Journal of Sports Medicine The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Graded Exercise Testing Protocols for the Determination of VO2max: Historical Perspectives, Progress, and Future Considerations Sun, 25 Dec 2016 06:25:16 +0000 Graded exercise testing (GXT) is the most widely used assessment to examine the dynamic relationship between exercise and integrated physiological systems. The information from GXT can be applied across the spectrum of sport performance, occupational safety screening, research, and clinical diagnostics. The suitability of GXT to determine a valid maximal oxygen consumption (VO2max) has been under investigation for decades. Although a set of recommended criteria exists to verify attainment of VO2max, the methods that originally established these criteria have been scrutinized. Many studies do not apply identical criteria or fail to consider individual variability in physiological responses. As an alternative to using traditional criteria, recent research efforts have been directed toward using a supramaximal verification protocol performed after a GXT to confirm attainment of VO2max. Furthermore, the emergence of self-paced protocols has provided a simple, yet reliable approach to designing and administering GXT. In order to develop a standardized GXT protocol, additional research should further examine the utility of self-paced protocols used in conjunction with verification protocols to elicit and confirm attainment of VO2max. Nicholas M. Beltz, Ann L. Gibson, Jeffrey M. Janot, Len Kravitz, Christine M. Mermier, and Lance C. Dalleck Copyright © 2016 Nicholas M. Beltz et al. All rights reserved. Efficiency of an Active Rehabilitation Intervention in a Slow-to-Recover Paediatric Population following Mild Traumatic Brain Injury: A Pilot Study Sun, 18 Dec 2016 09:26:12 +0000 Objective. The aim of this study was to identify whether the addition of an individualised Active Rehabilitation Intervention to standard care influences recovery of young patients who are slow-to-recover following a mTBI. Methods. Fifteen participants aged years received standard care and an individualised Active Rehabilitation Intervention which included (1) low- to high-intensity aerobic training; (2) sport-specific coordination exercises; and (3) therapeutic balance exercises. The following criteria were used to measure the resolution of signs and symptoms of mTBI: (1) absence of postconcussion symptoms for more than 7 consecutive days; (2) cognitive function corresponding to normative data; and (3) absence of deficits in coordination and balance. Results. The Active Rehabilitation Intervention lasted days. The duration of the intervention was correlated with self-reported participation (%, , ). The average postconcussion symptom inventory (PCSI) score went from a total of points to points after the intervention (, ). Conclusion. A progressive submaximal Active Rehabilitation Intervention may represent an important asset in the recovery of young patients who are slow-to-recover following a mTBI. Sarah Imhoff, Philippe Fait, Frédérike Carrier-Toutant, and Geneviève Boulard Copyright © 2016 Sarah Imhoff et al. All rights reserved. Quantifying the “Slosh Stomach”: A Novel Tool for Assessment of Exercise-Associated Gastroparesis Symptoms in Endurance Athletes Thu, 17 Nov 2016 09:39:38 +0000 Introduction. We describe a novel scale and its field use for evaluation of exercise-associated gastroparesis in the endurance athlete. Methods. A scale was created based on gastroparesis tools previously described in the medical literature. Surveys of the tool were administered to runners participating in a 210 km multiday foot race in Sri Lanka. Results. Use of this novel scale was demonstrated to be useful in assessing gastroparesis severity scores of athletes and how these symptoms affected their race performance. Of the 27 race participants who completed the survey, 27 felt that the tool adequately captured their symptoms. Conclusions. This novel survey tool was able to assess the presence and severity of exercise-associated gastroparesis symptoms in endurance racers in a remote location. This tool may be helpful with further research of the identification and management of gastroparesis and other gastrointestinal upset in the endurance race environment. Amy Sue Biondich and Jeremy D. Joslin Copyright © 2016 Amy Sue Biondich and Jeremy D. Joslin. All rights reserved. The Influence of Methylsulfonylmethane on Inflammation-Associated Cytokine Release before and following Strenuous Exercise Sun, 23 Oct 2016 12:27:01 +0000 Background. Inflammation is associated with strenuous exercise and methylsulfonylmethane (MSM) has been shown to have anti-inflammatory properties. Methods. Physically active men were supplemented with either placebo or MSM (3 grams per day) for 28 days before performing 100 repetitions of eccentric knee extension exercise. Ex vivo and in vitro testing consisted of evaluating cytokine production in blood (whole blood and isolated peripheral blood mononuclear cells (PBMCs)) exposed to lipopolysaccharide (LPS), before and through 72 hours after exercise, while in vivo testing included the evaluation of cytokines before and through 72 hours after exercise. Results. LPS stimulation of whole blood after MSM supplementation resulted in decreased induction of IL-1β, with no effect on IL-6, TNF-α, or IL-8. After exercise, there was a reduced response to LPS in the placebo, but MSM resulted in robust release of IL-6 and TNF-α. A small decrease in resting levels of proinflammatory cytokines was noted with MSM, while an acute postexercise increase in IL-10 was observed with MSM. Conclusion. Strenuous exercise causes a robust inflammatory reaction that precludes the cells from efficiently responding to additional stimuli. MSM appears to dampen the release of inflammatory molecules in response to exercise, resulting in a less incendiary environment, allowing cells to still have the capacity to mount an appropriate response to an additional stimulus after exercise. Mariè van der Merwe and Richard J. Bloomer Copyright © 2016 Mariè van der Merwe and Richard J. Bloomer. All rights reserved. Trajectories of Physical Activity Predict the Onset of Depressive Symptoms but Not Their Progression: A Prospective Cohort Study Tue, 04 Oct 2016 06:56:00 +0000 This prospective, community-based study examined trajectories of physical activity from childhood to adulthood and whether these trajectories contributed to depressive symptoms in adulthood to a greater degree than adulthood physical activity. Participants () were from the ongoing Cardiovascular Risk in Young Finns Study which started in 1980. Depressive symptoms were measured with Beck Depression Inventory (BDI-II) in 2012, and physical activity was assessed from 1980 to 2011 with self-reports. Analyses were adjusted for age, sex, childhood negative emotionality, socioeconomic factors, previous depressive symptoms, social support, body mass index, and smoking status (1980–2007). Highly, moderately, and lightly physically active trajectory groups were identified. Highly active participants reported lower levels of depressive symptoms compared to lightly active ones () and compared to moderately active ones (). Moderately active participants had less symptoms than lightly active ones (). High levels of adulthood physical activity associated with lower levels of depressive symptoms (). The findings did not withstand adjustment for previous depressive symptoms (). Lifelong physical activity trajectories or adulthood physical activity was not associated with the progression of depressive symptoms in adulthood. Thus, physical activity history does not contribute to the progression of the depressive symptoms to a greater degree than adulthood physical activity. Kaisa Kaseva, Tom Rosenström, Taina Hintsa, Laura Pulkki-Råback, Tuija Tammelin, Jari Lipsanen, Xiaolin Yang, Mirka Hintsanen, Christian Hakulinen, Katja Pahkala, Mirja Hirvensalo, Nina Hutri-Kähönen, Olli T. Raitakari, and Liisa Keltikangas-Järvinen Copyright © 2016 Kaisa Kaseva et al. All rights reserved. Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review Tue, 26 Jul 2016 09:58:09 +0000 Background. There is a lack of scientific evidence in the literature on the involvement of the cervical spine in mTBI; however, its involvement is clinically accepted. Objective. This paper reviews evidence for the involvement of the cervical spine in mTBI symptoms, the mechanisms of injury, and the efficacy of therapy for cervical spine with concussion-related symptoms. Methods. A keyword search was conducted on PubMed, ICL, SportDiscus, PEDro, CINAHL, and Cochrane Library databases for articles published since 1990. The reference lists of articles meeting the criteria (original data articles, literature reviews, and clinical guidelines) were also searched in the same databases. Results. 4,854 records were screened and 43 articles were retained. Those articles were used to describe different subjects such as mTBI’s signs and symptoms, mechanisms of injury, and treatments of the cervical spine. Conclusions. The hypothesis of cervical spine involvement in post-mTBI symptoms and in PCS (postconcussion syndrome) is supported by increasing evidence and is widely accepted clinically. For the management and treatment of mTBIs, few articles were available in the literature, and relevant studies showed interesting results about manual therapy and exercises as efficient tools for health care practitioners. Michael Morin, Pierre Langevin, and Philippe Fait Copyright © 2016 Michael Morin et al. All rights reserved. Validity of a Smartphone-Based Application for Determining Sprinting Performance Thu, 21 Jul 2016 13:02:17 +0000 Recent innovations in smartphone technology have led to the development of a number of applications for the valid and reliable measurement of physical performance. Smartphone applications offer a number of advantages over laboratory based testing including cost, portability, and absence of postprocessing. However, smartphone applications for the measurement of running speed have not yet been validated. In the present study, the iOS smartphone application, SpeedClock, was compared to conventional timing lights during flying 10 m sprints in recreationally active women. Independent samples -test showed no statistically significant difference between SpeedClock and timing lights (, ), while intraclass correlations showed excellent agreement between SpeedClock and timing lights (ICC (2,1) = 0.93, , 95% CI 0.64–0.97). Bland-Altman plots showed a small systematic bias (mean difference = 0.13 seconds) with SpeedClock giving slightly lower values compared to the timing lights. Our findings suggest SpeedClock for iOS devices is a low-cost, valid tool for the assessment of mean flying 10 m sprint velocity in recreationally active females. Systematic bias should be considered when interpreting the results from SpeedClock. Robert Stanton, Melanie Hayman, Nyree Humphris, Hanna Borgelt, Jordan Fox, Luke Del Vecchio, and Brendan Humphries Copyright © 2016 Robert Stanton et al. All rights reserved. Clinical Outcomes and Complications of Cortical Button Distal Biceps Repair: A Systematic Review of the Literature Thu, 21 Jul 2016 08:32:37 +0000 Objectives. The purpose of the present study was to investigate the clinical outcomes and complications of the cortical button distal biceps fixation method. Material and Methods. All methods followed the PRISMA guidelines. Included studies had to describe clinical outcomes and complications after acute distal biceps repair with cortical button fixation. Eligibility criteria also included English language, more than 5 cases with minimum follow-up of 6 months, and preferably usage of at least one relevant clinical score (MEPS, ASES, and/or DASH) for final outcome. A loss of at least 30° in motion—flexion, extension, pronation, or supination—and a loss of at least 30% of strength were considered an unsatisfactory result. Results. The review identified 7 articles including 105 patients (mean age 43.6 years) with 106 acute distal biceps ruptures. Mean follow-up was 26.3 months. Functional outcome of ROM regarding flexion/extension and pronation/supination was satisfactory in 94 (89.5%) and 86 (82%) patients in respect. Averaged flexion and supination strength had been reported in 6/7 studies (97 patients) and were satisfactory in 82.4% of them. The most common complication was transient nerve palsy (14.2%). The overall reoperation rate was 4.8% (5/105 cases). Conclusion. Cortical button fixation for acute distal biceps repair is a reproducible operation with good clinical results. Most of the complications can be avoided with appropriate surgical technique. Andreas Panagopoulos, Irini Tatani, Pantelis Tsoumpos, Dimitris Ntourantonis, Konstantinos Pantazis, and Ioannis K. Triantafyllopoulos Copyright © 2016 Andreas Panagopoulos et al. All rights reserved. Examining Measures of Weight as Risk Factors for Sport-Related Injury in Adolescents Wed, 20 Jul 2016 07:54:44 +0000 Objectives. To examine body mass index (BMI) and waist circumference (WC) as risk factors for sport injury in adolescents. Design. A secondary analysis of prospectively collected data from a pilot cluster randomized controlled trial. Methods. Adolescents () at the ages of 11–15 years from two Calgary junior high schools were included. BMI (kg/m2) and WC (cm) were measured from direct measures at baseline assessment. Categories (overweight/obese) were created using validated international (BMI) and national (WC) cut-off points. A Poisson regression analysis controlling for relevant covariates (sex, previous injury, sport participation, intervention group, and aerobic fitness level) estimated the risk of sport injury [incidence rate ratios (IRR) with 95% confidence intervals (CI)]. Results. There was an increased risk of time loss injury (IRR = 2.82, 95% CI: 1.01–8.04) and knee injury (IRR = 2.07, 95% CI: 1.00–6.94) in adolescents that were overweight/obese; however, increases in injury risk for all injury and lower extremity injury were not statistically significant. Estimates suggested a greater risk of time loss injury [IRR = 1.63 (95% CI: 0.93–2.47)] in adolescents with high measures of WC. Conclusions. There is an increased risk of time loss injury and knee injury in overweight/obese adolescents. Sport injury prevention training programs should include strategies that target all known risk factors for injury. Sarah A. Richmond, Alberto Nettel-Aguirre, Patricia K. Doyle-Baker, Alison Macpherson, and Carolyn A. Emery Copyright © 2016 Sarah A. Richmond et al. All rights reserved. A Scoping Review of the Associations of Golf with Eye Injuries in Adults and Children Mon, 18 Jul 2016 12:38:53 +0000 Introduction. Sport presents a risk of ocular trauma and accounts for a significant number of eye injuries that require hospital admission. The sport of golf presents a risk to eyesight from fast moving objects such as golf clubs and balls. This study aims to investigate the associations of golf with eye injuries and the reasons that these injuries occur. Material/Methods. A literature search was conducted using the databases MEDLINE, Web of Science, SPORTDiscus, and PsycINFO. Grey literature was searched using the WHO international clinical trials registry platform, Google Scholar, and ProQuest. Data was extracted using a standardised form and summarised into a report. Results and Discussion. Twenty-three studies were found relating to eye injuries in golf. Injuries appear to be rare, but more frequent in men and children. Injuries resulted in high rates of enucleation and visual impairment. Children sustained more injury from golf clubs whereas adults sustained more injuries from golf balls. Conclusion. Efforts are needed to encourage golf participants to understand the risks of ocular and indeed other head injuries. Initiatives to provide appropriate supervision and education on this topic are merited. Further research is needed to investigate the circumstances of eye injury in golf and assess the effects of interventions aimed at reducing risk of injury. Evan Jenkins, Roger Hawkes, and Andrew Murray Copyright © 2016 Evan Jenkins et al. All rights reserved. Muscle Activation Differs between Three Different Knee Joint-Angle Positions during a Maximal Isometric Back Squat Exercise Mon, 18 Jul 2016 12:24:49 +0000 The purpose of this study was to compare muscle activation of the lower limb muscles when performing a maximal isometric back squat exercise over three different positions. Fifteen young, healthy, resistance-trained men performed an isometric back squat at three knee joint angles (20°, 90°, and 140°) in a randomized, counterbalanced fashion. Surface electromyography was used to measure muscle activation of the vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), semitendinosus (ST), and gluteus maximus (GM). In general, muscle activity was the highest at 90° for the three quadriceps muscles, yet differences in muscle activation between knee angles were muscle specific. Activity of the GM was significantly greater at 20° and 90° compared to 140°. The BF and ST displayed similar activation at all joint angles. In conclusion, knee position alters muscles activation of the quadriceps and gluteus maximus muscles. An isometric back squat at 90° generates the highest overall muscle activation, yet an isometric back squat at 140° generates the lowest overall muscle activation of the VL and GM only. Paulo Henrique Marchetti, Josinaldo Jarbas da Silva, Brad Jon Schoenfeld, Priscyla Silva Monteiro Nardi, Silvio Luis Pecoraro, Julia Maria D’Andréa Greve, and Erin Hartigan Copyright © 2016 Paulo Henrique Marchetti et al. All rights reserved. Comparison of Muscle Onset Activation Sequences between a Golf or Tennis Swing and Common Training Exercises Using Surface Electromyography: A Pilot Study Wed, 15 Jun 2016 07:36:52 +0000 Aim. The purpose of this pilot study is to use surface electromyography to determine an individual athlete’s typical muscle onset activation sequence when performing a golf or tennis forward swing and to use the method to assess to what degree the sequence is reproduced with common conditioning exercises and a machine designed for this purpose. Methods. Data for 18 healthy male subjects were collected for 15 muscles of the trunk and lower extremities. Data were filtered and processed to determine the average onset of muscle activation for each motion. A Spearman correlation estimated congruence of activation order between the swing and each exercise. Correlations of each group were pooled with 95% confidence intervals using a random effects meta-analytic strategy. Results. The averaged sequences differed among each athlete tested, but pooled correlations demonstrated a positive association between each exercise and the participants’ natural muscle onset activation sequence. Conclusion. The selected training exercises and Turning Point™ device all partially reproduced our athletes’ averaged muscle onset activation sequences for both sports. The results support consideration of a larger, adequately powered study using this method to quantify to what degree each of the selected exercises is appropriate for use in both golf and tennis. John M. Vasudevan, Andrew Logan, Rebecca Shultz, Jeffrey J. Koval, Eugene Y. Roh, and Michael Fredericson Copyright © 2016 John M. Vasudevan et al. All rights reserved. Plasma Cytokine Profiles in Long-Term Strenuous Exercise Thu, 28 Apr 2016 06:17:35 +0000 The open window theory indicates altered immunity 3 to 72 hours after exercise. The J-curve describes the risk of illness in response to exercise. The aim of this study was to examine the secretion of proinflammatory and anti-inflammatory cytokines before and after long-term strenuous exercise. Fourteen marathon and 16 half-marathon runners and 10 military cadets participating in a military ranger-training course were recruited to this study. Within-subject design was used measuring levels of plasma cytokines before, during, and after exercise. Plasma cytokines were measured using Luminex multiplex technology and ELISA. Comparing pre/post plasma levels both the marathon- and the half-marathon runners showed heavily increased levels of IL-6, IL-10, and IL-8 (). LPS stimulation among the half-marathon runners decreased the postrace levels of IL-6, IL-1b, and TNFα by 45%, 24%, and 43%, respectively (). During the ranger training course the spontaneous and LPS-stimulated levels of IL-6, IL-8, IL-10, IL-1b, and TNFα changed in a similar fashion as in the half-marathon runners although the fluctuations were smaller. Our study supports the open window and the J-curve theory; the immune system is more activated and the subjects are more threatened to infectious pathogens after intensive physical activity and in the period after exercise. Hilde G. Nielsen, Olav Øktedalen, Per-Kristian Opstad, and Torstein Lyberg Copyright © 2016 Hilde G. Nielsen et al. All rights reserved. Corrigendum to “Validity and Reliability of Farsi Version of Youth Sport Environment Questionnaire” Mon, 12 Oct 2015 06:09:26 +0000 Mohammad Ali Eshghi, Ramin Kordi, Amir Hossein Memari, Ahmad Ghaziasgar, Mohammad-Ali Mansournia, and Seyed Hojjat Zamani Sani Copyright © 2015 Mohammad Ali Eshghi et al. All rights reserved. Amniotic Tissues for the Treatment of Chronic Plantar Fasciosis and Achilles Tendinosis Sun, 27 Sep 2015 14:02:28 +0000 Introduction. Allogeneic amniotic tissue and fluid may be used to treat chronic plantar fasciosis and Achilles tendinosis. This innovative approach involves delivering a unique allograft of live human cells in a nonimmunogenic structural tissue matrix to treat chronic tendon injury. These tissues convey very positive regenerative attributes; procurement is performed with maternal consent during elective caesarian birth. Materials and Methods. In the present investigation all patients were unresponsive to multiple standard therapies for a minimum of 6 months and were treated with one implantation of PalinGen SportFLOW around the plantar fascia and/or around the Achilles paratenon. The patients were given a standard protocol for postimplant active rehabilitation. Results. The analogue pretreatment pain score (VAS) of 8. By the fourth week after treatment, all patients had significantly reduced self-reported pain. Twelve weeks following the procedure the average pain level had reduced to only 2. No adverse reactions were reported in any of the patients. Conclusion. All patients in this study experienced heel or Achilles pain, unresponsive to standard therapy protocols. After treatment all patients noted significant pain reduction, indicating that granulized amniotic membrane and amniotic fluid can be successfully used to treat both chronic plantar fasciosis and Achilles tendinosis. Bruce Werber Copyright © 2015 Bruce Werber. All rights reserved. Changes in Tissue Oxygen Saturation in Response to Different Calf Compression Sleeves Tue, 08 Sep 2015 06:48:15 +0000 Aim. The purpose was to examine the changes in tissue oxygen saturation (StO2) in response to the application of different commercially available calf compression sleeves. Methods. Eight subjects came to the laboratory to complete a session in seated position including 10 min of quiet rest followed by 3 min measuring calf StO2 without compression sleeves and then alternating of 3 min of passive rest and 3 min measuring StO2 with calf compression sleeves. A total of 15 different commercially available compression sleeves were studied in a randomized order. Calf StO2 was recorded using near-infrared spectroscopy. Results. StO2 was significantly increased with all compression sleeves compared with no compression (from +6.9% for the least effective to +22.6% for the most effective). Large differences were observed between compression sleeves . StO2 was positively correlated with compression pressure (; ). Conclusion. This study shows that wearing compression sleeves from various brands differently affects tissue oxygen saturation. Differences were linked to the compression pressure: higher compression pressures were associated with higher StO2. T. Dermont, L. Morizot, M. Bouhaddi, and A. Ménétrier Copyright © 2015 T. Dermont et al. All rights reserved. Nutritional Considerations for Performance in Young Athletes Wed, 19 Aug 2015 13:50:03 +0000 Nutrition is an integral component to any athletes training and performance program. In adults the balance between energy intake and energy demands is crucial in training, recovery, and performance. In young athletes the demands for training and performance remain but should be a secondary focus behind the demands associated with maintaining the proper growth and maturation. Research interventions imposing significant physiological loads and diet manipulation are limited in youth due to the ethical considerations related to potential negative impacts on the growth and maturation processes associated with younger individuals. This necessary limitation results in practitioners providing nutritional guidance to young athletes to rely on exercise nutrition recommendations intended for adults. While many of the recommendations can appropriately be repurposed for the younger athlete attention needs to be taken towards the differences in metabolic needs and physiological differences. JohnEric W. Smith, Megan E. Holmes, and Matthew J. McAllister Copyright © 2015 JohnEric W. Smith et al. All rights reserved. Validity and Reliability of Farsi Version of Youth Sport Environment Questionnaire Wed, 12 Aug 2015 07:56:10 +0000 The Youth Sport Environment Questionnaire (YSEQ) had been developed from Group Environment Questionnaire, a well-known measure of team cohesion. The aim of this study was to adapt and examine the reliability and validity of the Farsi version of the YSEQ. This version was completed by 455 athletes aged 13–17 years. Results of confirmatory factor analysis indicated that two-factor solution showed a good fit to the data. The results also revealed that the Farsi YSEQ showed high internal consistency, test-retest reliability, and good concurrent validity. This study indicated that the Farsi version of the YSEQ is a valid and reliable measure to assess team cohesion in sport setting. Mohammad Ali Eshghi, Ramin Kordi, Amir Hossein Memari, Ahmad Ghaziasgar, Mohammad-Ali Mansournia, and Seyed Hojjat Zamani Sani Copyright © 2015 Mohammad Ali Eshghi et al. All rights reserved. Physiological and Psychophysical Responses to Listening to Music during Warm-Up and Circuit-Type Resistance Exercise in Strength Trained Men Tue, 04 Aug 2015 15:55:06 +0000 The purpose of this study was to assess the effects of listening to music during warm-up and resistance exercise on physiological (heart rate and blood pressure) and psychophysical (rating of perceived exertion) responses in trained athletes. Twelve strength trained male participants performed warm-up and resistance exercise without music (WU+RE without M), warm-up and resistance exercise with music (WU+RE with M), WU with M and RE without M, and WU without M and RE with M, with 48 hours space between sessions. After completing each session, the rating of perceived exertion (RPE) was measured. Also, heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), and rate pressure product (RPP) were assessed before, after, and 15, 30, 45, and 60 min after exercise. Results indicated that RPE was higher for WU+RE without M condition in comparison with other conditions. All conditions showed increases in cardiovascular variables after exercise. The responses of HR, SBP, and RPP were higher for WU+RE without M condition. Thus, using music during warm-up and resistance exercise is a legal method for decreasing RPE and cardiovascular responses due to resistance exercise. Hamid Arazi, Abbas Asadi, and Morteza Purabed Copyright © 2015 Hamid Arazi et al. All rights reserved. Validation of the Continuum of Care Conceptual Model for Athletic Therapy Mon, 27 Jul 2015 06:29:10 +0000 Utilization of conceptual models in field-based emergency care currently borrows from existing standards of medical and paramedical professions. The purpose of this study was to develop and validate a comprehensive conceptual model that could account for injuries ranging from nonurgent to catastrophic events including events that do not follow traditional medical or prehospital care protocols. The conceptual model should represent the continuum of care from the time of initial injury spanning to an athlete’s return to participation in their sport. Finally, the conceptual model should accommodate both novices and experts in the AT profession. This paper chronicles the content validation steps of the Continuum of Care Conceptual Model for Athletic Therapy (CCCM-AT). The stages of model development were domain and item generation, content expert validation using a three-stage modified Ebel procedure, and pilot testing. Only the final stage of the modified Ebel procedure reached a priori 80% consensus on three domains of interest: (1) heading descriptors; (2) the order of the model; (3) the conceptual model as a whole. Future research is required to test the use of the CCCM-AT in order to understand its efficacy in teaching and practice within the AT discipline. Mark R. Lafave, Dale Butterwick, and Breda Eubank Copyright © 2015 Mark R. Lafave et al. All rights reserved. The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients Sun, 09 Nov 2014 00:00:00 +0000 Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important. Konstantinos A. Starantzis, Dimitrios Mastrokalos, Dimitrios Koulalis, Olympia Papakonstantinou, Panayiotis N. Soucacos, and Panayiotis J. Papagelopoulos Copyright © 2014 Konstantinos A. Starantzis et al. All rights reserved. Strength Gains as a Result of Brief, Infrequent Resistance Exercise in Older Adults Tue, 30 Sep 2014 11:41:22 +0000 Chronological aging is associated with a decrease in skeletal muscle mass and bone mineral density, an increase in fat mass, frequency of falls and fractures, and the likelihood of obesity, diabetes, and coronary heart disease. Resistance exercise has been shown to counter all of these effects of aging and, in turn, reduce the risk of all-cause mortality. However, variables such as volume and frequency have become contentious issues, with recent publications suggesting that similar physiological adaptations are possible with both high- and low-volume approaches. The aim of this research was to consider strength increases as a result of brief, infrequent resistance exercise. The present study offers data from 33 (14 male and 19 female) older adults ( years) who underwent brief (<15 minutes per exercise session), infrequent (2×/week), resistance exercise to a high intensity of effort (6-repetition maximum) at a controlled repetition duration (10 seconds concentric : 10 seconds eccentric) on 5 resistance machines (chest press, leg press, pull-down, seated row, and overhead press). Data is presented for training interventions of 12 weeks (male) and 19 weeks (female). Significant strength increases were identified for all exercises. With the detailed health benefits obtainable, the present study suggests that resistance exercise can be efficacious in much smaller volumes than previously considered. James Fisher, James Steele, Pat McKinnon, and Stephen McKinnon Copyright © 2014 James Fisher et al. All rights reserved. Functional Popliteal Artery Entrapment Syndrome: Poorly Understood and Frequently Missed? A Review of Clinical Features, Appropriate Investigations, and Treatment Options Sun, 07 Sep 2014 07:03:03 +0000 Functional popliteal artery entrapment syndrome (PAES) is an important and possibly underrecognized cause of exertional leg pain (ELP). As it is poorly understood, it is at risk of misdiagnosis and mismanagement. The features indicative of PAES are outlined, as it can share features with other causes of ELP. Investigating functional PAES is also fraught with potential problems and if it is performed incorrectly, it can result in false negative and false positive findings. A review of the current vascular investigations is provided, highlighting some of the limitations standard tests have in determining functional PAES. Once a clinical suspicion for PAES is satisfied, it is necessary to further distinguish the subcategories of anatomical and functional entrapment and the group of asymptomatic occluders. When definitive entrapment is confirmed, it is important to identify the level of entrapment so that precise intervention can be performed. Treatment strategies for functional PAES are discussed, including the possibility of a new, less invasive intervention of guided Botulinum toxin injection at the level of entrapment as an alternative to vascular surgery. Matthew Hislop, Dominic Kennedy, Brendan Cramp, and Sanjay Dhupelia Copyright © 2014 Matthew Hislop et al. All rights reserved. Effects of Cooling on Ankle Muscle Strength, Electromyography, and Gait Ground Reaction Forces Sun, 04 May 2014 10:24:01 +0000 The effects of cooling on neuromuscular function and performance during gait are not fully examined. The purpose of this study was to investigate the effects of local cooling for 20 min in cold water at 10°C in a climate chamber also at 10°C on maximal isometric force and electromyographic (EMG) activity of the lower leg muscles. Gait ground reaction forces (GRFs) were also assessed. Sixteen healthy university students participated in the within subject design experimental study. Isometric forces of the tibialis anterior (TA) and the gastrocnemius medialis (GM) were measured using a handheld dynamometer and the EMG was recorded using surface electrodes. Ground reaction forces during gait and the required coefficient of friction (RCOF) were recorded using a force plate. There was a significantly reduced isometric maximum force in the TA muscle () after cooling. The mean EMG amplitude of GM muscle was increased after cooling (), indicating that fatigue was induced. We found no significant changes in the gait GRFs and RCOF on dry and level surface. These findings may indicate that local moderate cooling 20 min of 10°C cold water, may influence maximal muscle performance without affecting activities at sub-maximal effort. Amitava Halder, Chuansi Gao, and Michael Miller Copyright © 2014 Amitava Halder et al. All rights reserved. The Effect of Acute Rhodiola rosea Ingestion on Exercise Heart Rate, Substrate Utilisation, Mood State, and Perceptions of Exertion, Arousal, and Pleasure/Displeasure in Active Men Sun, 27 Apr 2014 08:58:27 +0000 The aim of this study was to examine the effect of acute Rhodiola rosea (R. rosea) ingestion on substrate utilisation, mood state, RPE, and exercise affect. Ten males (mean age ± S.D. = 26 ± 6 years) completed two 30-minute cycling trials at an intensity of 70% of following ingestion of either 3 mg·kg−1 body mass of R. rosea or placebo using a double-blind, crossover design. During exercise, heart rate and RPE were recorded. Participants completed measures of mood state and exercise affect before and after exercise. Expired air samples were taken during exercise to determine substrate utilisation. Repeated measures analysis of variance indicated that RPE was significantly lower at 30 minutes into exercise versus placebo (). Perceptions of arousal () and pleasure were significantly higher after exercise with R. rosea compared to placebo (). Mood state scores for vigor were also higher in R. rosea condition compared to placebo (). There were no significant differences in energy expenditure, carbohydrate, or fat oxidation between conditions (). Ingestion of R. rosea favourably influenced RPE and exercise affect without changes in energy expenditure or substrate utilization during 30-minute submaximal cycling performance. Michael J. Duncan and Neil D. Clarke Copyright © 2014 Michael J. Duncan and Neil D. Clarke. All rights reserved. Immediate Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome Tue, 15 Apr 2014 12:40:13 +0000 Background. Hamstring injuries continue to affect active individuals and although inadequate muscle extensibility remains a commonly accepted factor, little is known about the most effective method to improve flexibility. Purpose. To determine if an isolated neurodynamic sciatic sliding technique would improve hamstring flexibility to a greater degree than stretching or a placebo intervention in asymptomatic subjects with short hamstring syndrome (SHS). Study Design. Randomized double-blinded controlled trial. Methods. One hundred and twenty subjects with SHS were randomized to 1 of 3 groups: neurodynamic sliding, hamstring stretching, and placebo control. Each subject’s dominant leg was measured for straight leg raise (SLR) range of motion (ROM) before and after interventions. Data were analyzed with a mixed model ANOVA followed by simple main effects analyses. Results. At the end of the study, more ROM was observed in the Neurodynamic and Stretching groups compared to the Control group and more ROM in the Neurodynamic group compared to Stretching group. Conclusion. Findings suggest that a neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects with SHS. Clinical Relevance. The use of neurodynamic sliding techniques to improve hamstring flexibility in sports may lead to a decreased incidence in injuries; however, this needs to be formally tested. Yolanda Castellote-Caballero, Maríe C. Valenza, Emilio J. Puentedura, César Fernández-de-las-Peñas, and Francisco Alburquerque-Sendín Copyright © 2014 Yolanda Castellote-Caballero et al. All rights reserved. Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability Thu, 20 Mar 2014 11:37:45 +0000 Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24–75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (), Kujala (), Tegner (), or VAS () scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° () and 60° (). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study. Marc Tompkins, Christopher M. Kuenze, David R. Diduch, Mark D. Miller, Matthew D. Milewski, and Joseph P. Hart Copyright © 2014 Marc Tompkins et al. All rights reserved. Incidence and Time to Return to Training for Stress Fractures during Military Basic Training Tue, 21 Jan 2014 14:25:27 +0000 Currently, little is known about the length of time required to rehabilitate patients from stress fractures and their return to preinjury level of physical activity. Previous studies have looked at the return to sport in athletes, in a general population, where rehabilitation is not as controlled as within a captive military population. In this study, a longitudinal prospective epidemiological database was assessed to determine the incidence of stress fractures and the time taken to rehabilitate recruits to preinjury stage of training. Findings demonstrated a background prevalence of 5% stress fractures in Royal Marine training; femoral and tibial stress fractures take 21.1 weeks to return to training with metatarsal stress fractures being the most common injury taking 12.2 weeks. Rehabilitation from stress fractures accounts for 814 weeks of recruit rehabilitation time per annum. Stress fracture incidence is still common in military training; despite this stress fracture recovery times remain constant and represent a significant interruption in training. It takes on average 5 weeks after exercise specific training has restarted to reenter training at a preinjury level, regardless of which bone has a stress fracture. Further research into their prevention, treatment, and rehabilitation is required to help reduce these burdens. Alexander M. Wood, Richard Hales, Andre Keenan, Alexandra Moss, Michael Chapman, Trish Davey, and Andrew Nelstrop Copyright © 2014 Alexander M. Wood et al. All rights reserved. Experiences of Injuries and Injury Reporting among Swedish Skydivers Thu, 16 Jan 2014 09:24:41 +0000 The objective was to illuminate the experience of injuries and the process of injury reporting within the Swedish skydiving culture. Data contained narrative interviews that were subsequently analyzed with content analysis. Seventeen respondents (22–44 years) were recruited at three skydiving drop zones in Sweden. In the results injury events related to the full phase of a skydive were described. Risk of injury is individually viewed as an integrated element of the recreational activity counterbalanced by its recreational value. The human factor of inadequate judgment such as miscalculation and distraction dominates the descriptions as causes of injuries. Organization and leadership act as facilitators or constrainers for reporting incidents and injuries. On the basis of this study it is interpreted that safety work and incident reporting in Swedish skydiving may be influenced more by local drop zone culture than the national association regulations. Formal and informal hierarchical structures among skydivers seem to decide how skydiving is practiced, rules are enforced, and injuries are reported. We suggest that initial training and continuing education need to be changed from the current top-down to a bottom-up perspective, where the individual skydiver learns to see the positive implications of safety work and injury reporting. Mats Jong, Anton Westman, and Britt-Inger Saveman Copyright © 2014 Mats Jong et al. All rights reserved. Interrater and Intrarater Reliability of the Tuck Jump Assessment by Health Professionals of Varied Educational Backgrounds Mon, 16 Dec 2013 08:53:46 +0000 Objective. The Tuck Jump Assessment (TJA), a clinical plyometric assessment, identifies 10 jumping and landing technique flaws. The study objective was to investigate TJA interrater and intrarater reliability with raters of different educational and clinical backgrounds. Methods. 40 participants were video recorded performing the TJA using published protocol and instructions. Five raters of varied educational and clinical backgrounds scored the TJA. Each score of the 10 technique flaws was summed for the total TJA score. Approximately one month later, 3 raters scored the videos again. Intraclass correlation coefficients determined interrater (5 and 3 raters for first and second session, resp.) and intrarater (3 raters) reliability. Results. Interrater reliability with 5 raters was poor (ICC = 0.47; 95% confidence intervals (CI) 0.33–0.62). Interrater reliability between 3 raters who completed 2 scoring sessions improved from 0.52 (95% CI 0.35–0.68) for session one to 0.69 (95% CI 0.55–0.81) for session two. Intrarater reliability was poor to moderate, ranging from 0.44 (95% CI 0.22–0.68) to 0.72 (95% CI 0.55–0.84). Conclusion. Published protocol and training of raters were insufficient to allow consistent TJA scoring. There may be a learned effect with the TJA since interrater reliability improved with repetition. TJA instructions and training should be modified and enhanced before clinical implementation. Lisa A. Dudley, Craig A. Smith, Brandon K. Olson, Nicole J. Chimera, Brian Schmitz, and Meghan Warren Copyright © 2013 Lisa A. Dudley et al. All rights reserved.