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Matas S, Lalín C, Corbi F, Planas-Anzano A, Moya JM, Mas-Alòs S, Peirau-Terés X. Content Validity of a New Soccer (Football) Return-to-Play Test: The RONDO-TEST. J Funct Morphol Kinesiol 2024; 10:3. [PMID: 39846644 PMCID: PMC11755452 DOI: 10.3390/jfmk10010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/23/2024] [Accepted: 12/24/2024] [Indexed: 01/24/2025] Open
Abstract
OBJECTIVES The aim was to assess the content validity of a new field test on general and soccer-specific motor skills before return to play. METHODS The RONDO-TEST was assessed by a Delphi panel for its content validity. It included a survey to evaluate 16 items related to the test consisting of four 10 m lines which cross over at their mid-point, resulting in eight 5 m sectors that include locomotor skills (speeding, moving sideways, side cutting, and jumping) and soccer-specific technical skills (dribbling, slalom course, and kicking/passing). The content validity was calculated with the Aiken's V coefficient of acceptance at 0.69 and 95% of confidence interval. RESULTS Eight experts participated in the Delphi and agreed on the administration procedures after three rounds of suggestions. Major changes included the order of execution and the descriptions of the sectors. The results showed consensus (V = 1, maximum acceptance) for the clarity of instructions, the relevance of the skills to be evaluated, the order of execution, the materials and the relevance of measuring total and partial sector times. CONCLUSIONS The RONDO-TEST may be feasible and simple to administer and evaluate technical functional skills (actions) and condition-related abilities (e.g., the ability to repeat the test, fatigue curve, etc.), which are relevant aspects for return to play under optimum conditions.
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Affiliation(s)
- Sergi Matas
- Institut Nacional d’Educació Física de Catalunya (INEFC), Partida la Caparrella, 97, E-25192 Lleida, Spain; (F.C.); (A.P.-A.); (X.P.-T.)
- Human Movement Research Group (GRMH), University of Lleida (UdL), [2021 SGR 01619], E-25002 Lleida, Spain
| | - Carlos Lalín
- Tottenham Hotspur F. C., White Hart Lane, Bill Nicholson Way, 748 High Road, Tottenham N17 0AP, UK;
| | - Francisco Corbi
- Institut Nacional d’Educació Física de Catalunya (INEFC), Partida la Caparrella, 97, E-25192 Lleida, Spain; (F.C.); (A.P.-A.); (X.P.-T.)
- Human Movement Research Group (GRMH), University of Lleida (UdL), [2021 SGR 01619], E-25002 Lleida, Spain
| | - Antoni Planas-Anzano
- Institut Nacional d’Educació Física de Catalunya (INEFC), Partida la Caparrella, 97, E-25192 Lleida, Spain; (F.C.); (A.P.-A.); (X.P.-T.)
- Human Movement Research Group (GRMH), University of Lleida (UdL), [2021 SGR 01619], E-25002 Lleida, Spain
| | - José M. Moya
- Facultad de Formación del Profesorado y la Educación, Departamento Educación Física, Deporte y Motricidad Humana, Autonomous University of Madrid, Ciudad Universitaria de Cantoblanco CA, E-28049 Madrid, Spain;
| | - Sebastià Mas-Alòs
- Institut Nacional d’Educació Física de Catalunya (INEFC), Partida la Caparrella, 97, E-25192 Lleida, Spain; (F.C.); (A.P.-A.); (X.P.-T.)
- Human Movement Research Group (GRMH), University of Lleida (UdL), [2021 SGR 01619], E-25002 Lleida, Spain
| | - Xavier Peirau-Terés
- Institut Nacional d’Educació Física de Catalunya (INEFC), Partida la Caparrella, 97, E-25192 Lleida, Spain; (F.C.); (A.P.-A.); (X.P.-T.)
- Human Movement Research Group (GRMH), University of Lleida (UdL), [2021 SGR 01619], E-25002 Lleida, Spain
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2
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Brazalovich P, Simon JE, Criss CR, Yom JP, Grooms DR. The effects of virtual reality immersion on drop landing mechanics. Sports Biomech 2024; 23:2564-2580. [PMID: 35139757 DOI: 10.1080/14763141.2022.2035427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Virtual reality (VR) can be used to alter the environment and challenge sensory calibration which rehabilitation and return-to-sport testing lack. The purpose was to establish how VR manipulation of the environment changes knee landing biomechanics. Twenty-nine healthy active adults (22 males; 20.52 ± 1.21 years; 1.75 ± 0.09 m; 78.34 ± 14.33 kg) were recruited. Three drop landing trials (31 cm height box) were performed for three conditions: eyes-open (EO), eyes-closed (EC), and VR, consisting of a head-mounted display of a 360° photo of a steep man-made edge or drop. Knee kinematics and kinetics were evaluated using 3D motion capture. The VR condition significantly increased Landing Error Score System errors relative to EO (1.28 ± 0.20, p < 0.001) and EC (0.98 ± 0.22, p < 0.001) and increased vertical ground reaction force relative to EO (0.41 ± 0.09 N·bw-1, p < 0.001) and EC (0.34 ± 0.07 N·bw-1, p < 0.001). The VR condition had less knee flexion at initial contact compared to EO (4.39 ± 0.75°, p = 0.001) and EC (1.83 ± 0.63°, p = 0.021). The VR condition had more knee abduction at initial contact compared to EO (0.71 ± 0.24°, p = 0.002) and EC (0.69 ± 0.22°, p = 0.002) and increased knee abduction at maximum flexion compared to EO (2.01 ± 0.58°, p = 0.026). Landing in VR increased injury risk landing biomechanics, indicating that VR may option to incorporate into return-to-play or injury risk assessment.
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Affiliation(s)
- Philip Brazalovich
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Janet E Simon
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Jae P Yom
- Department of Allied Health, University of Illinois Springfield, Springfield, IL, USA
| | - Dustin R Grooms
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
- School of Rehabilitation and Communications Science, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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Herring SA, Putukian M, Kibler WB, LeClere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Curr Sports Med Rep 2024; 23:183-191. [PMID: 38709944 DOI: 10.1249/jsr.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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4
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Herring SA, Putukian M, Kibler WB, Leclere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Med Sci Sports Exerc 2024; 56:767-775. [PMID: 38616326 DOI: 10.1249/mss.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance Leclere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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5
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Ammendolia A, de Sire A, Lippi L, Ammendolia V, Spanò R, Reggiani A, Invernizzi M, Marotta N. Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial. Sports (Basel) 2023; 11:180. [PMID: 37755857 PMCID: PMC10537008 DOI: 10.3390/sports11090180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains. METHODS Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3). RESULTS After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported. CONCLUSIONS Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.
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Affiliation(s)
- Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Integrated Activities Research and Innovation Department (DAIRI), Translational Medicine, Hospital SS. Antonio Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Valerio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
| | - Riccardo Spanò
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
| | - Andrea Reggiani
- Physical and Rehabilitative Medicine, Casa di Cura La Madonnina, 20122 Milan, Italy;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Integrated Activities Research and Innovation Department (DAIRI), Translational Medicine, Hospital SS. Antonio Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Gomez-Espejo V, Olmedilla A, Abenza-Cano L, Garcia-Mas A, Ortega E. Psychological readiness to return to sports practice and risk of recurrence: Case studies. Front Psychol 2022; 13:905816. [PMID: 36211933 PMCID: PMC9540195 DOI: 10.3389/fpsyg.2022.905816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Returning to sport after the sports injury is a difficult decision because it's multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan's iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes' incorporation into their sports practice with a guarantee of success.
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Affiliation(s)
| | - Aurelio Olmedilla
- Department of Personality, Evaluation and Psychological Treatment, University of Murcia, Murcia, Spain
| | | | - Alejandro Garcia-Mas
- Grupo de Investigación en Ciencias de la Actividad Fisica (GICAFE) (Research Group of Sports Sciences), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Enrique Ortega
- Department of Physical Activity and Sport, Campus of Excellence Mare Nostrum, University of Murcia, Murcia, Spain
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7
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Roberts WO, Armstrong LE, Sawka MN, Yeargin SW, Heled Y, O'Connor FG. ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. Curr Sports Med Rep 2021; 20:470-484. [PMID: 34524191 DOI: 10.1249/jsr.0000000000000878] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.
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Affiliation(s)
- William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | | | - Michael N Sawka
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Yuval Heled
- Clinical and Integrative Physiology Unit, Heller Institute of Medical Research, Sheba Medical Center, ISRAEL
| | - Francis G O'Connor
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
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8
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Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop 2020; 11:534-558. [PMID: 33362991 PMCID: PMC7745493 DOI: 10.5312/wjo.v11.i12.534] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.
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Affiliation(s)
- Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran
| | - Mohammad Hassabi
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran 19979-64151, Iran
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9
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Simon JE, Yom J, Grooms DR. Symmetry does not Indicate Recovery: Single-leg Hop Before and After a Lower Extremity Injury. Int J Sports Med 2020; 42:344-349. [PMID: 33017852 DOI: 10.1055/a-1244-9959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Current recommendations for return-to-play decision-making involve comparison of the injured limb to the uninjured limb. However, the use of the uninjured limb as a comparison for hop testing lacks empirical evidence. Thus, the purpose of this study was to determine the effects of lower extremity injury on limb symmetry and performance on the single-leg hop for distance. Two-hundred thirty-six adolescent athletes completed the single-leg hop for distance before the beginning of the season (pre-injury). Forty-four adolescent athletes sustained a lower extremity injury (22 ankle and 12 knee) and missed at least three days of sports participation. All individuals had completed the single-leg hop for distance before the beginning of the season (pre-injury) and at discharge (post-injury). Injured limb single-leg hop for distance significantly decreased at return-to-play from pre-injury with a mean decrease of 48.9 centimeters; the uninjured limb also significantly decreased, with a mean decrease of 33.8 centimeters. Limb symmetry did not significantly change pre- to post-injury with a mean difference of 1.5%. Following a lower extremity injury, single-leg hop for distance performance degrades not only for the injured limb but also the uninjured limb. However, limb symmetry did not change following a lower extremity injury.
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Affiliation(s)
- Janet E Simon
- Division of Athletic Training, School of Applie 00d Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens
| | - Jae Yom
- Allied Health, University of Illinois at Springfield, Springfield
| | - Dustin R Grooms
- Division of Athletic Training, School of Applie 00d Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens.,Division of Physical Therapy, School of Rehabilitation and Communications Science, College of Health Sciences and Professions, Ohio University, Athens
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10
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Madsen LP, Booth RL, Volz JD, Docherty CL. Using Normative Data and Unilateral Hopping Tests to Reduce Ambiguity in Return-to-Play Decisions. J Athl Train 2020; 55:699-706. [PMID: 32511713 DOI: 10.4085/1062-6050-0050.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. OBJECTIVE To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). INTERVENTION(S) Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. MAIN OUTCOME MEASURE(S) Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. RESULTS The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. CONCLUSIONS We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.
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Affiliation(s)
- Leif P Madsen
- Department of Kinesiology, Indiana University, Bloomington
| | - Raya L Booth
- Department of Kinesiology, Indiana University, Bloomington
| | - James D Volz
- Department of Kinesiology, Indiana University, Bloomington
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11
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Bisciotti GN, Volpi P, Alberti G, Aprato A, Artina M, Auci A, Bait C, Belli A, Bellistri G, Bettinsoli P, Bisciotti A, Bisciotti A, Bona S, Bresciani M, Bruzzone A, Buda R, Buffoli M, Callini M, Canata G, Cardinali D, Cassaghi G, Castagnetti L, Clerici S, Corradini B, Corsini A, D'Agostino C, Dellasette E, Di Pietto F, Enrica D, Eirale C, Foglia A, Franceschi F, Frizziero A, Galbiati A, Giammatei C, Landreau P, Mazzola C, Moretti B, Muratore M, Nanni G, Niccolai R, Orizio C, Pantalone A, Parra F, Pasta G, Patroni P, Pelella D, Pulici L, Quaglia A, Respizzi S, Ricciotti L, Rispoli A, Rosa F, Rossato A, Sannicandro I, Sprenger C, Tarantola C, Tenconi FG, Tognini G, Tosi F, Trinchese GF, Vago P, Zappia M, Vuckovich Z, Zini R, Trainini M, Chamari K. Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer). BMJ Open Sport Exerc Med 2019; 5:e000505. [PMID: 31673400 PMCID: PMC6797382 DOI: 10.1136/bmjsem-2018-000505] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.
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Affiliation(s)
| | - Piero Volpi
- Humanitas Clinical Institute, Rozzano, Milano, Italy.,FC Internazionale Milano, Milano, Milano, Italy
| | - Giampietro Alberti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | - Alessio Auci
- UOS Angiografia e Radiologia Interventistica, Ospedale delle Apuane, Massa Carrara, Massa Carrara, Italy
| | | | | | | | | | | | | | - Stefano Bona
- Humanitas Clinical Institute, Rozzano, Milano, Italy
| | | | | | - Roberto Buda
- Dipartimento di Scienze Biomediche e Neuromotorie, Università Bologna, Bologna, Italy
| | | | | | - Gianluigi Canata
- Ospedale Koelliker, Torino, Italy.,Istituto di Medicina dello Sport di Torino, Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | - Cristiano Eirale
- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Paris St Germain FC, Paris, France
| | - Andrea Foglia
- Physiotherapy, Studio Riabilita, Civitanova Marche, Italy
| | | | | | | | | | | | | | - Biagio Moretti
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università di Bari, Bari, Italy
| | | | - Gianni Nanni
- FIFA Medical Centre of Excellence, Bologna, Isokinetic Medical Group, Bologna, Italy.,Bologna FC, Bologna, Italy
| | | | | | - Andrea Pantalone
- Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Italy.,Ospedale SS Annunziata, Chieti, Italy
| | | | - Giulio Pasta
- Parma Calcio, Parma, Italy.,Studio Radiologico Pasta, Parma, Italy
| | | | | | - Luca Pulici
- FC Internazionale Milano, Milano, Milano, Italy
| | - Alessandro Quaglia
- Humanitas Clinical Institute, Rozzano, Milano, Italy.,FC Internazionale Milano, Milano, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Fabio Tosi
- FC Internazionale Milano, Milano, Milano, Italy
| | | | - Paola Vago
- Universita Cattolica del Sacro Cuore, Milano, Italy
| | | | | | - Raul Zini
- Villa Maria Cecilia, Cotignola, Italy
| | | | - Karim Chamari
- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Lab, National Center of Science and Sports Medicine Tunis, Tunis, Tunisia
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12
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Niederer D, Keller M, Achtnich A, Akoto R, Ateschrang A, Banzer W, Barié A, Best R, Ellermann A, Fischer A, Guenther D, Herbort M, Höher J, Janko M, Jung TM, Krause M, Petersen W, Stoffels T, Stöhr A, Welsch F, Stein T. Effectiveness of a home-based re-injury prevention program on motor control, return to sport and recurrence rates after anterior cruciate ligament reconstruction: study protocol for a multicenter, single-blind, randomized controlled trial (PReP). Trials 2019; 20:495. [PMID: 31409425 PMCID: PMC6693217 DOI: 10.1186/s13063-019-3610-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/23/2019] [Indexed: 12/26/2022] Open
Abstract
Background Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction. Methods and design A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18–35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4–8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency – intensity – type and time). All questionnaires are completed online using the participants’ pseudonym only. Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines. Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes. Trial registration German Clinical Trials Register, identification number DRKS00015313. Registered on 1 October 2018.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt am Main, Germany.
| | | | - Andrea Achtnich
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Ralph Akoto
- Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Atesch Ateschrang
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt am Main, Germany.,Department of Preventive and Sports Medicine, Institute for Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Alexander Barié
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany.,Department of Orthopaedic Sportsmedicine, University of Tuebingen, Tuebingen, Germany
| | | | - Andreas Fischer
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Jürgen Höher
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Maren Janko
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Tobias M Jung
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Thomas Stoffels
- Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Marzahn, Berlin, Germany
| | | | - Frederic Welsch
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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13
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Al Bimani SA, Gates LS, Warner M, Bowen C. Factors influencing return to play following conservatively treated ankle sprain: a systematic review. PHYSICIAN SPORTSMED 2019; 47:31-46. [PMID: 30324860 DOI: 10.1080/00913847.2018.1533392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle sprain is a very common injury, yet uncertainty exists in what is appropriate time to return to play (RTP). Such guidance may inform treatment pathways and effective practice. OBJECTIVES To determine if consensus exist about potential influencing factors for time to RTP in conservatively treated ankle sprain. METHODS We searched AMED, CINAHL Plus, Cochrane library, EMBASE, MEDLINE (EBSCO), SPOERDiscus, PsycINFO, PEDro, Scopus, unpublished literature and ongoing trials and Google Scholar from inception until April 2017. The quality of the eligible papers was assessed using the Downs and Black tool for randomized controlled trials (RCTs) and Critical Appraisal Skills Program (CASP) for observational studies. RESULTS The initial search identified 1885 articles. After screening, 14 articles were included. Of these, 11 were RCTs and 3 were prospective observational studies. Individual treatment methods that resulted in a shorter time to RTP were functional treatment, compression stockings, anteroposterior joint mobilization, hyaluronic acid injection (HA), Jump Stretch Flex Band programme (JSFB) and diclofenac medication. Prognostic factors for determining time to RTP in the included prospective observational studies were measures of Global function, SF 36PF, athlete's ambulation status, weight-bearing activity scores and self-reported athletic ability. CONCLUSION To our knowledge, this is the first review to report influencing factors for time to RTP following conservatively treated ankle sprain. Findings from this review identified factors that influence time to RTP. However, caution should be taken in generalizing these results due to the heterogeneity of studies and inability to clearly define and list the criteria for safe RTP. The inclusion of factors such as age, sex, BMI, level of sport, injury related factors in future studies might help to understand the course of injury and therefore assist in constructing safer criteria.
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Affiliation(s)
- Saed A Al Bimani
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK.,c Department of Physiotherapy , College of Health Sciences , Muscat , Oman
| | - Lucy S Gates
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
| | - Martin Warner
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
| | - Catherine Bowen
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
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14
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Functional Performance Measures Used for Return-to-Sport Criteria in Youth Following Lower-Extremity Injury. J Sport Rehabil 2018; 27:581-590. [PMID: 29405808 DOI: 10.1123/jsr.2017-0061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT As sport participation increases globally, so will injury-related risks. The process used to determine return-to-sport following injury is vital to future sport participation and injury prevention. Early specialization along with poor management of sport participation causes an increase in injury risk and potential long-term health consequences for youth athletes. OBJECTIVES Previous injury is a common intrinsic risk factor for new injuries. Identifying functional performance deficits, defined by return-to-sport criteria, minimizes these risk factors and provides athletes with guidelines to return safely to sport. The purposes of this clinical commentary and literature review are to provide a summary of current concepts and clinical practices and to identify functional performance measures as clinical assessment tools for return-to-play criteria in the youth population. EVIDENCE A literature review was completed using numerous databases, where 154 relevant articles were reviewed and 22 articles were included in this commentary. Of the 22 articles using functional performance measures for return-to-sport criteria, 6 were specific to youth, 12 had mixed populations of adults and youth, and 4 were normative samples for specific youth populations. Acquisition: The gaps in the literature pertaining to functional performance measures in the youth population are addressed, and future research needs for return-to-sport criteria are identified. EVIDENCE SYNTHESIS This descriptive literature review identifies 22 articles that meet the search criteria for the youth population discussing the use of clinical functional performance measures in order to identify return-to-sport criteria for lower-extremity injuries. CONCLUSIONS Due to the inconsistencies in terminology, definitions, and standardization of clinical assessment tools, it seems necessary to create a comprehensive functional performance test battery for the lower extremity that can be used as return-to-sport criteria.
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15
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OʼConnor FG, Heled Y, Deuster PA. Exertional Heat Stroke, the Return to Play Decision, and the Role of Heat Tolerance Testing: A Clinician's Dilemma. Curr Sports Med Rep 2018; 17:244-248. [PMID: 29994825 DOI: 10.1249/jsr.0000000000000502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Exertional heat stroke (EHS) is a leading cause of preventable morbidity and mortality among both athletes and warfighters. Since current evidence suggests that the history of a prior event is an important risk factor for an EHS event, sports medicine providers can find post-EHS return to play/duty (RTP/D) decisions challenging. Heat tolerance testing is a tool that can help with such decisions by exposing the subject to a given heat load under controlled conditions to assess the presence or absence of heat tolerance. This special communication explores the challenge of the RTP/D after an EHS event and the potential role of heat tolerance testing in making this clinical decision.
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16
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Can a Repeated Sprint Ability Test Help Clear a Previously Injured Soccer Player for Fully Functional Return to Activity? A Pilot Study. Clin J Sport Med 2017; 27:361-368. [PMID: 27428681 DOI: 10.1097/jsm.0000000000000368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of fatigue induced by a repeated sprint ability (RSA) test on the neuromuscular responses of soccer players with a recent history of lower limb injuries (CH) and a matched control group in good fitness condition (GH). DESIGN This was a case-control study. PARTICIPANTS Nine CH and 9 GH. INDEPENDENT VARIABLE Allocation to CH or GH. MAIN OUTCOME MEASURES Each player was assessed for blood lactate concentration and jumping performance [squat jump (SJ) and countermovement jump (CMJ)] before/after RSA. Post-RSA rate of perceived exertion (RPE) was obtained. Receiver operating characteristic analysis was performed to calculate RSA sensitivity and specificity in distinguishing between CH and GH. Intraclass correlation coefficient was used to assess reliability. RESULTS No baseline differences were found for any variable. ΔSJ before/after RSA was -14 ± 2% and -5 ± 2% in CH and GH, respectively (P < 0.05). ΔCMJ before/after RSA was -15 ± 2% and -7 ± 2% in CH and GH, respectively (P < 0.05). ΔSJ-based and ΔCMJ-based (before/after RSA) area under curve (AUC) resulted in 0.90 ± 0.07 and 0.86 ± 0.09, respectively, with both AUCs differentiating between CH and GH with 77.78% sensitivity and 88.89% specificity. Pooled AUC resulted in 0.88 ± 0.06. Intraclass correlation coefficient was high (0.85/0.97). CONCLUSIONS Repeated sprint ability is a simple, low-cost field test potentially able to assist in clinical decision making for return to sport.
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17
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Huggins RA, Scarneo SE, Casa DJ, Belval LN, Carr KS, Chiampas G, Clayton M, Curtis RM, Duffy AJ, Flury A, Gammons M, Hosokawa Y, Jardine JF, LaBella CR, Oats R, Ransone JW, Sailor SR, Scott K, Stearns RL, Vandermark LW, Weston T. The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues. J Athl Train 2017; 52:384-400. [PMID: 28430552 DOI: 10.4085/1062-6050-52.2.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Robert A Huggins
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Samantha E Scarneo
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Douglas J Casa
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Luke N Belval
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | | | - George Chiampas
- Korey Stringer Institute, University of Connecticut.,US Soccer Federation.,Northwestern University
| | | | - Ryan M Curtis
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - A J Duffy
- National Athletic Trainers' Association
| | | | | | - Yuri Hosokawa
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | | | | | | | | | | | | | - Rebecca L Stearns
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
| | - Lesley W Vandermark
- National Athletic Trainers' Association.,Korey Stringer Institute, University of Connecticut
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18
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Abstract
Return-to-play (RTP) decisions often represent a challenge to physicians caring for athletes. The multifaceted and unique nature of each RTP decision makes standardization of the decision-making process impossible and demands of the physician thoughtful consideration of all competing interests and variables. Such difficult medical decisions are further complicated by unique ethical and legal considerations. Although no concrete RTP recommendations are available, the consensus of experienced team physicians and knowledge of the rules and regulations that apply to RTP are helpful guides to treating the various upper extremity injuries that occur in elite athletes.
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19
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Chin EY, Nelson LD, Barr WB, McCrory P, McCrea MA. Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes. Am J Sports Med 2016; 44:2276-85. [PMID: 27281276 DOI: 10.1177/0363546516648141] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Sport Concussion Assessment Tool-3 (SCAT3) facilitates sideline clinical assessments of concussed athletes. Yet, there is little published research on clinically relevant metrics for the SCAT3 as a whole. PURPOSE We documented the psychometric properties of the major SCAT3 components (symptoms, cognition, balance) and derived clinical decision criteria (ie, reliable change score cutoffs and normative conversation tables) for clinicians to apply to cases with and without available preinjury baseline data. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS High school and collegiate athletes (N = 2018) completed preseason baseline evaluations including the SCAT3. Re-evaluations of 166 injured athletes and 164 noninjured controls were performed within 24 hours of injury and at 8, 15, and 45 days after injury. Analyses focused on predictors of baseline performance, test-retest reliability, and sensitivity and specificity of the SCAT3 using either single postinjury cutoffs or reliable change index (RCI) criteria derived from this sample. RESULTS Athlete sex, level of competition, attention-deficit/hyperactivity disorder (ADHD), learning disability (LD), and estimated verbal intellectual ability (but not concussion history) were associated with baseline scores on ≥1 SCAT3 components (small to moderate effect sizes). Female sex, high school level of competition (vs college), and ADHD were associated with higher baseline symptom ratings (d = 0.25-0.32). Male sex, ADHD, and LD were associated with lower baseline Standardized Assessment of Concussion (SAC) scores (d = 0.28-0.68). Male sex, high school level of competition, ADHD, and LD were associated with poorer baseline Balance Error Scoring System (BESS) performance (d = 0.14-0.26). After injury, the symptom checklist manifested the largest effect size at the 24-hour assessment (d = 1.52), with group differences diminished but statistically significant at day 8 (d = 0.39) and nonsignificant at day 15. Effect sizes for the SAC and BESS were small to moderate at 24 hours (SAC: d = -0.36; modified BESS: d = 0.46; full BESS: d = 0.51) and became nonsignificant at day 8 (SAC) and day 15 (BESS). Receiver operating characteristic curve analyses demonstrated a stronger discrimination for symptoms (area under the curve [AUC] = 0.86) than cognitive and balance measures (AUCs = 0.58 and 0.62, respectively), with comparable discrimination of each SCAT3 component using postinjury scores alone versus baseline-adjusted scores (P = .71-.90). Normative conversion tables and RCI criteria were created to facilitate the use of the SCAT3 both with and without baseline test results. CONCLUSION Individual predictors should be taken into account when interpreting the SCAT3. The normative conversion tables and RCIs presented can be used to help interpret concussed athletes' performance both with and without baseline data, given the comparability of the 2 interpretative approaches.
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Affiliation(s)
- Esther Y Chin
- Alexian Brothers Neurosciences Institute, AMITA Health, Elk Grove Village/Hoffman Estates, Illinois, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William B Barr
- Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Paul McCrory
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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20
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Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med 2016; 50:1325-1332. [PMID: 27259751 DOI: 10.1136/bjsports-2016-096106] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/26/2022]
Abstract
AIM This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. DESIGN A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. DATA SOURCES PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included. RESULTS 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001). CONCLUSIONS 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.
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Affiliation(s)
- Jennifer A Zellers
- Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Michael R Carmont
- Department of Orthopaedic Surgery, The Princess Royal Hospital, Telford, Shropshire, UK.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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21
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Richie DH, Izadi FE. Return to play after an ankle sprain: guidelines for the podiatric physician. Clin Podiatr Med Surg 2015; 32:195-215. [PMID: 25804710 DOI: 10.1016/j.cpm.2014.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ankle sprain is the most common injury in sport and has a high incidence of long-term disability. This disability may be partly due to early return to sport before ligament healing has been completed. The podiatric physician can follow sound guidelines for making a return-to-play decision for athletes suffering from an ankle sprain. The decision-making process requires the podiatric physician to monitor the rehabilitation process and then administer patient self-reported questionnaires as well as functional performance tests to assess the status of ankle function after injury.
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Affiliation(s)
- Douglas H Richie
- Seal Beach Podiatry Group Inc, 550 Pacific Coast Highway, Suite 209, Seal Beach, CA 90174, USA.
| | - Faye E Izadi
- Seal Beach Podiatry Group Inc, 550 Pacific Coast Highway, Suite 209, Seal Beach, CA 90174, USA
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22
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Niederer D, Wilke J, Füzéki E, Banzer W. [Sporting loads to Spondylodesis of lumbar spine: The return-to-play process]. DER ORTHOPADE 2014; 43:1100-5. [PMID: 25403690 DOI: 10.1007/s00132-014-3038-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Return to play (RTP) and competition following spinal fusion is of particular importance for athletes. There is a lack of guidelines for decision making in RTP processes. OBJECTIVE The purpose of this work was to provide a systematic review of the criteria and time of return in the RTP decision process for adults undergoing lumbar spinal fusion. METHODS Two independent investigators searched MEDLINE using MeSH terms. Targeted outcomes were criteria for return to play decisions and total duration of the RTP process. RESULTS So far, no prospective randomized controlled trials on RTP after spinal fusion considering inclusion and exclusion criteria are available. Five of the included studies are based on original data. Most of the identified studies are narrative reviews and, thus, exhibit low evidence levels. In addition to the narrative reviews, one observational study, two expert opinion surveys and two model development studies were found. CONCLUSION Based on the literature research, a positive RTP decision can be made if the following criteria are fulfilled: (1) anatomical and functional healing is complete, (2) safety of the athlete and secondary subjects during training and competition is guaranteed, (3) sport-specific skills are regained, and (4) patient is psychosocially ready. The RTP process can often be successfully initiated 6 months after surgery; some patients however, will never manage the return to full-contact sports and/or sports with risk of collision.
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Affiliation(s)
- D Niederer
- Abteilung Sportmedizin, Goethe-Universität Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Deutschland,
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23
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Bjerke W, Steinman S, Cotto V. Cardiac rehabilitation programmes for low-risk patients and leisure athletes: A potential paradox. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.2.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Wendy Bjerke
- associate clinical professor at Sacred Heart University in Fairfield CT, USA
| | - Stu Steinman
- Owner and Director of Westsports Medicine in Westport CT and is an Adjunct Professor at Sacred Heart University, USA
| | - Vincent Cotto
- environmental health and safety ergonomics intern at Sikorsky Aircraft Corporation in Stratford CT, USA
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24
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Courson R, Goldenberg M, Adams KG, Anderson SA, Colgate B, Cooper L, Dewald L, Floyd R, Gregory DB, Indelicato PA, Klossner D, O'Leary R, Ray T, Selgo T, Thompson C, Turbak G. Inter-association consensus statement on best practices for sports medicine management for secondary schools and colleges. J Athl Train 2014; 49:128-37. [PMID: 24499040 PMCID: PMC3917289 DOI: 10.4085/1062-6050-49.1.06] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Kevin G. Adams
- National Interscholastic Athletic Administrators Association
| | | | - Bob Colgate
- National Federation of State High School Associations
| | | | | | | | | | | | | | | | - Tracy Ray
- ‡American Medical Society for Sports Medicine
| | - Tim Selgo
- §National Association of Collegiate Directors of Athletics
| | | | - Gary Turbak
- National Association of Intercollegiate Athletics
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Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train 2013; 48:528-45. [PMID: 23855363 PMCID: PMC3718356 DOI: 10.4085/1062-6050-48.4.02] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. BACKGROUND Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. RECOMMENDATIONS The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.
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Affiliation(s)
- Thomas W Kaminski
- National Athletic Trainers’ Association, Communications Department, 2952 Stemmons Freeway, Dallas, TX 75247, USA
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Casa DJ, Armstrong LE, Kenny GP, O'Connor FG, Huggins RA. Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep 2012; 11:115-23. [PMID: 22580488 DOI: 10.1249/jsr.0b013e31825615cc] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
When athletes, warfighters, and laborers perform intense exercise in the heat, the risk of exertional heat stroke (EHS) is ever present. The recent data regarding the fatalities due to EHS within the confines of organized American sport are not promising: during the past 35 years, the highest number of deaths in a 5-year period occurred from 2005 to 2009. This reminds us that, regardless of the advancements of knowledge in the area of EHS prevention, recognition, and treatment, knowledge has not been translated into practice. This article addresses important issues related to EHS cause and care. We focus on the predisposing factors, errors in care, physiology of cold water immersion, and return-to-play or duty considerations.
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Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, 2095 Hillside Road, U-1110, Storrs, CT 06269-1110, USA.
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Della Villa S, Boldrini L, Ricci M, Danelon F, Snyder-Mackler L, Nanni G, Roi GS. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health 2012; 4:17-24. [PMID: 23016064 PMCID: PMC3435892 DOI: 10.1177/1941738111417564] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. Study Design: Case series. Hypothesis: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. Methods: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests. Results: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. Conclusions: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.
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Abstract
Golf has great popularity as a spectator sport, as well as a participation sport. Providing coverage for golf events can range from mass event coverage for large professional tournaments to provision of injury care at local golf events. This article provides a brief introduction to the game of golf for those unfamiliar with its play, an overview of the types of injuries seen, and consideration in providing care for a variety of golf competitions.
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Affiliation(s)
- L Tyler Wadsworth
- Department of Family and Community Medicine; Primary Care Sports Medicine Fellowship, Saint Louis University School of Medicine, 180 South Third Street, Belleville, IL 62220, USA.
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Abstract
OBJECTIVE Return-to-play (RTP) decisions are a central component of the Team Physician's clinical work, yet there is little more than anecdotal reference to these in the literature. We recently published a 3-step model for return-to-play medical decision making and, in the current paper, undertook a systematic review of the literature to determine the level of evidence in support of this model. DATA SOURCES PubMed, Web of Science, and CINAHL electronic databases. Any article specifically related to concussion, head injuries, neck injuries, illness, medical conditions (including cardiovascular and renal), and preparticipation in sport or that reported RTP as a clinical outcome was excluded. Any article that contained a discussion on one of the components of the 3-step decision-based RTP model was included. RESULTS We reviewed 148 articles that met the criteria for inclusion and found 98 review articles, 39 original articles, 6 case reports, and 5 editorials. Of these, 141 articles mentioned Step 1 of the medical decision-making process for RTP (Medical Factors), 26 mentioned Step 2 (Sport Risk Modifiers), and 20 mentioned Step 3 (Decision Modifiers). Of the 148 articles in total, only 13 focused on RTP as the main subject and the remaining 135 mentioned RTP anecdotally. Of these 13 articles, 5 were reviews, 4 were editorials, and 4 were original research. CONCLUSIONS Although 148 articles we retrieved mention RTP in relation to a specific injury, medical condition, or specific topic, only 13 articles focused specifically on the RTP decision-making process, and 6 of 13 were restricted to Step 1 of the 3-step model (Medical Factors). Return-to-play is a fertile field for research and thought leadership beginning with a focus on the Team Physician's appropriate role in RTP decision making, particularly considering the factors identified in Step 3 (Decision Modification).
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Della Villa S, Kon E, Filardo G, Ricci M, Vincentelli F, Delcogliano M, Marcacci M. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med 2010; 38:68-77. [PMID: 20051508 DOI: 10.1177/0363546509348490] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite improvement in treatment for articular cartilage lesions, prolonged recovery still precludes early return to competitive sports. The challenge of postoperative rehabilitation is to optimize return to preinjury activities without jeopardizing the graft. HYPOTHESIS Intensive rehabilitation after second-generation arthroscopic autologous cartilage implantation (Hyalograft C) facilitates graft maturation and safely allows for early return to competition without jeopardizing clinical outcome at longer follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The outcome of 31 competitive male athletes with International Cartilage Repair Society grade III-IV cartilaginous lesions of the medial or lateral femoral condyle or trochlea were evaluated at 1-, 2-, and 5-year follow-up. The athletic cohort was compared with a similar control cohort of 34 nonathletic patients who were treated with autologous chondrocyte implantation. The athletic cohort followed a 4-phase intensive rehabilitation protocol. Eleven of the patients in this cohort were also treated with an isokinetic exercise program and on-field rehabilitation. The patients in the control cohort completed only phase 1 of rehabilitation. RESULTS When comparing the 2 groups, a greater improvement in the group of athletes was achieved at 5-year follow-up (P = .037) in the self-assessment of quality of life and International Knee Documentation Committee subjective evaluation at 12 months and at 5 years of follow-up (P = .001 and P = .002, respectively). When analyzing the return to sports activity, 80.6% of the athletes returned to their previous activity level in 12.4 +/- 1.6 months; athletes treated with the on-field rehabilitation and isokinetic exercise program had faster recovery and an even earlier return to competition (10.6 +/- 2.0 months). CONCLUSION For optimal results, autologous chondrocyte implantation rehabilitation should not only follow but also facilitate the process of graft maturation. Intensive rehabilitation may safely allow a faster return to competition and also influence positively the clinical outcome at medium-term follow-up.
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Standaert CJ, Herring SA. Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Stingers. Arch Phys Med Rehabil 2009; 90:402-6. [DOI: 10.1016/j.apmr.2008.09.569] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 12/26/2022]
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Psychological issues related to injury in athletes and the team physician: a consensus statement. Med Sci Sports Exerc 2007; 38:2030-4. [PMID: 17095938 DOI: 10.1249/mss.0b013e31802b37a6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the healthcare profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization.
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Fuller CW, Walker J. Quantifying the functional rehabilitation of injured football players. Br J Sports Med 2006; 40:151-7; discussion 151-7. [PMID: 16432003 PMCID: PMC2492043 DOI: 10.1136/bjsm.2005.021048] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine whether quantified, auditable records of functional rehabilitation can be generated using subjective assessments of players' performance in fitness tests routinely used in professional football. METHOD Ten sequential test elements grouped into three phases (fitness, ball and match skills, match pace football) were used to monitor players' functional recovery from injury. Physiotherapists subjectively assessed players' performance in each test element using a six point subjective rating scale. Satisfactory performance in each element of the assessment programme added 10% to the injured player's recovery score. Daily recovery scores for injured players were recorded against the time spent in functional rehabilitation. RESULTS Rehabilitation data for 118 injuries sustained by 55 players over two seasons were recorded. The average time in functional rehabilitation depended on the time spent in pre-functional rehabilitation and the nature and location of injury. Benchmark functional rehabilitation curves (y = mln(x) + c) were developed for thigh (n = 15) and lower leg (n = 8) muscle strains and knee (n = 7) and ankle (n = 9) ligament sprains (R(2) = 0.95-0.98). CONCLUSIONS A structured, quantified rehabilitation programme based on routine fitness and skills exercises and a graded subjective assessment of performance provides an auditable record of a player's functional recovery from a range of lower limb injuries and a transparent exit point from rehabilitation. The proposed method provides a permanent record of the functional rehabilitation of players' injuries and evidence based data to support management's return to play decisions.
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Abstract
OBJECTIVE To review evidence-based support for return to play criteria following acute exercise-induced bronchoconstriction. DATA SOURCES Electronic databases Ovid Medline and PubMed were searched for papers relating to exercise related asthma and bronchoconstriction and return to play criteria. Additional references from the bibliographies of retrieved articles were also reviewed. DATA SYNTHESIS There is clear evidence that exercise-induced airways narrowing is increasing in prevalence among athletes from school children to Olympians to professionals, yet there have been no studies specifically addressing return to play criteria. Although deaths from exercise associated bronchoconstriction were previously thought to be rare, recent reports of such deaths call for increased awareness by physicians, athletic trainers, and coaches of the potential fatal consequences of unrecognized episodes or of inadequate treatment. CONCLUSIONS No agreed-upon protocol for safe return to play following an acute episode of exercise induced bronchoconstriction has been published. A specific detailed protocol for return to play would assist physicians and other heath professionals to determine with greater confidence that an athlete is fully recovered and can safely return to play.
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Affiliation(s)
- Thomas W Allen
- University of Oklahoma College of Medicine, 1111 St. Louis Avenue, Tulsa, OK 74120, USA.
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