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More randomized controlled trials and comparative analyses are needed for direct correlative conclusions for which interventional orthobiologic treatment and rehabilitation protocol is best after each respective treatment. Level of Evidence 5. © 2020 by the Sports Physical Therapy Section.Low back pain in adolescent athletes is quite common, and an isthmic spondylolysis is the most common identifiable cause. Spondylolysis, a bone stress injury of the pars interarticularis, typically presents as focal low back pain which worsens with activity, particularly with back extension movements. Research on spondylolysis has focused on diagnosis, radiographic healing, the effects of bracing, and rest from activity. Although physical therapy is frequently recommended for adolescent athletes with spondylolysis, there have been no randomized controlled trials investigating rehabilitation. Additionally, there are no detailed descriptions of physical therapy care for adolescent athletes with spondylolysis. The purpose of this clinical commentary is to provide a brief background regarding the pathology of isthmic spondylolysis and provide a detailed description of a proposed plan for physical therapy management of spondylolysis in adolescent athletes. Level of Evidence 5. © 2020 by the Sports Physical Therapy Section.Background/and Purpose Musculoskeletal ultrasound imaging (MSK US) is an emerging diagnostic tool in physical therapy, which allows for dynamic visualization of tissues in real time. Plantar fasciitis is a common condition causing heel and arch pain and has been related with degenerative changes in the plantar fascia resulting in tissue thickening. Instrument Assisted Soft Tissue Mobilization (IASTM) is an intervention that allows clinicians deep penetration to treat tissues. The mechanical forces caused by IASTM might cause localized tissue trauma leading to stimulation of the body's natural inflammation and healing processes. The purpose of this case report is to demonstrate the use of ultrasound imaging to guide the decision-making process and to discern the optimal location for the application of IASTM. Case description The subject was a 46-year-old female yoga practitioner and runner, who presented with right foot pain. The clinical impression was formulated based on the combination of traditional physical therapy examination procedures and MSK US imaging findings of the plantar fascia demonstrating thickness and tendinosis like changes within the plantar fascia 3 cm distally from the calcaneus. Outcomes The subject was seen for eight treatment sessions over four weeks, at which time the goals of normal ankle dorsiflexion, no pain with palpation of the plantar fascia, negative windlass test, and no reported pain during gait were achieved. Discussion This case report illustrates the use of MSK US imaging as a method to objectively assess tissue quality and guide decision-making when managing patients with plantar fascia related pain. MSK US was used to determine the optimal location for the application of IASTM during the conservative management of a runner with plantar fasciitis. Level of evidence Therapy, Level 5. © 2020 by the Sports Physical Therapy Section.Background/Purpose Hamstring strain (HS), a common condition found among the injured physically active population, is often treated with rest, stretching, and modalities. Primal Reflex Release Technique™ (PRRT™) is a manual therapy technique used to treat pain caused by over-stimulation of the body's primal reflexes. The purpose of this case series was to explore the immediate effects of PRRT™ for treating hamstring strains. Description of Cases A multi-site case series approach was used to report on the treatment of six patients with HS using PRRT™. The Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS) and range of motion (ROM) measurements were collected, as well as evaluation of symmetry of the sacroiliac joints, reported as sacroiliac dysfunction(SJD). Outcomes Primal Reflex Release Technique™ (PRRT™) was an effective treatment for subjects with HS. Subjects reported a significant decrease in pain on the NPRS, averaging five points over the course of the treatment (95% CI of 3.374the Sports Physical Therapy Section.Background Anterior cruciate ligament (ACL) injuries are a common cause of time loss in sports. Approximately one-third of ACL reconstructed athletes who return to sport suffer secondary injury. The presence of fatigue during athletic performance has been hypothesized to increase susceptibility to ACL injury. However, the relative role of fatigue in secondary ACL failures remains unexplored. Purpose To assess how time elapsed within a game and within a season associate with secondary ACL injury occurrence in international professional athletes and American collegiate athletes. Study Design Retrospective cohort analysis. Methods The public domain was searched for secondary ACL injuries that occurred during competitive matches between 2000-2018. Demographics (age, height, weight), side of injury, type of injury (contact, noncontact), and timing of injury within competition and within season were determined for each case. Results Sixty-seven secondary ACL injuries were identified. Within-game, there were no differences in the distribution of ACL injures across each quarter of game time (p = 0.284). This was consistent between sport (p = 0.120-0.448). Within-season, there were no differences in the distribution of secondary ACL injures across each quarter of the season (p = 0.491). This was again consistent between sport (p = 0.151-0.872). Relative risk was not found to be significantly greater for any combination of season and game. Conclusion The results of the current study indicate that the occurrences of secondary ACL injuries were equally distributed with respect to in-game and in-season timing. Both in-game and in-season timing were not significantly different across each individual sport examined. These results implicate that overall there is not an association between fatigue and secondary ACL injury occurrence in professional athletes. Level of Evidence 3. © 2020 by the Sports Physical Therapy Section.Background Eccentric hamstring strength seems important in reducing the odds of future hamstring injuries. While age and previous injury are well-known risk factors for future hamstring injuries, the association of age and previous hamstring injury with eccentric hamstring strength in the following season is unknown. Purpose To investigate the association of age and previous hamstring injury with preseason eccentric hamstring strength in soccer players, and to investigate the association between previous hamstring injury duration and preseason eccentric hamstring strength. Study design Descriptive, cross-sectional study. Methods A convenience sample of 284 male amateur soccer players (age 18-38 years) was included in the analyses. Self-reported information about previous season hamstring injury and its duration (three weeks or less; more than three weeks) was collected. Preseason eccentric hamstring strength was obtained during the Nordic hamstring exercise using a field-based device. Results Age had a negative association with preseason eccentric hamstring strength with 0.9% reduction per year. Players with a previous hamstring injury duration of more than three weeks (n=27) had 13% lower preseason eccentric hamstring strength compared to players without previous hamstring injury. Conclusion Older players have lower preseason eccentric hamstring strength than younger players. Players with a previous hamstring injury duration of more than three weeks have lower preseason eccentric hamstring strength than the rest of the players. These results highlight the need to monitor and address the identified weaknesses in eccentric hamstring strength in amateur soccer players, with specific emphasis on older players with a previous hamstring injury of longer duration. Level of evidence 2b. © 2020 by the Sports Physical Therapy Section.Background Substantial deficits in the performance of the hip abductor muscles are reported in females with common lower extremity conditions. In this context, the hip abductor isometric test (HAIE) test has been developed to assess the endurance of the hip abductors. Purposes The aims of the study were 1) to assess the test-retest reliability of the HAIE test and 2) to determine if the HAIE test is valid for the measuring hip abductor muscle fatigue. Design Diagnostic accuracy of clinical tests; test retest reliability and validity. Methods Fifty-two healthy females, aged 18-30 years, were recruited. In two identical sessions, spaced by seven days, the participants performed the HAIE test and the test-retest reliability (ICC, SEM and MDC) was calculated. In ten subjects, surface EMG was used during the test in order to observe the change in the median frequency of EMG output of the gluteus medius and to determine if decrease of the median frequency is correlated with performance on the test, in order to discern validity. Results The HAIE test demonstrated good test-retest reliability (ICC = 0.84, SEM = 11.5 seconds and MDC = 32.8 seconds). Significant differences were noted between the average median frequency of participants for the last four fifteen second intervals (p = 0.02). Moderate correlation between MFslope and endurance time (r = 0.56, p = 0.008) and strong correlation between MFslope75s and endurance time (r = 0.71, p = 0.001) were found. Conclusion The results from this study support that the HAIE test is a reliable test for evaluating the endurance of the hip abductors. Further investigations should continue to explore the validity of the test, especially to determine which muscles limit the endurance time in healthy and unhealthy subjects. Level of evidence 2b. © 2020 by the Sports Physical Therapy Section.Background Increased hip adduction and internal rotation during the early stance phase of running have been linked to an increased risk of lower extremity injury. Both the gluteus maximus (GMAX) and gluteus medius (GMED) eccentrically control these motions. GMAX and GMED activation levels during commonly used rehabilitation exercises requires further exploration. Hypothesis/Purpose The purpose of this study was to compare peak surface electromyography (sEMG) amplitudes of GMAX and GMED between three closed-chain rehabilitation exercises bilateral hip external rotation with resistance band (BER), forward lunge with resistance band (FL), and single-leg rotational squat (SLS). It was hypothesized that the FL would elicit greater peak amplitude in the GMAX and GMED than SLS and BER. Study Design Descriptive, observational cohort study. Methods Twenty-two healthy runners (14 male, 8 female) had sEMG electrodes placed bilaterally on GMAX and GMED. Participants completed three repetitions each of BER, FL, and SLS ex70% MRC. All three exercises had comparable eccentric peak amplitudes; however, the BER exercise produced a significantly reduced GMAX and GMED amplitude during the concentric phase versus the FL and SLS. The FL and SLS appear equally effective at eliciting peak GMAX and GMED activation. Level of Evidence 3. © 2020 by the Sports Physical Therapy Section.
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