must comprehend the inherent limitations due to the design of the optical sensors.

Changes in muscle thickness after exercise and biofeedback in people with low back pain.

CONTEXT: Individuals with low back pain (LBP) have reduced function of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles. Biofeedback during exercise may increase the ability to contract the TrA and LM muscles compared with exercise alone. OBJECTIVE: To compare TrA preferential activation ratio (PAR) and the percent change in LM-muscle thickness in patients with LBP history before and after exercise with or without biofeedback. DESIGN: Controlled laboratory study. SETTING: University research laboratory. PATIENTS: 20 LBP individuals, 10 exercise alone and 10 exercise with biofeedback. INTERVENTIONS: Patients were allotted to tabletop exercises in isolation or tabletop exercises with visual, auditory, and tactile biofeedback. MAIN OUTCOME MEASURES: TrA PAR and percent change in LM-muscle thickness. RESULTS: There were no differences between groups at baseline (all P > .05). Nonparametric statistics showed decreased resting muscle thickness for total lateral abdominal-wall muscles (P = .007) but not TrA (P = .410) or LM (P = .173). Percent TrA thickness increased from table to standing positions before (P = .006) and after exercise (P = .009). TrA PAR increased after exercise (pre 0.01 ± 0.02, post 0.03 ± 0.04, P = .033) for all patients and for exercise with biofeedback (pre 0.02 ± 0.01, post 0.03 ± 0.01, P = .037) but not for exercise alone (pre 0.01 ± 0.02, post 0.02 ± 0.05, P = .241). No group differences were observed for TrA PAR before (exercise 0.01 ± 0.02, exercise with biofeedback 0.02 ± 0.01, P = .290) or after exercise (exercise 0.02 ± 0.05, exercise with biofeedback 0.03 ± 0.01, P = .174). There were no group differences in LM percent change before exercise (P = .999) or after exercise (P = .597). In addition, no changes were observed in LM percent change as a result of exercise among all participants (P = .391) or for each group (exercise P = .508, exercise with biofeedback P = .575). CONCLUSION: TrA PAR increased after a single session of exercises, whereas no thickness changes occurred in LM.

Eccentric training for the rehabilitation of a high level wrestler with distal biceps tendinosis: a case report.

BACKGROUND AND PURPOSE: Distal biceps brachii tendinosis is a relatively uncommon clinical diagnosis seen by physical therapists. As a result, there is little evidence guiding clinical decisions regarding best practice or effective treatment options to restore individuals to their previous level of function. The purpose of this case report is to describe the use of eccentric training as the primary intervention in the rehabilitation of a patient with distal biceps tendinosis. CASE DESCRIPTION: A 41-year-old male electrician and collegiate wrestling coach presented to a university outpatient physical therapy clinic with a two month duration of pain in the right antecubital space which occurred when the patient was performing close-grip body weight curl ups for the first time. Sharp pain was noted in the right arm during the lowering phase of the exercise. Following the examination, distal biceps tendinosis appeared to be the likely diagnosis. The patient was educated in eccentric exercise principles and was prescribed eccentric loading exercises for the distal biceps brachii tendon in two different positions of elbow flexion. OUTCOMES: The patient was seen in physical therapy for three visits over the course of four weeks. Following eccentric training, the patient reported decreased pain, demonstrated increased right elbow flexion and forearm supination strength, was no longer tender to palpation of the distal biceps tendon and showed clinically significant improvement in QuickDASH scores. DISCUSSION: Given the lack of available research on the rehabilitation of distal biceps tendinosis, eccentric training showing benefits with other upper quarter tendinoses and the positive outcomes in this case, it may be appropriate for physical therapists to employ eccentric training for patients with distal biceps tendinosis. LEVEL OF EVIDENCE: 5 (Single case report).

Lumbopelvic joint manipulation and quadriceps activation of people with patellofemoral pain syndrome.

CONTEXT: Quadriceps weakness and inhibition are impairments associated with patellofemoral pain syndrome (PFPS). Lumbopelvic joint manipulation has been shown to improve quadriceps force output and inhibition, but the duration of the effect is unknown. OBJECTIVE: To determine whether quadriceps strength and activation are increased and maintained for 1 hour after high-grade or low-grade joint mobilization or manipulation applied at the lumbopelvic region in people with PFPS. DESIGN: Randomized controlled clinical trial. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Forty-eight people with PFPS (age = 24.6 ± 8.9 years, height = 174.3 ± 11.2 cm, mass = 78.4 ± 16.8 kg) participated. INTERVENTION(S): Participants were randomized to 1 of 3 groups: lumbopelvic joint manipulation (grade V), side-lying lumbar midrange flexion and extension passive range of motion (grade II) for 1 minute, or prone extension on the elbows for 3 minutes. MAIN OUTCOME MEASURE(S): Quadriceps force and activation were measured using the burst superimposition technique during a seated isometric knee extension task. A 2-way repeated-measures analysis of variance was performed to compare changes in quadriceps force and activation among groups over time (before intervention and at 0, 20, 40, and 60 minutes after intervention). RESULTS: We found no differences in quadriceps force output (F(5.33,101.18) = 0.65, P = .67) or central activation ratio (F(4.84,92.03) = 0.38, P = .86) values among groups after intervention. When groups were pooled, we found differences across time for quadriceps force (F(2.66,101.18) = 5.03, P = .004) and activation (F(2.42,92.03) = 3.85, P = .02). Quadriceps force was not different at 0 minutes after intervention (t(40) = 1.68, P = .10), but it decreased at 20 (t(40) = 2.16, P = .04), 40 (t(40) = 2.87, P = .01) and 60 (t(40) = 3.04, P = .004) minutes after intervention. All groups demonstrated decreased quadriceps activation at 0 minutes after intervention (t(40) = 4.17, P < .001), but subsequent measures were not different from preintervention levels (t(40) range, 1.53-1.83, P > .09). CONCLUSIONS: Interventions directed at the lumbopelvic region did not have immediate effects on quadriceps force output or activation. Muscle fatigue might have contributed to decreased force output and activation over 1 hour of testing.

Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability.

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To determine whether manipulation of the proximal or distal tibiofibular joint would change ankle dorsiflexion range of motion and functional outcomes over a 3-week period in individuals with chronic ankle instability. BACKGROUND: Altered joint arthrokinematics may play a role in chronic ankle instability dysfunction. Joint mobilization or manipulation may offer the ability to restore normal joint arthrokinematics and improve function. METHODS: Forty-three participants (mean ± SD age, 25.6 ± 7.6 years; height, 174.3 ± 10.2 cm; mass, 74.6 ± 16.7 kg) with chronic ankle instability were randomized to proximal tibiofibular joint manipulation, distal tibiofibular joint manipulation, or a control group. Outcome measures included ankle dorsiflexion range of motion, the single-limb stance on foam component of the Balance Error Scoring System, the step-down test, and the Foot and Ankle Ability Measure sports subscale. Measurements were obtained prior to the intervention (before day 1) and following the intervention (on days 1, 7, 14, and 21). RESULTS: There was no significant change in dorsiflexion between groups across time. When groups were pooled, there was a significant increase (P<.001) in dorsiflexion at each postintervention time interval. No differences were found among the Balance Error Scoring System foam, step-down test, and Foot and Ankle Ability Measure sports subscale scores. CONCLUSIONS: The use of a proximal or distal tibiofibular joint manipulation in isolation did not enhance outcome effects beyond those of the control group. Collectively, all groups demonstrated increases in ankle dorsiflexion range of motion over the 3-week intervention period. These increases might have been due to practice effects associated with repeated testing. LEVEL OF EVIDENCE: Therapy, level 2b-.

Changes in lateral abdominal muscle thickness during an abdominal drawing-in maneuver in individuals with and without low back pain.

The purpose of this study was to compare lateral abdominal muscle thickness changes in individuals with and without low back pain (LBP) during an abdominal drawing-in maneuver (ADIM) using ultrasound imaging. Twenty individuals (13 females and 7 males, average age 40.1 ± 13.4) with stabilization classification LBP and 19 controls (10 females and 9 males, average age 30.3 ± 8.7) participated in this study. Bilateral measurements were made using ultrasound imaging to determine changes in thickness of the transversus abdominus (TrA) and external and internal oblique (EO+IO) muscles during an ADIM. There were no significant differences in relaxed muscle thickness values or contraction ratios for the TrA or EO+IO between groups or side. Individuals with stabilization classification LBP demonstrated no difference in lateral abdominal muscle thickness during an ADIM when compared with controls without LBP when using a pressure biofeedback device to monitor stability.

Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability.

Persistent muscle inhibition of the fibularis longus and soleus muscles and altered joint arthrokinematics may play a role in chronic ankle instability (CAI). Joint mobilization has been shown to improve ankle joint motion, but effects on surrounding musculature is unknown. The purpose of this study was to determine the change in fibularis longus and soleus activation following tibiofibular joint manipulation in individuals with CAI. Forty-three subjects were randomized to one of three groups (proximal tibiofibular manipulation, distal tibiofibular manipulation, or control). A two-way mixed model ANOVA was used to compare changes in the ratio of the maximum H-reflex and maximum M-wave measurements (H/M ratio) of the fibularis longus and soleus between groups over time (pre, post 0, 10, 20, 30 min). The distal tibiofibular joint manipulation group demonstrated a significant increase (P<.05) in soleus H/M ratio at all post-intervention time periods except 20 min post-intervention (P=.48). The proximal tibiofibular joint manipulation and control groups did not demonstrate a change in soleus H/M ratios. All groups demonstrated a decrease (P<.05) from baseline values in fibularis longus (10-30 min post-intervention) and soleus (30 min post-intervention) H/M ratios. Interventions directed at the distal tibiofibular joint acutely increase soleus muscle activation.

Evaluation of the injured runner.

The evaluation of the injured runner emphasizes the identification of intrinsic and extrinsic risk factors in addition to establishing injury-specific diagnosis. The history emphasizes identification of contributory changes in training regimen or technique. The physical examination includes a biomechanical and functional screening to identify related imbalances in posture, alignment, strength, flexibility, and lower quarter stability. Each runner is also observed walking and running because running is a dynamic activity, and subtle abnormalities not evident during static or open chain examination may become evident upon functional and dynamic evaluation. This comprehensive, running-specific approach to diagnosis assists the clinician in developing optimum rehabilitation programs.

Exertional compartment syndrome.

Chronic exertional compartment syndrome should be considered in any runner experiencing exertional leg pain. Runners typically describe a tight, cramping ache over the involved compartment that commences at a reproducible point in the run and resolves with rest. Diagnosis should include a careful history and physical examination as well as documentation with intramuscular compartment pressure monitoring. Milder cases will resolve with activity modification and conservative care. More severe cases or those failing conservative care are referred for fasciotomy.

Effects of lumbopelvic joint manipulation on quadriceps activation and strength in healthy individuals.

Lumbopelvic joint manipulation has been shown to increase quadriceps force output and activation, but the duration of effect is unknown. It is also unknown whether lower grade joint mobilisations may have a similar effect. Forty-two healthy volunteers (x+/-SD; age=28.3+/-7.3 yr; ht=172.8+/-9.8 cm; mass=76.6+/-21.7 kg) were randomly assigned to one of three groups (lumbopelvic joint manipulation, 1 min lumbar passive range of motion (PROM), or prone extension on elbows for 3 min). Quadriceps force and activation were measured using the burst-superimposition technique during a seated isometric knee extension task before and at 0, 20, 40, and 60 min following intervention. Collectively, all groups demonstrated a significant decrease (p<0.001) in quadriceps force output without changes in activation (p>0.05) at all time intervals following intervention. The group that received a lumbopelvic joint manipulation demonstrated a significant increase in quadriceps force (3%) and activation (5%) (p<0.05) immediately following intervention, but this effect was not present after the 20 min interval. Since participants in this study were free of knee joint pathology, it is possible that they did not have the capacity to allow for large changes in quadriceps muscle activation to occur.

Treatment of lateral knee pain by addressing tibiofibular hypomobility in a recreational runner.

BACKGROUND: Altered joint arthrokinematics can affect structures distal and proximal to the site of dysfunction. Hypomobility of the proximal tibiofibular joint may limit ankle dorsiflexion and indirectly alter stresses about the knee. OBJECTIVES: To examine the effect of addressing hypomobility of the proximal tibiofibular joint in an individual with lateral knee pain. CASE DESCRIPTION: A 24 year old female recreational runner presented with a three month history of right lateral knee pain. Limited right ankle dorsiflexion was noted and determined to be related to decreased mobility of the proximal tibiofibular joint, as well as, the talocrural and distal tibiofibular joints. Functional movement deficits were noted during the squat test and step down test. Treatment was performed three times over the course of two weeks which included proximal tibiofibular joint manipulation and an exercise program consisting of hip strengthening, balance, and gastrocnemius/soleus muscle complex stretching. OUTCOMES: Immediately following intervention, improvements were noted for ankle dorsiflexion, squat test, and step down test. One week following the initial intervention the patient reported she was able to run pain free. DISCUSSION: Addressing impairments distant to the site of dysfunction, such as the proximal tibiofibular joint, may be indicated in individuals with lateral knee pain.

Rehabilitation of head and neck injuries in the athlete.

This article has given a general overview of a specific and reproducible physical therapy evaluation that can be used to assess progress toward and achievement of goals of treatment. General descriptions of types of presentations that can be seen clinically were also delineated. General treatment goals were discussed and some specific exercises were introduced to help in developing a comprehensive program for the athlete. The main emphasis of the treatment of the athlete requires application of clinical reasoning to the evaluation, treatment, and reassessment process in order to achieve the athlete's goal of full return to sport.