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Objective: Injury to the sternoclavicular joint is a rare phenomenon that has implications for the shoulder complex. Limited literature exists on optimal physical therapy rehabilitation after a sternoclavicular ligament sprain. This case report details the physical therapy management and outcomes of a patient with a posterior sternoclavicular joint sprain., Case Description: The patient was a 34-year-old female who sustained a grade I posteriorly directed sternoclavicular sprain during a motor vehicle accident. She received a combination of acromioclavicular joint mobilizations and therapeutic exercise for her shoulder complex for five sessions over six weeks., Outcomes: At discharge, the patient surpassed the minimally clinically important difference (MCID) and the minimal detectable change (MDC) in her Quick-DASH score. She surpassed the MDC and MCID in her Numerical Pain Rating Scale score. She was able to regain full functional use of her involved upper extremity and returned to her work and original exercise regimen with no further limitations., Conclusion: The outcomes suggest that a combination of acromioclavicular joint mobilizations and therapeutic exercise for the shoulder complex was a suitable option for the conservative management of this patient's grade I sternoclavicular sprain.

Purpose: Proximal interphalangeal (PIP) joint sprains are common injuries that often result in prolonged swelling, stiffness, and dysfunction; however, the duration of these sequelae is unknown. The purpose of this study was to determine the duration of time that patients experience finger swelling, stiffness, and dysfunction following a PIP joint sprain., Methods: This was a prospective, longitudinal, survey-based study. To identify patients with PIP joint sprains, the electronic medical record was queried monthly using International Classification of Disease, Tenth Revision, codes for PIP joint sprain. A five-question survey was emailed monthly for 1 year or until their response indicated resolution of swelling, whichever occurred sooner. Two cohorts were established: patients with (resolution cohort) and patients without (no-resolution cohort) self-reported resolution of swelling of the involved finger within 1 year of a PIP joint sprain injury. The measured outcomes included self-reported resolution of swelling, self-reported limitations to range of motion, limitations to activities of daily living, Visual Analog Scale (VAS) pain score, and return to normalcy., Results: Of 93 patients, 59 (63%) had complete resolution of swelling within 1 year of a PIP joint sprain. Of the patients in the resolution cohort, 42% reported return to subjective normalcy, with 47% having self-reported limitations in range of motion and 41% having limitations in activities of daily living. At the time of resolution of swelling, the average VAS pain score was 0.8 out of 10. In contrast, only 15% of patients in the no-resolution cohort reported return to subjective normalcy, with 82% having self-reported limitations in range of motion and 65% having limitations in activities of daily living. For this cohort, the average VAS pain score at 1 year was 2.6 out of 10., Conclusions: It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains., Type of Study/level of Evidence: Prognostic IV., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Abstract: Rehbein, CO, McDougle, JM, Peñailillo, L, and Earp, JE. Intramuscular hamstring stiffness affects anatomically modeled localized muscle strain during passive hip flexion. J Strength Cond Res 38(11): 1860-1866, 2024-Hamstring strain injuries occur when localized tissue strain capacity is exceeded. Localized strain may be affected by intramuscular variation in stiffness, but research in this area is lacking. The purpose of this study was to determine the effects of intramuscular hamstring stiffness on localized muscle strain during passive hip flexion. Twenty-eight (age 25.0 ± 4.9 years) healthy women ( n = 15) and men ( n = 13) had biceps femoris, semitendinosus, and semimembranosus stiffness measured proximally, medially, and distally during passive hip flexion and extension using shear-wave elastography. Anthropometric and stiffness measurements were entered into an anatomical model of equivalent springs to estimate localized tissue strain and differentiate between the relative contribution to passive strain from each muscular region. In shortened and stretched positions, stiffness was lowest proximally for all muscles (Cohen's d = 0.66-0.79, p < 0.001). In addition, relative strain contribution was greater proximally (37.5-39.4%) compared with middle (31.74-32.2%) or distal (28.6-30.3%) regions ( p < 0.001), with proximal contribution to strain increasing with greater hip flexion. Our results suggest that intramuscular variations in passive hamstring stiffness contribute to inhomogeneous strain throughout the muscle during passive hip flexion. Given the prevalence of proximal stretch-pattern strain injuries, variation in intramuscular stiffness may contribute to risk for such injuries., (Copyright © 2024 National Strength and Conditioning Association.)

We aimed to investigate whether there is clinical and MRI evidence of healing of lateral ligaments 6 weeks after acute lateral ankle sprain (LAS). We prospectively enrolled 18 participants (age 32.7 ± 7.5 years) who sustained an acute LAS and underwent conservative treatment. An ankle MRI was acquired up to 48 hours and 6 weeks following the LAS. A partial tear of the anterior talofibular ligament (ATFL) was observed in 10/18 and a complete tear in 8/18 of the patients. The calcaneofibular ligament (CFL) was partially torn in 11/18 and completely torn in 1/18 of the patients. The healing status, intensity, and thickness of the ligaments, Anterior Drawer Test (ADT), and FAOS scale were assessed. A control group (CG) was composed by 17 participants (age 40 ± 13.9 years). Six weeks after the LAS, 89% of the participants presented MRI evidence of ATFL healing. The repaired ATFL was thicker in comparison with the CG (p < .001). The cut-off of 2.5 mm for ATFL thickness in the 6th week maximized sensitivity (62.5%) and specificity (100%). CFL and PTFL presented 94% and 100% of healing signs, respectively. In the 6th week, 11/18 (61%) participants showed mild residual instability and a mean FAOS of 80 ± 11. The MRI revealed signs of the repair process in 89% of ATFL and 94% of CFL tears, 6 weeks after a moderate or severe LAS. The MRI findings were concomitant with enhancements in mechanical ankle stability and function., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Despite increased awareness of the multifactorial nature of Hamstring Strain Injury (HSI), the role of running biomechanics remains unclear. The aim of this systematic review was to investigate whether an association exists between running biomechanics and HSI. Five databases were searched from inception to January 2021. Eligibility criteria included epidemiological studies that provide data on running biomechanics in athletes who have sustained a HSI (retrospectively or prospectively) and compared to control data. Searches yielded 4,798 articles. Twelve met the selection criteria. Biomechanical analysis differed considerably across studies, thus meta-analyses was not possible. Studies largely found either no differences or contradicting findings between running biomechanics of athletes who have sustained a HSI (retrospectively or prospectively) and controls, with the exception of lateral trunk kinematics and horizontal propulsive forces. It is important to note some concern regarding the quality of included studies, particularly sample size, increasing the risk of bias associated with results. Further research utilising validated methods of biomechanical analysis, is needed to determine if an association exists between running biomechanics and HSI. Until then, definitive conclusions cannot be drawn as to whether specific biomechanical interventions should be included in injury prevention and/or rehabilitation programmes.

Hamstring strain injuries (HSIs) are prevalent in sports involving high-speed running and most of the HSIs are biceps femoris long head (BFlh) injuries. The primary cause for HSIs during high-speed running remains controversial due to the lack of in vivo measurement of the BFlh muscle behavior during running. Therefore, the purpose of this study was to quantify the muscle-tendon unit (MTU) and fascicle behavior of BFlh during running. Seven college male sprinters (22.14 ± 1.8 years; 177.7 ± 2.5 cm; 70.57 ± 5.1 kg; personal bests in 100m: 11.1 ± 0.2 s) were tested on a motorized treadmill instrumented with two force plate for running at 4, 5, 6m/s. The ground reaction force (GRF), 3D lower limb kinematics, EMG, and ultrasound images of biceps femoris long head (BFlh) in the middle region were recorded simultaneously. BFlh fascicles undergo little length change (about 1 cm) in the late swing phase during running at three submaximal speeds. BFlh fascicle lengthening accounted for about 30% of MTU length change during the late swing phase. BFlh was most active during the late swing and early stance phases, ranging from 83%MVC at a running speed of 4 m/s to 116%MVC at 6 m/s. Muscle fascicles in the middle region of BFlh undergo relatively little lengthening relative to the MTU in the late swing phase during running in comparison to results from simulation studies. These results suggest that there is a decoupling between the fascicle in the middle region and MTU length changes during the late swing phase of running., (© Journal of Sports Science and Medicine.)

This study aimed to characterize muscle activity in male soccer players with a history of hamstring strain injuries (HSI) during accelerated sprinting. Thirteen patients each in the HSI group (history of HSI) and in the healthy group (with no history of HSI) were included. 26 male soccer players of which 13 with and 13 without HSI history were included in this study. Ten muscles were evaluated on electromyography activity during overground sprinting. The testing protocol consisted of a maximal sprint over a distance of 30 meters. One running stride was divided into the early stance phase, late stance phase, early swing phase, mid-swing phase, and late swing phase, and the average muscle activity per phase and the timing of the peak root-mean-square value appearance during each stride were calculated. Statistical analysis was performed using repeated-measures two-way ANOVA (group × phase), and multiple comparison tests were performed using the Bonferroni method when the interaction or main effect was significant. The statistical significance level was set at p < 0.05. Gluteus maximus (Gmax), gluteus medius (Gmed), and external oblique (EO) showed activity differences based on HSI history. Gmax was 30% lower, EO was 20% lower, and Gmed was 40% higher in HSI group. This study suggests that, despite previous findings that HSI is most likely during the late swing phase, the HSI group shows a higher injury risk in the early stance phase. This is due to differences in trunk and gluteal muscle activity between the late swing and early stance phases compared to the healthy group. In summary, HSI group had lower activity in the muscles contributing to trunk instability, especially EO and Gmax, before and after ground impact during accelerated sprinting, compared to Healthy., (© Journal of Sports Science and Medicine.)

Introduction: Ankle braces can effectively decrease the incidence of recurrent ankle sprain; however, whether the brace can decrease the severity of sprain and its related mechanism during sprain remain unknown., Methods: Twenty-two patients with functional ankle instability (FAI) (12 males and 10 females) and 16 healthy subjects (8 males and 8 females) were enrolled in this study. All of the subjects walked on a custom-built tilting platform that offered a 30° inversion (IV) to mimic the IV of ankle sprain. We collected the kinematic and surface electromyography data of patients with FAI with or without ankle brace and normal controls 6 times., Results: The FAI without brace group showed significantly higher maximum IV angles and average IV velocities than the control group (P < .001). The FAI with brace group revealed significantly lower maximum IV angles and average IV velocities than the FAI without brace group (P < .001); this group also showed significantly higher maximum external rotation (ER) angle and average ER velocities than the FAI with brace (P < .001) and control (P < .001) groups. The FAI with brace group indicated significantly lower average EMGPrep (P = .047), EMGTilt (P = .037), and EMGafterTilt (P = .004) of the peroneus longus than the FAI without brace group., Conclusions: The ankle brace could effectively decrease IV angles and their velocities and increase ER angles and their corresponding velocities during ankle sprain in patients with FAI. It could also decrease the activity of the peroneus longus muscle during ankle sprain., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Hamstring strain injuries (HSI) are a common occurrence in athletics and complicated by high rates of reinjury. Evidence of remaining injury observed on magnetic resonance imaging (MRI) at the time of return to sport (RTS) may be associated with strength deficits and prognostic for reinjury, however, conventional imaging has failed to establish a relationship. Quantitative measure of muscle microstructure using diffusion tensor imaging (DTI) may hold potential for assessing a possible association between injury-related structural changes and clinical outcomes. The purpose of this study was to determine the association of RTS MRI-based quantitative measures, such as edema volume, muscle volume, and DTI metrics, with clinical outcomes (i.e., strength and reinjury) following HSI. Spearman's correlations and Firth logistic regressions were used to determine relationships in between-limb imaging measures and between-limb eccentric strength and reinjury status, respectively. Twenty injuries were observed, with four reinjuries. At the time of RTS, between-limb differences in eccentric hamstring strength were significantly associated with principal effective diffusivity eigenvalue λ 1 (r = -0.64, p = 0.003) and marginally associated with mean diffusivity (r = -0.46, p = 0.056). Significant relationships between other MRI-based measures of morphology and eccentric strength were not detected, as well as between any MRI-based measure and reinjury status. In conclusion, this preliminary evidence indicates DTI may track differences in hamstring muscle microstructure, not captured by conventional imaging at the whole muscle level, that relate to eccentric strength., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Select authors of this manuscript declare relationships with the following companies: Dr. Bryan Heiderscheit declares a potential conflict of interest directly related to this work (research support to institution from NBA and GE HealthCare). The other authors (CMW, SAH, MRJ, KL, RK) of this manuscript declare no direct relationships with any companies, whose products or services may be related to the subject matter of the article]., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball., Purpose: To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training., Methods: Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18-30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups., Results: There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*)., Conclusion: Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III., (© 2024. The Author(s).)

Background: Acute lateral ankle sprains (ALAS) are associated with long-term impairments and instability tied to altered neural excitability. Arthrogenic muscle inhibition (AMI) has been observed in this population; however, relationships with injury-related impairments are unclear, potentially due to the resting, prone position in which AMI is typically measured. Assessing AMI during bipedal stance may provide a better understanding of this relationship., Methods: AMI was assessed in 38 young adults (19 ALAS within 72 h of injury: 10 males, 21.4 ± 2.7 years; 19 healthy controls: 10 males, 21.9 ± 2.2 years; mean ± SD) using the Hoffmann reflex (H-reflex) during bipedal stance. Electrical stimulation was administered to identify the maximal H-reflex (H max ) and maximal motor response (M max ) from the soleus, fibularis longus, and tibialis anterior muscles. The primary outcome measure was the H max /M max ratio. Secondary outcomes included acute symptoms (pain and swelling), postural control during bipedal stance, and self-reported function., Results: No significant group-by-limb interactions were observed for any muscle. However, a significant group main effect was observed in the soleus muscle (F (1,35)  = 6.82, p = 0.013), indicating significantly lower H max /M max ratios following ALAS (0.38 ± 0.20) compared to healthy controls (0.53 ± 0.16). Furthermore, lower H max /M max ratios in the soleus significantly correlated with acute symptoms and self-reported function but not with postural control., Conclusion: This study supports previous evidence of AMI in patients with ALAS, providing insight into neurophysiologic impacts of musculoskeletal injury. Our results suggest that assessing AMI in a standing position following acute injury may provide valuable insight into how AMI develops and guide potential therapeutic options to curb and offset the formation of joint instability., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Background: Lateral ankle sprains are a common musculoskeletal injury. Ankle braces are frequently used to prevent ankle injuries., Aim: The purpose of this study was to examine the anterior translation of the talocrural joint of 2 ankle braces relative to a control., Methods: Ankle mobility was assessed with the Mobil-Aider arthrometer in 3 conditions: TayCo ankle brace, Aircast ankle brace, and control. Three measures were recorded for each condition., Results: Thirty participants (9 male and 21 female patients) participated. Friedman's analysis of variance found significant between-group differences for the trial with the largest translation. Wilcoxon signed-ranks post hoc testing found significant between-group differences between the control and TayCo (P < .001) and the control and Aircast conditions (P < .001). Post hoc power analysis revealed a Kendall's W of 0.804., Clinical Application: The TayCo brace is unique in that it is worn on the outside of the athletic shoe, whereas the Aircast is composed of lateral constraints worn inside the shoe. Both braces provided significant constraint over anterior talus translation when compared to control. The TayCo brace (51%-52% of control) was also significantly better than the Aircast (58%-59% of control) with less anterior translation permitted. This may be instrumental in preventing ankle injuries., Level of Evidence: 2b., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DTG acknowledges owning the intellectual property of the Mobil-Aider device.

Although platelet-rich plasma (PRP) has been widely used regardless of the severity of muscle strain, there have been very few basic studies in which its effects on muscle injury were examined by using models that accurately mimic the clinical muscle strain injury process. Therefore, the aim of this study was to confirm by physiological and structural analyses whether PRP purified by a general preparation method has a muscle healing effect on muscle damage caused by eccentric contraction (ECC). Male Wistar rats were subjected to muscle injury induced by ECC in bilateral plantar flexor muscles using electrical stimulation and an automatically dorsiflexing footplate. The rats were randomly assigned to three groups by type of injection: phosphate-buffered saline (PBS), leukocyte-poor PRP (LP-PRP), or leukocyte-rich PRP (LR-PRP) injection into gastrocnemius muscles three times at weekly intervals. The platelet concentrations of the LP-PRP and LR-PRP were three to five times higher than that of whole blood. The recovery process of torque strength in the plantar flexor muscle, signal changes in MRI images, and histological evaluation 3 weeks after injury showed no obvious differences among the three groups, and every muscle recovered well from the injury without marked fibrosis. The results that neither LP-PRP nor LR-PRP was found to accelerate healing of muscle injuries suggested that conventional preparation and use of PRP for simple muscle injuries caused by muscle strain should be carefully considered, and further basic research using models that accurately mimic clinical practice should be carried out to determine the optimal use of PRP., (© 2024 Orthopaedic Research Society.)

Background: Lateral ankle sprains are a common musculoskeletal injury across a variety of activities. Researchers have sought to identify a method to objectively assess joint laxity with a device that is simple to use and affordable., Aim: The purpose of this study was to assess the use of an ankle arthrometer on individuals with ankle sprains., Methods: The participant was evaluated by the physician and the degree of ankle sprain was identified. In the prone position, the arthrometer was used to perform an anterior drawer test (uninjured before injured, 3 measures each). Both clinicians were blinded to the data of the other., Results: There were 30 participants, 10 in each group (uninjured, grade 1 sprain, grade 2 sprain). Mann-Whitney U testing found significant differences between the control and grade I ankle sprain groups (P < .001), the control and grade II ankle sprain groups (P < .001), and the grade I and grade II ankle sprain groups (P = .004). There was ±0.31-mm difference in anterior translation between healthy ankles, whereas there was 1.11- and 2.16-mm difference between ankles in grade 1 and grade 2 sprains, respectively., Clinical Application: Despite the manual anterior drawer test being convenient, the subjectivity makes it unreliable. This study is consistent with prior literature about the difference in translation (millimeters) between the uninjured and injured ankles corresponding to the magnitude of ankle laxity. This study also contributes to the evolving evidence to support the relationship of a ratio of measures (injured/uninjured) as an objective measure of laxity. These comparisons to the individual's healthy ankle mitigate the variability of the normative values. The use of an arthrometer to assess ankle joint laxity enhances the objectivity of patient assessment throughout the recovery process., Levels of Evidence: Level III., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Dawn T. Gulick declares she holds the patent for the Mobil-Aider device.

Background: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains., Methods: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in millimeters were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, and in right and left feet., Results: The study determined that the two-point discrimination threshold values measured at the first toe tip, heel, third plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems., Conclusions: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains.

Background: Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries., Purpose: To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses., Study Design: Cohort study (diagnosis); Level of evidence, 3., Methods: Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T -scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively., Results: The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively ( P = .27)., Conclusion: The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Objective: To evaluate the rabbit modle of frozen shoulder induced by persistent strain injuries and ice compression., Methods: Twelve clean, healthy male New Zealand rabbits with a mass of (2 500±500) g were selected and randomly divided into a blank group and a control group with 6 rabbits in each group. In the control group, the rabbits were modeled with persistent strain injuries and ice compression, the general conditions of the rabbits and the active and passive activities of the shoulder joint were observed and their body weights were recorded. MRI was performed on the affected shoulder joints at 6 d and 29 d after modelling to observe the fluid and soft tissue;HE staining was used to observe the morphology of the rabbit biceps longus tendon and the synovial membrane of the joint capsule;Masson staining was used to observe the fibrous deposits of the rabbit biceps longus tendon and the synovial membrane of the joint capsule, and the fibrous deposits were analysed semi-quantitatively by Image J software., Results: Six days after the end of modeling, the active movement of the shoulder joints in the control group was limited, the passive movement was not significantly limited, and they walked with a limp;29 days after the end of the modeling, the active and passive movements of the shoulder joints in the model group were severely limited. Compared with the blank group (2.50±0.14) kg, the body weight of the model group (2.20±0.17) kg was significantly reduced( P <0.01). MRI showed that 6 days after modelling, the muscles around the shoulder joint were not smooth in shape, the joint capsule structure was narrowed and a large amount of fluid was seen in the joint cavity;29 days after modelling, the muscles around the shoulder joint were rough in shape, structure of the joint capsule was unclear and the fluid in the joint cavity was reduced compared with 6 days after modelling. Pathological staining showed that the long-headed biceps tendon fibres in the control group were disorganised, curled or even broken, and the synovial tissue of the joint capsule was heavily vascularised, with collagen fibre deposits and severe inflammatory cell infiltration. The fiber deposition of the long head of biceps brachii in the model group [(23.58±3.41)%, (27.56±3.70)%] and synovial tissue [(41.78±5.59)%, (62.19±7.54)%] were significantly higher than those in the blank group [(1.79±1.03) %, (1.29±0.63) %] at 7 and 30 days after modeling and synovial tissue fiber deposition [(8.15±3.61) %, (11.29±7.10) %], as shown by the semi-quantitative analysis of Masson staining results by Image J software. And the longer the time, the more severe the fibrosis ( P <0.01)., Conclusion: The behavioral, imaging and pathological findings showed that the rabbit frozen shoulder model with persistent strain injuries and ice compression is consistent with the clinical manifestations and pathogenesis of periarthritis, making it an ideal method for periarthritis research.

Introduction: Previous studies have suggested that a reduced length of the biceps femoris long head (BF lh ) fascicles may increase the risk of hamstring strain injury (HSI). However, it remains unclear whether the BF lh fascicles of the injured limb are shorter than those of the contralateral limb in athletes with an acute HSI., Objective: To investigate the between-limb asymmetry of BF lh fascicle length in amateur athletes with an acute HSI., Methods: Male amateur athletes were evaluated using ultrasound scans within five days following an HSI. The BF lh fascicle length was estimated using a validated equation., Results: Eighteen injured athletes participated in this study. There was no significant difference (p = 0.27) in the length of BF lh fascicles between the injured limb (9.53 ± 2.55 cm; 95%CI 8.26 to 10.80 cm) and the uninjured limb (10.54 ± 2.87 cm; 95%CI 9.11 to 11.97 cm). Individual analysis revealed high heterogeneity, with between-limb asymmetries (percentage difference of the injured limb compared to the uninjured limb) ranging from -42% to 25%. Nine out of the 18 athletes had a fascicle length that was more than 10% shorter in the injured limb compared to the uninjured limb, five athletes had a difference of less than 10%, and four athletes had a fascicle length that was more than 10% longer in the injured limb compared to the uninjured limb., Conclusion: The architecture characteristics of injured and uninjured muscles is not consistent among athletes with HSI. Therefore, rehabilitation programs focused on fascicle lengthening should be evaluated on a case-by-case basis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration., (© 2023. The Author(s).)

Purpose : Acute ankle sprain may affect ankle function during sport and daily activities. This study aimed to use vector coding technique to analyze the difference over time between injured and healthy lower limb during the first week of acute ankle sprain phase (P1) and post a 1-month recovery phase (P2) to understand the return-to-play coordination strategy in the lower extremity. Methods : Six females attended the gait experiments with attached 40 reflective markers using eight-camera Vicon motion capture system. All participants walked barefoot while turning in four directions (T0°, T45°, T90°, T135°) at their self-selected speed. Coordination patterns were classified as in-phase, anti-phase, proximal or distal dominancy between lower limb joints involving hip, knee, ankle, subtalar, metatarsophalangeal (MTP) joint and tarsometatarsal (TMT) joint. Results : P1 showed more proximal joint dominant in Hip-Knee coupling angles but P2 displayed more distal joint dominant in Knee-Ankle joint coordination pattern and mainly distal joint dominant in Ankle-MTP coupling angle mapping. The Ankle-TMT1 and Ankle-TMT5 coordination patterns matched best in straight walking but worst in T135 walking. Conclusions : Investigating inter-segmental coordination in different turning movements could provide insights into gait changes from acute ankle sprain from one-month return-to-play recovery. Knowledge of lower limb coordination pattern may provide clinical implications to improve dynamic balance and gait stability for individuals with acute ankle sprain., (© 2023 Xiaoyi Yang et al., published by Sciendo.)

Background and Objective: Ankle sprains, very common injuries occurred especially during sports activities, are mainly caused by indirect trauma, which influences exaggerated stress exceeding the strength of stabilization mechanisms. Up to 85% of such injuries result from a sudden flexion and inversion of the foot. In this study, we analyzed the effectiveness of the platform Pro-kin, an innovative system that has given us the possibility to combine the functionality of the older proprioceptive boards with very accurate software in order to improve and accelerate the recovery after ankle injuries., Methods: 30 patients with moderate ankle sprain outcomes in two groups (A and B) were included in this study. Group A was only treated with proprioceptive exercises for 3 weeks, while the group B was trained with the innovative Pro-kin. In both groups, we evaluated VAS scale, the ratio between the number of circumductions performed by the injured foot and the time spent on doing them and the percentage of load among the injured and the healthy foot in statics and dynamics with electronic baropodometry. Our data has been collected at t0 (beginning of study), t1 (one week later), t2 (two weeks later), t3 (one month later), t4 (two months later), and then analyzed by the two-way analysis of variance (2-way ANOVA) test., Results: At t0 no statistical differences of pain in the 2 groups (3.3 and 3.4); the values were similar, as well as at time t1, t2, t3 and t4. Therefore we deduce that Pro-kin treatment is not painful. The number of circumductions performed was definitely better in B group since the first week; for the A group the values considerably increased only at t3 (one month later). Comparing the load percentages on two feet detected by the electronic baropodometer in statics and in dynamics, we deduced that the patients of A group tend to lean mostly on the healthy foot than B group., Conclusion: This study demonstrates that new technological resources (such as Pro-kin) may be helpful to improve and speed up the recovery of ankle sprain in athletes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: In a closed claims study, most patients experiencing cervical spinal cord injury had stable cervical spines. This raises two questions. First, in the presence of an intact (stable) cervical spine, are there tracheal intubation conditions in which cervical intervertebral motions exceed physiologically normal maximum values? Second, with an intact spine, are there tracheal intubation conditions in which potentially injurious cervical cord strains can occur?, Methods: This study utilized a computational model of the cervical spine and cord to predict intervertebral motions (rotation, translation) and cord strains (stretch, compression). Routine (Macintosh) intubation force conditions were defined by a specific application location (mid-C3 vertebral body), magnitude (48.8 N), and direction (70 degrees). A total of 48 intubation conditions were modeled: all combinations of 4 force locations (cephalad and caudad of routine), 4 magnitudes (50 to 200% of routine), and 3 directions (50, 70, and 90 degrees). Modeled maximum intervertebral motions were compared to motions reported in previous clinical studies of the range of voluntary cervical motion. Modeled peak cord strains were compared to potential strain injury thresholds., Results: Modeled maximum intervertebral motions occurred with maximum force magnitude (97.6 N) and did not differ from physiologically normal maximum motion values. Peak tensile cord strains (stretch) did not exceed the potential injury threshold (0.14) in any of the 48 force conditions. Peak compressive strains exceeded the potential injury threshold (-0.20) in 3 of 48 conditions, all with maximum force magnitude applied in a nonroutine location., Conclusions: With an intact cervical spine, even with application of twice the routine value of force magnitude, intervertebral motions during intubation did not exceed physiologically normal maximum values. However, under nonroutine high-force conditions, compressive strains exceeded potentially injurious values. In patients whose cords have less than normal tolerance to acute strain, compressive strains occurring with routine intubation forces may reach potentially injurious values., (Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.)

Limited information is available on site-specific features of muscle stiffness and aponeurosis strain of the biceps femoris long head (BFlh) during contractions. Therefore, understanding of the mechanics and etiology of hamstring strain injuries remains difficult. As a first step to gain further insight into them, the present study aimed to identify whether active muscle stiffness and proximal aponeurosis strain during contractions are varied along the long axis of the BFlh. The BFlh muscle shear wave speed (proxy for stiffness) was measured in the proximal, central, and distal sites during 20%, 50%, and 80% of maximal voluntary isometric contraction (MVC) of knee flexion exerted with the hip and knee joints flexed at 40° and 30°, respectively, using ultrasound shear wave elastography. Further, a segmental strain of the BFlh proximal aponeurosis was assessed in the proximal, central, and distal sites during isometric knee flexion, using B-mode ultrasonography. The shear wave speed was significantly higher in the distal site than the proximal and central sites at 20% MVC (p ≤ .002, with a large effect size), whereas no significant difference was found between the three sites at 50% and 80% MVC. The BFlh proximal aponeurosis strain showed no significant difference between the proximal, central, and distal sites at any contraction intensity. These findings indicate that site-specific differences in muscle stiffness and proximal aponeurosis strain are substantially small and that muscle stiffness and proximal aponeurosis strain of the BFlh at moderate-to-high contraction intensity is not exceptional in the site where a sprinting-type hamstring strain typically occurs., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We tested the hypothesis that the magnitude of changes in indirect muscle damage markers would be greater after maximal elbow flexor eccentric exercise in the supinated (shorter biceps brachii) than neutral wrist (longer) position, and the difference in the magnitude would be associated with greater elongation over contractions for the supinated than neutral position, rather than the initial muscle length. Ten untrained men (21-39 years) performed two bouts of 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors in the supinated position for one arm and neutral position for the other arm separated by 2 weeks in a randomized order. Biceps brachii myotendinous junction (MTJ) movements during eccentric contractions were recorded by B-mode ultrasonography, and the displacement from the start to end of each contraction was quantified. Peak torque (supinated: 367.8 ± 112.5 Nm, neutral: 381.5 ± 120.4 Nm) and total work (1816 ± 539 J, 1865 ± 673 J) produced during eccentric contractions were similar between conditions. The average MTJ displacement increased (P < .05) from the 1st set (8.0 ± 2.0 mm) to 10th set (15.8 ± 1.9 mm) for the supinated condition, but no such increase was found in the neutral condition (1st set: 5.1 ± 1.0 mm, 10th set: 5.0 ± 0.8 mm). Changes in indirect muscle damage markers (maximal voluntary isometric contraction torque, range of motion, serum creatine kinase activity, and muscle soreness) after exercise were greater (P < .05) for the supinated than neutral condition. These results suggest that the greater muscle damage marker changes for the supinated than neutral wrist position was associated with the greater muscle lengthening (strain)., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: This study aimed 1) to determine whether talar cartilage deformation measured via ultrasonography (US) after standing and hopping loading protocols differs between chronic ankle instability (CAI) patients and healthy controls and 2) to determine whether the US measurement of cartilage deformation reflects viscoelasticity between standing and hopping protocols., Methods: A total of 30 CAI and 30 controls participated. After a 60-min off-loading period, US images of the talar cartilage were acquired before and after static (2-min single-leg standing) and dynamic (60 single-leg forward hops) loading conditions. We calculated cartilage deformation by assessing the change in average thickness (mm) for overall, medial, and lateral talar cartilage. The independent variables include time (Pre60 and postloading), condition (standing and dynamic loading), and group (CAI and control). A three-way mixed-model repeated-measures ANCOVA and appropriate post hoc tests were used to compare cartilage deformation between the groups after static and dynamic loading., Results: After the static loading condition, those with CAI had greater talar cartilage deformation compared with healthy individuals for overall (-10.87% vs -6.84%, P = 0.032) and medial (-12.98% vs -5.80%, P = 0.006) talar cartilage. Similarly, the CAI group had greater deformation relative to the control group for overall (-8.59% vs -3.46%, P = 0.038) and medial (-8.51% vs -3.31%, P = 0.043) talar cartilage after the dynamic loading condition. In the combined cohort, cartilage deformation was greater after static loading compared with dynamic in overall (-8.85% vs -6.03%, P = 0.003), medial (-9.38% vs -5.91%, P = 0.043), and lateral (-7.90% vs -5.65%, P = 0.009) cartilage., Conclusion: US is capable of detecting differences in cartilage deformation between those with CAI and uninjured controls after standardized physiologic loads. Across both groups, our results demonstrate that static loading results in greater cartilage deformation compared with dynamic loading., (Copyright © 2021 by the American College of Sports Medicine.)

Background: The role of the measurements of postural stability in the context of screening for ankle sprain risk is still equivocal. Transient characteristics of body sway have been suggested as an alternative or an improvement to traditional whole-trial analyses., Research Question: Are transient characteristics of body sway sensitive to the history of ankle sprain?., Methods: The assessment of 30-s single-leg body sway was performed on a group of 93 athletes from basketball, soccer, tennis and running who reported at least 1 ankle sprain in the last 12 months, while a group of 244 athletes from the same disciplines served as a control group without an ankle sprain reported for the same time period. We considered the mean center-of-pressure (CoP) velocity, CoP amplitude and CoP frequency. In addition to traditional whole-trial variables, we calculated the relative differences between the 1 st and the 2nd (DIF&#95;21) and 1 st and 3rd (DIF&#95;31) 10-s time intervals within the whole trial., Results: The indexes of transient characteristics of body sway (i.e., the DIF&#95;21 and DIF&#95;31) were in trivial or weak correlations with whole-trial variables (all r ≤ 0.29). Athletes with ankle sprain history exhibited smaller CoP ML velocity (p = 0.002) and larger CoP ML frequency (p = 0.001). In the injured group, the injured leg exhibited lower total and medial-lateral (ML) CoP velocity (p = 0.005-0.040), as well as lower CoP ML amplitude (p = 0.002) and higher CoP ML frequency (p = 0.010). The transient characteristics of body sway (DIF&#95;21 and DIF&#95;31) were very similar between the groups and between the injured and uninjured legs., Significance: Transient characteristics of body sway do not appear to differentiate the athletes with and without a history of ankle sprain. Further research is needed to confirm if the transient characteristics of body sway could be used for detection of risk of falls in older adults or assessment of athletic performance., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: High-speed running is commonly implicated in the genesis of hamstring injury. The success of hamstring injury management is typically quantified by the duration of time loss or reinjury rate. These metrics do not consider any loss in performance after returning to play from hamstring injury. It is not known to what extent high-speed running is altered on return to play after such injury., Hypothesis: Match high-speed running distance will change after returning from hamstring injury., Study Design: Non-randomized cohort., Level of Evidence: Level 3., Methods: Match high-speed running distance in highest level professional football (soccer, Rugby League, Rugby Union, and Australian Rules) were examined for a minimum of 5 games prior and subsequent to hamstring strain injury for individual differences using a linear regression models approach. A total of 22 injuries in 15 players were available for analysis., Results: Preinjury cumulative high-speed running distances were strongly correlated for each individual ( r 2 = 0.92-1.0; P < 0.0001). Pre- and postinjury high-speed running data were available for a median of 15 matches (range, 6-15). Variance from the preinjury high-speed running distance was significantly less ( P = 0.0005) than the post injury values suggesting a suppression of high-speed running distance after returning from injury. On return to play, 7 of the 15 players showed a sustained absolute reduction in preinjury high-speed running distance, 7 showed no change, and 1 player (only) showed an increase. Analysis of subsequent (second and third injury) return to play showed no differences to return from the index injury., Conclusion: Return to play was not associated with return to high-speed running performance for nearly half of the players examined, although the same number showed no difference. Persisting deficits in match high-speed running may exist for many players after hamstring strain injury., Clinical Relevance: Returning to play does not mean returning to (high-speed running) performance for nearly half of the high-level professional football players examined in this study. This suggests that successful return to play metrics should be expanded from simple time taken and recurrence to include performance.

This review aimed to investigate characteristics of muscle activation and ground reaction force (GRF) patterns in patients with ankle instability (AI). Relevant studies were sourced from PubMed, CINAHL, SPORTDiscus, and Web of Science through December 2019 for case-control study in any laboratory setting. Inclusion criteria for study selection were (1) subjects with chronic, functional, or mechanical instability or recurrent ankle sprains; (2) primary outcomes consisted of muscle activation of the lower extremity and GRF during landing; and (3) peer-reviewed articles with full text available, including mean, standard deviation, and sample size, to enable data reanalysis. We evaluated four variables related to landing task: (1) muscle activation of the lower extremity before landing, (2) muscle activation of the lower extremity during landing, (3) magnitude of GRF, and (4) time to peak GRF. The effect size using standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for these variables to make comparisons across studies. Patients with AI had a lower activation of peroneal muscles before landing (SMD = -0.63, p < 0.001, CI = -0.95 to -0.31), greater peak vertical GRF (SMD = 0.21, p = 0.03, CI = 0.01 to 0.40), and shorter time to peak vertical GRF (SMD = -0.51, p < 0.001, CI = -0.72 to -0.29) than those of normal subjects during landing. There was no significant difference in other muscle activation and GRF components between the patients with AI and normal subjects ( p > 0.05). Altered muscle activation and GRF before and during landing in AI cases may contribute to both recurrent ankle and ACL injuries and degenerative change of articular., (© Journal of Sports Science and Medicine.)

Context: Approximately 72% of patients with an ankle sprain report residual symptoms 6 to 18 months later. Although 44% of patients return to activity in less than 24 hours after experiencing a sprain, residual symptoms should be evaluated in the long term to determine if deficits exist. These residual symptoms may be due to the quality of ligament tissue and motion after injury., Objective: To compare mechanical laxity of the talocrural joint and dorsiflexion range of motion (DFROM) over time (24 to 72 hours, 2 to 4 weeks, and 6 months) after an acute lateral ankle sprain (LAS)., Design: Cross-sectional study., Setting: Athletic training research laboratory., Patients or Other Participants: A total of 108 volunteers were recruited. Fifty-five participants had an acute LAS and 53 participants were control individuals without a history of LAS., Main Outcome Measure(s): Mechanical laxity (talofibular interval and anterior talofibular ligament length) was measured in inversion (INV) and via the anterior drawer test. The weight-bearing lunge test was conducted and DFROM was measured. The data were analyzed using repeated-measures analysis of variance, independent-samples t tests, and 1-way analysis of variance., Results: Of the 55 LASs, 21 (38%) were grade I, 27 (49%) were grade II, and 7 (13%) were grade III. Increases were noted in DFROM over time, between 24 and 72 hours, at 2 to 4 weeks, and at 6 months (P < .05). The DFROM was less in participants with grade III than grade I LASs (P = .004) at 24 to 72 hours; INV length was greater at 24 to 72 hours than at 2 to 4 weeks (P = .023) and at 6 months (P = .035) than at 24 to 72 hours. The anterior drawer length (P = .001) and INV talofibular interval (P = .004) were greater in the LAS group than in the control group at 6 months., Conclusions: Differences in range of motion and laxity were evident among grades at various time points and may indicate different clinical responses after an LAS., (© by the National Athletic Trainers' Association, Inc.)

Objectives: The purpose of this study was to identify prospectively the anatomical and functional intrinsic risk factors for lateral ankle sprain (LAS) in adolescent athletes participating in team sports., Design: A prospective cohort study., Setting: University research laboratory., Participants: A total of 152 adolescent male athletes (age: 14.45 ± 2.96 years; height: 165.63 ± 15.33 cm; weight: 55.60 ± 16.56 kg; body mass index: 19.97 ± 3.58 kg/m 2 ) participated in this study., Main Outcome Measures: The participants were assessed during the preseason for previous ankle sprain history, navicular drop, tibia vara, Q angle, tibia torsion, knee recurvatum, and ankle ROM. LASs were prospectively recorded and diagnosed for two consecutive seasons (20 months)., Results: Previous ankle sprain history (odds ratio [OR] = 60.911, p < 0.001), increased navicular drop (OR = 1.767, p < 0.001), and knee recurvatum (OR = 1.881, p = 0.002) were positively associated with the incidence of LAS. The receiver operating characteristic (ROC) analyses revealed the predictive potentials of previous ankle sprain history (the area under the ROC [AUROC] = 0.706, p < 0.001), navicular drop (AUROC = 0.906, p < 0.001), and knee recurvatum (AUROC = 0.724, p < 0.001)., Conclusion: Athletes with previous ankle sprain history, knee recurvatum, and especially navicular drop may have a greater risk of LAS injury. The data from this study can help therapists and trainers to identify people with a higher risk of LAS., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To determine the effect of mobilization with movement (MWM) on pain, ankle mobility and function in patients with acute and sub-acute grade I and II inversion ankle sprain., Study Design: Randomized placebo controlled trial., Setting: A general hospital., Subjects: 32 adults with inversion ankle sprain., Main Outcome Measures: The primary outcome was pain intensity on an 11 point Numeric Rating Scale (NRS) with higher score indicating greater pain intensity. Ankle disability identified by the Foot and Ankle Disability index (FADI) with higher score indicating lower disability, functional ankle dorsiflexion range, pressure pain threshold, and dynamic balance measured with the Y balance test were secondary outcomes., Results: Thirty participants completed the study. At each follow-up point, significant differences were found between groups favouring those receiving MWM for all variables. Pain intensity showed a mean difference of 1.7 points (95% confidence interval, 1.4 to 2.1) and 0.9 points (95% confidence interval, 0.5 to 1.3) at one and six-months follow-up respectively. Benefits were also shown for FADI, ankle mobility, pressure pain threshold and balance., Conclusion: This study provides preliminary data for the benefits of MWM for acute and sub-acute ankle sprain in terms of pain, ankle mobility, disability and balance., Competing Interests: Declaration of competing interest Toby Hall and Kiran Satpute are accredited Mulligan concept teachers. Kiran Satpute is a member of Mulligan Concept Teachers Association and gains a teaching fee when running Mulligan Concept courses., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Recently, coupled musculoskeletal-finite element modelling approaches have emerged as a way to investigate femoral neck loading during various daily activities. Combining personalised gait data with finite element models will not only allow us to study changes in motion/movement, but also their effects on critical internal structures, such as the femur. However, previous studies have been hampered by the small sample size and the lack of fully personalised data in order to construct the coupled model. Therefore, the aim of this study was to build a pipeline for a fully personalised multiscale (body-organ level) model to investigate the strain levels at the femoral neck during a normal gait cycle. Five postmenopausal women were included in this study. The CT and MRI scans of the lower limb, and gait data were collected for all participants. Muscle forces derived from the body level musculoskeletal models were used as boundary constraints on the finite element femur models. Principal strains were estimated at the femoral neck region during a full gait cycle. Considerable variation was found in the predicted peak strain among individuals with mean peak first principal strain of 0.24% ± 0.11% and mean third principal strain of -0.29% ± 0.24%. For four individuals, two overall peaks of the maximum strains were found to occur when both feet were in contact with the floor, while one individual had one peak at the toe-off phase. Both the joint contact forces and the muscular forces were found to substantially influence the loading at the femoral neck. A higher correlation was found between the predicted peak strains and the gluteus medius (R2 ranged between 0.95 and 0.99) than the hip joint contact forces (R2 ranged between 0.63 and 0.96). Therefore, the current findings suggest that personal variations are substantial, and hence it is important to consider multiple subjects before deriving general conclusions for a target population., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Hamstring injuries in athletes can lead to significant time away from competition as a result of persistent posterior thigh pain. These cases are often difficult to treat as the state of the tissues alone cannot explain symptoms. In non-athletic populations with persistent pain, disruptions to tactile, proprioceptive, and spatial cortical representations exist, which has led to promising brain-based treatments. Here, we explored whether athletes with persistent posterior thigh pain also display impairments in these cortical representations., Design: Cross-sectional study., Methods: Fourteen male professional athletes with persistent posterior thigh pain ('Patients') and 14 pain-free age, sport, body mass index and level-matched controls ('Controls') participated. The tactile cortical representation was assessed using two-point discrimination (TPD) threshold and accuracy of tactile localisation; the proprioceptive cortical representation was assessed using a left/right judgement task; spatial processing was assessed using an auditory detection task., Results: TPD thresholds were similar for Patients and Controls (p=0.70). Patients were less accurate at localising tactile stimuli delivered to their affected leg, slower to make left/right judgements when the lower limb image corresponded to the side of their affected leg, and less accurate at detecting auditory stimuli delivered near their affected leg, when compared to their healthy leg or to the leg of Controls (p<0.01 for all)., Conclusions: Leg-specific tactile, proprioceptive, and spatial processing deficits exist in athletes with persistent posterior thigh pain. That these processing deficits exist despite rehabilitation and normal tissue healing time suggests they may play a role in the persistence of posterior thigh pain., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment-based rehabilitation on gait biomechanics and patient-reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty-seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment-based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three-dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:-7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:-5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM-ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment-based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To study postural control and muscle activity during the limit of stability test (LOS) in subjects with chronic ankle instability., Design: Observational study., Setting: University laboratory., Participants: 10 healthy subjects were included in the control group and 10 subjects in the CAI group (age between 18 and 30 years, with history of the multiple ankle "giving way" episodes in the last six months and score ≤24 in the Cumberland Ankle Instability Tool)., Main Outcome Measures: A computerized dynamic posturography equipment was used for assessing the LOS. The electromyography activity of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG) and peroneus longus (PL) was registered., Results: Subjects with CAI had a greater activation in TA to forward (p < .01), forward affected (p = .001), backward affected (p = .007) and backward directions (p < .01); in PL to forward affected (p < .01) and affected directions (p = .001); in MG to forward (p = .023) and affected directions (p < .01) and in SOL to the affected direction (p = .009). We observed restricted excursions and less directional control in subjects with CAI., Conclusions: Subjects with CAI exhibited poorer ability to move their center of gravity within stability limits. In addition, they have an altered ankle muscle activity during LOS test toward the affected ankle joint., Competing Interests: Declaration of competing interest We affirm that we have no financial affiliation or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. Any other conflict of interest is also disclosed in an attachment., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Preventing lateral ankle sprain injuries (LAS) in females competing in court sports is a high priority, as an athlete's risk for re-injury and developing long term dysfunction increases significantly after sustaining an acute LAS. Stability to the ankle joint is passively provided by the joint congruity and ligaments, and actively by the muscles acting on the foot. The ankle joint is most stable when loaded and dorsiflexed. However, during unanticipated changes of direction, typical in court sports, the foot is often in a vulnerable unloaded, plantarflexed position. Stability of the forefoot and controlling rearfoot movement to avoid excessive ankle inversion and adduction thus becomes imperative. Information regarding the coupling relationship between the forefoot (hallux and metatarsal segments) and the rearfoot (calcaneus segment) during unanticipated changes of direction is lacking. The aim of this study was to supplement current LAS prophylactic knowledge by describing and quantifying hallux-calcaneus and metatarsal-calcaneus coupling. The coupling angles between sagittal plane hallux, tri-planar metatarsal and frontal- and transverse plane calcaneus movement, respectively, were calculated with a modified vector coding technique which used segmental velocities in a local, anatomical reference frame instead of segmental angles in a global reference frame. Coupling relationships revealed anti-phase movement between sagittal- metatarsal and frontal plane calcaneus movement throughout stance. During loading, sagittal- and frontal plane metatarsal acceleration/deceleration were coupled with frontal-transverse plane calcaneus acceleration/deceleration respectively. The remainder of the braking phase was characterized by calcaneus eversion deceleration. During propulsion, the hallux and metatarsal segments increased plantar flexion velocity in response to calcaneus inversion and adduction acceleration. As the forefoot was the only point of contact during stance, the coupling between segments were most likely neuromuscular. Strengthening intrinsic and extrinsic foot muscles may thus contribute to foot and ankle stability, adding to current prophylactic LAS strategies., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. Open anatomic reconstruction is an effective method of stabilization. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. An anatomic approach provides full range of motion, stability, and return to sport and activity. Allograft or suture tape augmentation can be useful for patients with generalized ligamentous laxity, patients with high body mass index, and elite athletes. Allograft reconstruction may be especially useful in revision procedures. Arthroscopic approach to lateral ankle ligament stabilization may provide good outcomes, with long-term data still limited., Competing Interests: Disclosure Dr E. Ferkel discloses that he is a consultant and instructor for Arthrex and Ferring Pharmaceuticals. Dr S. Nguyen and C. Kwong have nothing to disclose. Southern California Orthopedic Institute Sports Medicine and Arthroscopy Fellowship receives institutional support from Depuy Mitek and Smith & Nephew., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Unexplained pain in the medial proximal tibia frequently leads to revision after unicondylar knee arthroplasty (UKA). As one of the most important factors for osteogenic adaptive response, increased bone strain following UKA has been suggested as a possible cause., Questions/purposes: In this study we: (1) performed a cadaver-based kinematic analysis on paired cadaveric specimens before and after mobile-bearing and fixed-bearing UKA; and (2) simultaneously characterized the strain distribution in the anterior and posterior proximal tibia during squatting., Methods: Five pairs of fresh, frozen full-leg cadaver specimens (four male, one female, 64 years to 87 years) were subjected to a dynamic squatting motion on a kinematic rig to simulate joint loading for a large ROM. Forces were applied to the quadriceps and hamstrings during the simulation while an infrared camera system tracked the location of reflective markers attached to the tibia and femur. Tibial cortical bone strain was measured with stacked strain gauge rosettes attached at predefined anterior and posterior positions on the medial cortex. Pairwise implantation of mobile-bearing (UKAMB) and fixed-bearing implants (UKAFB) allowed a direct comparison of right and left knees from the same donor through a linear mixed model., Results: UKAMB more closely replicated native kinematics in terms of tibial rotation and in AP and mediolateral translation. Maximum principal bone strain values were consistently increased compared with native (anteromedial, mean [± SD] peak strain: 311 µε ± 190 and posterior, mean peak strain: 321 µε ± 147) with both designs in the anteromedial (UKAFB, mean peak strain: 551 µε ± 381, Cohen's d effect size 1.3 and UKAMB, mean peak strain: 596 µε ± 564, Cohen's d effect size 1.5) and posterior (UKAFB, mean peak strain: 505 µε ± 511, Cohen's d effect size 1.3 and UKAMB, mean peak strain: 633 µε ± 424, Cohen's d effect size 2.1) region. However, in the anterolateral region of the medial tibial bone, UKAFB demonstrated the overall largest increase in strain (mean peak strain: 1010 µε ± 787, Cohen's d effect size 1.9), while UKAMB (613 µε ± 395, Cohen's d effect size 0.2) closely replicated values of the native knee (563 µε ± 234)., Conclusion: In this in vitro cadaver study both UKAMB and UKAFB led to an increase in bone strain in comparison with the native knee. However, in the anterolateral region of the medial tibial plateau, proximal tibial bone strain was lower after UKAMB and UKAFB. Both UKAMB and UKAFB lead to comparable increases in anteromedial and posterior tibial strain in comparison with the native knee. In the anterolateral region of the medial tibial plateau UKA, proximal tibial bone strain was closer to the native knee after UKAMB than after UKAFB. In an attempt to link kinematics and strain behavior of these designs there seemed to be no obvious relation., Clinical Relevance: Further clinical research may be able to discern whether the observed differences in cortical strain after UKA is associated with unexplained pain in patients and whether the observed differences in cortical bone strain between mobile-bearing and fixed unicondylar designs results in a further difference in unexplained pain.

Objective: To systematically review risk factors for hamstring strain injury (HSI)., Design: Systematic review update., Data Sources: Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches., Eligibility Criteria for Selecting Studies: Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI., Method: Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI., Results: The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury., Summary/conclusion: Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: There is a lack of definitive evidence supporting deficits in voluntary activation in participants with prior hamstring injury; moreover, it remains unknown if spinal mechanisms contribute to suspected deficits., Purpose: This study aimed to determine the effect of prior hamstring strain injury on knee flexor concentric and eccentric strength, voluntary activation, surface electromyographic (sEMG) activity, and stretch and tendon reflex amplitudes., Methods: Twenty-five participants were recruited, 12 with a history of unilateral hamstring strain injury of at least moderate severity. Voluntary activation, strength, and sEMG activity were recorded during maximal eccentric and concentric knee flexor contractions at 60°·s. Stretch and tendon reflexes were also recorded at rest., Results: Previously injured limbs exhibited lower levels of voluntary activation (mean difference = -24.1%, 95% confidence interval [CI] = -34.1% to -14.0%, P < 0.001), strength (mean difference vs control group = -0.37 Nm·kg, 95% CI = -0.71% to -0.03 N·m·kg, P = 0.03), and normalized sEMG (mean difference = -17%, 95% CI = -32% to -2%, P = 0.02) during maximal eccentric knee flexor contractions compared with control group. No such differences were seen in concentric contractions. Stretch reflexes (mean difference = -3.8%, 95% CI = -6.8 to -0.8, P = 0.02) and tendon reflexes (mean difference = -13%, 95% CI = -26% to 0%, P = 0.04) were also lower in previously injured compared with control biceps femoris muscles., Conclusion: Moderate to severe hamstring strain injury is associated with long-term deficits in voluntary activation during maximal eccentric contraction. Hamstring injury history is also associated with deficits in stretch reflex and tendon reflex amplitude.

Background: The interaction of functional and mechanical deficits in chronic ankle instability remains a major issue in current research. After an index sprain, some patients develop sufficient coping strategies, while others require mechanical support. This study aimed to analyze persisting functional deficits in mechanically unstable ankles requiring operative stabilization., Methods: We retrospectively analyzed the functional testing of 43 patients suffering from chronic, unilateral mechanical ankle instability (MAI) and in which long-term conservative treatment had failed. Manual testing and arthroscopy confirmed mechanical instability. The functional testing included balance test, gait analysis, and concentric-concentric, isokinetic strength measurements and was compared between the non-affected and the MAI ankles., Results: Plantarflexion, supination, and pronation strength was significantly reduced in MAI ankles. A sub-analysis of the strength measurement revealed that in non-MAI ankles, the peak pronation torque was reached earlier during pronation (maximum peak torque angle at 20° vs. 14° of supination, p < 0.001). Furthermore, active range of motion was reduced in dorsiflexion and supination. In balance testing, patients exhibited a significant increased perimeter for the injured ankle (p < 0.02). During gait analysis, we observed an increased external rotation in MAI (8.7 vs. 6.8°, p<0.02)., Conclusions: This study assesses functional deficits existent in a well-defined population of patients suffering from chronic MAI. Impairments of postural sway, gait asymmetries, and asymmetric isokinetic strength can be observed despite long-term functional treatment. The finding that pronation strength is particularly reduced with the foot in a close-to-accident position indicates potential muscular dysfunction in MAI. Possibly, these deficits alongside the underlying mechanical instability characterize patients requiring mechanical stabilization.

Introduction: Chronic ankle instability (CAI) is known to induce impairments throughout the lower quarter kinetic chain, however there is currently no synthesized information on proximal adaptations of the trunk, hip, thigh, and knee for neuromuscular and biomechanical outcomes during strength, balance, jumping, and gait among CAI patients. The purpose of this systematic review and meta-analysis was to synthesize trunk, hip, thigh and knee neuromuscular and biomechanical outcome measures during functional assessments when comparing CAI to healthy groups., Methods: Cumulative Index of Nursing and Allied Health Literature and Medical Literature Analysis and Retrieval System Online with PubMed databases were searched on June 3, 2019. Studies comparing outcomes at the trunk, hip, thigh, or knee regardless of assessment type in CAI versus healthy groups were considered for inclusion. Assessment categories were used to differentiate adaptations by assessment type after inclusion. Two independent reviewers assessed methodological quality using the Physiotherapy Evidence Database scoring criteria. Data pertaining to study methodology and primary proximal adaptation outcomes were extracted. Separate random effects meta-analyses were performed for consistently reported outcome measures., Results: Pooled estimates reflected that CAI patients had decreased triplanar isometric hip strength outcomes (P < 0.001, effect size range: 0.52-0.93). Knee kinematics did not differ from healthy groups during dynamic balance testing (P = 0.26). Few studies found CAI patients have altered knee kinematics during jumping tasks. The remaining findings were isolated to individual studies and thus inconclusive., Conclusions: The CAI groups demonstrated triplanar hip strength deficits and altered knee flexion angles during jumping assessments. Clinicians should consider proximal evaluations and interventions for CAI patients.

Ankle sprains are the most common injury in regular badminton players and usually occur at the end of a match or training. The purpose of the present study was to examine the influence of fatigue produced by badminton practice on the lower limb biomechanics of badminton players. It was hypothesized that fatigue induces ankle kinematic and lower leg muscle activity changes which may increase the risk of ankle sprain. Ankle kinematics, ankle kinetics and muscles activities of 17 regular badminton players were recorded during lateral jumps before and after an intense badminton practice session. Post-fatigue, ankle inversion at foot strike and peak ankle inversion increased (+2.6°, p  = 0.003 and +2.5°, p  = 0.005, respectively). EMG pre-activation within 100 ms before foot landing significantly decreased after fatigue for soleus (-23.4%, p  = 0.031), gastrocnemius lateralis (-12.2%, p  = 0.035), gastrocnemius medialis (-23.3%, p  = 0.047) and peroneus brevis (-17.4%, p  = 0.036). These results demonstrate impaired biomechanics of badminton players when fatigue increases, which may cause a greater risk of experiencing an ankle sprain injury.

Background: Lateral ankle sprain is the most common injury in basketball, and many of these sprains resulted in residual functional deficits. This study aimed to compare ankle strength and range of motion, and postural balance between competitive basketball players with and without lateral ankle sprain., Methods: This was a cross-sectional study involving 42 male competitive basketball players. Subjects were divided into the injured and uninjured groups based on self-reported questionnaires. Ankle range of motion (ROM) was measured using a goniometer, ankle isokinetic strength testing performed using Biodex System 4 PRO, and single-leg stability tests performed using Biodex Balance System SD., Results: Between the injured and uninjured ankles, there was a decrease in plantarflexion ROM (44.89±6.85 vs. 50.75±9.31, P<0.05) and an increase in eversion ROM (14.50±5.63 vs. 11.74±4.53, P<0.05). There was a reduction in inversion and plantarflexion strength at 30°/s peak torque and 120 °/s peak torque (P<0.05). However, no significant difference observed in the postural stability indexes between the two groups., Conclusions: This study proves that there are residual ROM and strength deficits after an ankle sprain, however, these deficits do not affect their balance ability.

Purpose: The sudden rise in the injury incidence during adolescence is also evident in soccer-related injuries to the groin. Submaximal passing applies high stress on the adductor muscles and pubic symphysis and is therefore likely to be connected to the occurrence of groin injuries. Therefore, the purpose of the study was to compare hip joint kinematics and adductor muscle forces of different adolescent age groups during submaximal soccer passing., Methods: Sixty participants, in four groups, younger than 12, 15, 16. and 23 yr (U12, U15, U16, U23), were analyzed. A Footbonaut, equipped with a 3D motion capture system consisting of 16 cameras, was used to capture kinematic data of short passes. Inverse dynamic analysis was performed to calculate muscle forces of 10 passes of each subject., Results: The U15 group showed reduced angular velocities. A rise in hip adductor muscle forces was evident from the youngest group up to the oldest groups. The largest increase (49%) was found between U12 and U15. Lower-limb mass was identified as the best predictor for the increasing adductor force., Conclusions: The reduced angular velocities of the U15 and the increase in muscle forces between all age groups were attributed to the increasing segment masses and length. This increases the moments of inertia of the leg segments thereby demanding higher forces to accelerate the segments. Most likely, the stress put upon the adductors apophyses increases during adolescence, as tendons are known to adapt slower than muscles, increasing the risk for overuse injuries. Coaches could use lower-limb mass as an indicator for fast increases in the force demand to identify players who would benefit from a reduced training volume.

Objectives: This randomised, single blinded cohort study was designed to assess the immediate effect of manual fascial manipulation on walking pain and the range of ankle dorsiflexion within the first 4 days after ankle trauma., Methods: Measurements were taken from 19 subjects, 5 female and 14 male, who presented with grade I-III ankle sprains. Ankle dorsiflexion was photographed in a standardised position and calculated by means of the Dartfish® Advanced Video Analysis Software and SPSS® (version 17) was used to compare the pre- and post-treatment data., Results: After one treatment session 13 of the 19 subjects were walking pain free and 3 of the 19 where walking with only little pain. The highly significant (p<0.001) mean improvement of ankle dorsiflexion was 7.9° (±5.8°). All, apart from one subject, whom were walking pain free after treatment showed a minimum of 4° increased dorsiflexion., Conclusion: Early fascia work around the injured ankle improves ankle dorsiflexion and reduces walking pain. It may reduce the delay of tissue healing and, thus, optimise further rehabilitation of the sprained ankle which may also reduce socio-economic costs., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the clinical measures of foot posture and morphology, multisegmented joint motion and play, strength, and dynamic balance in recreationally active young adults with and without a history of a lateral ankle sprain (LAS), copers, and chronic ankle instability (CAI)., Methods: Eighty recreationally active individuals (healthy: n = 22, coper: n = 21, LAS: n = 17, CAI: n = 20) were included. Foot posture index (FPI), morphologic measures, joint motion (weight-bearing dorsiflexion (WBDF), rearfoot dorsiflexion, plantar flexion, inversion, eversion; forefoot inversion, eversion; hallux flexion, extension), joint play (proximal and distal tibiofibular; talocrural and subtalar, forefoot; 1st tarsometatarsal and metatarsophalangeal), strength (dorsiflexion, plantar flexion, inversion, eversion, hallux flexion, lesser toe flexion), and Star Excursion Balance Test (SEBT) (anterior, posteromedial, posterolateral) were assessed., Results: There were no group differences in FPI or morphological measures. LAS and CAI groups had decreased ankle dorsiflexion (p = 0.001) and greater frontal plane motion (p < 0.001), first MT plantar flexion, and sagittal excursion (p < 0.001); increased talocrural glide (p = 0.02) and internal rotation (p < 0.001) and decreased forefoot inversion joint play (p < 0.001); and decreased strength in all measures (p < 0.001) except dorsiflexion compared to healthy controls. The LAS group also demonstrated decreased distal tibiofibular (p = 0.04) and forefoot general laxity (p = 0.05) and SEBT performance (anterior: p = 0.02; posteromedial: p < 0.001; posterolateral: p < 0.001)., Conclusion: Individuals with LAS or CAI have increased pain, impaired physiologic and accessory joint motion, ligamentous tenderness, and strength in the foot and ankle. Clinicians should assess the multiple segments of the ankle-foot complex when caring for individuals with an LAS or CAI., Level of Evidence: II.

Background: Single-leg balance (SLB) impairment from eyes-open to eyes-closed trials is significantly greater in patients with chronic ankle instability than in uninjured controls, indicating higher reliance on visual information. It is of clinical interest to see if the visual adaptation occurs immediately after injury., Research Question: We aimed to investigate visual reliance in patients with acute lateral ankle sprain (ALAS) during SLB with both injured and uninjured limbs and during double-leg balance (DLB)., Methods: The study assessed visual reliance of 53 participants: 27 ALAS patients and 26 persons without a history of ALAS. All participants executed DLB with eyes open and closed, and then completed SLB with both the injured and uninjured limbs (side-matched limbs of the uninjured control group) in both visual conditions. Order of limb and visual condition for SLB was randomly selected. Visual reliance was quantified for each postural task with a percent change between the two visual conditions, with the greater change representing higher visual reliance. We performed separate group-by-limb analysis-of-variance with repeated measures for SLB percent scores and independent t-tests for DLB outcomes., Results: For all SLB measures there were no significant group-by-limb interactions (p > 0.05) but significant group main effects (p = 0.013-0.029). With no side-to-side differences, the ALAS group presented higher declines in SLB from the eyes-open to eyes-closed conditions than did the uninjured control group, indicating higher visual reliance. Similarly, for DLB there were significant group differences for almost all measures (p = <.001-0.037), with the ALAS group showing greater visual reliance., Significance: Moderately higher visual reliance occurs acutely and bilaterally during SLB in ALAS patients. Similar visual adaptions also occur during DLS. These findings will provide insight into a central mechanism underlying bilateral sensorimotor deficits following ALAS and allow clinicians to improve current rehabilitation strategies for acute patients., Competing Interests: Declaration of Competing Interest The author confirms that there are no conflicts of interest associated with this work., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Due to the continual increase in the number of children engaging in sports today, physicians encounter finger injuries at an increasing frequency. This study sought to investigate the effectiveness of the method of Kinesio taping versus classic finger splint technique on pediatric patients with PIP (proximal interphalangeal) joint sprains of the fingers. Method: This is a retrospective cohort study. Forty-nine pediatric patients with PIP joint sprains were included in the study. The patients were divided into two groups, Group 1 being those treated with Kinesio taping and Group 2, those treated with splints. The area around the PIP joint was measured before and after treatment. Visual analog scale (VAS) evaluation: nighttime pain, numbness, pain at rest, and pain during activity were each separately evaluated before and after treatment. Also, flexion was measured at rest and in active motion before and after treatment. Results: The patients' periarticular measurements of the affected joint were statistically significant in both groups after treatment ( p  < 0.001). In the comparison between the groups, it was found that the group treated with Kinesio taping displayed a better outcome ( p  < 0.021). According to the VAS for PIP joint pain, it was observed that in both groups, pain at rest, pain during activity, nighttime pain, and numbness were statistically significant after treatment ( p  < 0.001). In the comparison of the groups, it was seen that the difference was statistically significant only in terms of nighttime pain ( p  < 0.013). Conclusions: The study conducted supported the literature that Kinesio taping method does not restrict the function of the extremity to which it is applied and also does not produce the complications reported in other treatment techniques. Kinesio taping was found to have a higher patient compliance and the outcomes were better in terms of edema and joint range of motion as well as night time pain when compared to the group treated with splint.