Musculoskeletal Sports Injuries Research Articles

Adolescent Athletes with Stronger Athletic Identity Perceptions Have Weaker Fear Avoidance Perceptions During Musculoskeletal Injury Rehabilitation Return to Sports Preparation.

Adolescent athletes who sustain a musculoskeletal sports injury are at high re-injury risk. This prospective study evaluated athletic identity perception and fear avoidance perception relationships during the return to sport preparation phase of musculoskeletal injury rehabilitation. From 140 consecutive physical therapy outpatients, 50 (26 females, 24 males) adolescent athletes (mean age 16.8, range 14 to 22 y) completed the 7-item Athletic Identity Measurement Scale (AIMS), the 10-item Athletic Fear Avoidance Questionnaire (AFAQ), and the AFAQ with 2 additional movement-related fear and pain questions (AFAQ+). Correlational analysis was performed of overall AIMS and AIMS subscale scores (social identity, exclusivity, negative affectivity), with AFAQ and AFAQ+ scores (P≤0.05). Adolescent athletes were receiving treatment for musculoskeletal injuries sustained during soccer (n=10), lacrosse (n=7), baseball (n=6), basketball (n=5), volleyball (n=5), track or cross country (n=4), American football (n=4), field hockey or ice hockey (n=3), softball (n=2), tennis (n=2), and gymnastics (n=2). Lower extremity conditions included anterior cruciate ligament reconstruction (n=23) or other lower extremity conditions (n=17). Upper extremity conditions included shoulder dislocation or labral repair (n=6), elbow sprain or fracture (n=3), and clavicle fracture (n=1). The AIMS score displayed moderate inverse relationships with AFAQ (r=-0.40, P=0.008) and AFAQ+ (r=-0.41, P<0.004) scores. The "social identity" AIMS subscale score displayed a moderate inverse relationship with AFAQ (r=- 0.48, P<0.001) and AFAQ+ (r=-0.46, P=0.001) scores. The "exclusivity" AIMS subscale score displayed moderate inverse relationships with AFAQ (r=-0.40, P=0.005) and AFAQ+ (r=-0.46, P=0.001) scores. The "negative affectivity" subscale did not display significant relationships with AFAQ or AFAQ+ scores. Subject age displayed moderate inverse relationships with the AIMS "social identity" (r=-0.56, P<0.001) and "exclusivity" (r=-0.42, P=0.004) subscale scores and weak direct relationships with AFAQ (r=0.30, P=0.04) and AFAQ+ (r=0.32, P=0.02) scores. Adolescent athletes with stronger athletic identity perceptions during the return to the sports preparation phase of musculoskeletal injury rehabilitation had weaker fear avoidance perceptions. As age increased from early to late adolescence, athletic identity perceptions became weaker, and fear avoidance perceptions became stronger. To decrease re-injury rates, early identification and surveillance of injured adolescent athletes with stronger, more exclusive athletic identity perceptions and weaker fear avoidance perceptions may influence rehabilitation progression and return to play decisions. Level-II, prospective cohort, correlational study.

Approach to Ankle Instability in Patients With a Negative Ankle MRI: A Case Series.

Objectives Injuries to the ankle ligaments are some of the most common musculoskeletal sports injuries. Ankle magnetic resonance imaging (MRI) is the standard diagnostic procedure in today's practice, but its reliability and validity remain controversial. The aim of this study was to explore the approach for patients with negative ankle MRI who continue to have symptoms of ankle instability despite conservative therapy. Methods A total of eight patients who were 14 years or older with negative ankle MRI who continue to have symptoms of ankle instability despite conservative therapy were admitted to our institution from January 1, 2015 to December 31, 2021. Results Eight patients with a mean age of 36, and a mean body mass index (BMI) of 37.7. All patients presented with ankle pain, locking, and giving way in variable severity. All the patients had a radiograph followed by an ankle MRI, which showed normal alignment of ankle joints without abnormality. Initially, all patients were treated conservatively but did not show any improvement. After that, they underwent an operation of lateral ankle ligament reconstruction by modified Brostrom technique, followed by casting and physiotherapy. The symptoms of ankle instability resolved in all patients. The ankle pain resolved completely in six patients, improved in one patient, and did not improve in one patient. Conclusion Based on our results, we advocate reconstruction surgery by modified Brostrom technique for ligament repair in patients with clinical evidence of chronic ankle instability who have failed a trial of conservative management, even in the context of a normal ankle MRI.

Conservative Management of Acute Lateral Ankle Sprain: A Review of Systematic Reviews

Acute lateral ankle sprains (ALAS) are one the most observed musculoskeletal sports injuries. This review aimed to analyze the various systematic reviews from Jan 2010 to June 2022 to evaluate the best evidence-based conservative management of ALAS. Various popular search engines including PubMed, Scopus, Web of Science, and EMBASE were searched. Out of a total of 2357 citations, 26 studies were evaluated after duplicates were eliminated based on eligibility criteria. After the procedure, 20 systematic reviews with a mean AMSTAR quality score of 8.25/11 were included in this analysis review, which demonstrated PT functional therapy is better for managing ALAS even though not fully conclusive in certain parameters.

Prevalence of Musculoskeletal Sports Injuries of Head, Neck and Upper Limb among Cricket Players

Sports injuries have been reported with growing rate in a quest to identify patterns by which they can be predicted and prevented. Injury investigation in cricket has been started for almost twenty years. Objective: To determine the prevalence of musculoskeletal sports injuries of head, neck and upper limb among cricket players. Methods: It was a Cross-sectional study. Data were taken from 180 selected cricket players from different cricket academies, clubs of Lahore Pakistan. The data were analyzed by SPSS version 21 and with a self-generated questionnaire. Results: This study showed very low prevalence of head and neck injuries which is 5.6 % and very high prevalence of shoulder injuries are seen in this study which is 77.78 %. Elbow injuries are seen 19.4 % while there is a significant association between type of cricketers and shoulder pain. Conclusions: The prevalence of musculoskeletal sports injuries found very high in shoulder joint, then in elbow joint and then in head and neck which has affected their performance. Study also showed a significant correlation between the type of players and shoulder pain

The Effects of Motor Imagery on Pain in Lower Limb Sports Injuries: A Systematic Review and Meta-Analysis.

This review evaluated the efficacy of Motor Imagery intervention in athletes with lower limb sports injuries that could affect their pain levels during rehabilitation. We carried out a thorough research of the scientific literature for RCT studies in athletes with lower limb musculoskeletal sports injuries including search terms Motor Imagery AND pain, Motor Imagery AND sport injuries, Motor Imagery AND lower limb. We searched 3 major databases, PubMed, Scopus, and ScienceDirect, with the search period ranging from their inception until May 2022. We assessed the quality of the studies using the PEDro Scale and the data was recorded and extracted with the use of Mendeley software. The search criteria resulted in a pool of 10.107 possible articles. Upon completion of the selection procedure, only 3 RCT studies met the inclusion criteria with a total of 60 injured athletes (n = 18 with ankle sprain and n = 42 with ACL injuries). The meta-analysis showed no statistically significant positive effects of MI intervention on pain intensity after lower limb sports injuries (n = 60; MD = -1.57; 95% CI: -3.60 to 0.46; I2 = 50%; p = 0.13). The limited number of studies could justify the statistically insignificant effect of MI, but although the methodological quality of the studies was moderate to high, the heterogeneity of them was also relatively high. More RCT's are required to explore the effect of MI on pain in athletes with lower limb injuries in order to address psychophysiological processes during rehabilitation.

Sensitivity of a Subject-specific Ankle Sprain Simulation to Extrinsic Versus Intrinsic Biomechanical Factors.

Ankle sprains are the most common musculoskeletal injury in sport and military activity, despite existing prophylactic strategies. The purpose of this report was to develop a probabilistic simulation of lateral ankle sprains during single-limb drop landing, towards accelerating innovation in ankle sprain prevention. A deterministic, subject-specific musculoskeletal model was extended with automation and probabilistic distributions on sprain-related biomechanical factors. Probabilistic simulations were generated using traditional Monte Carlo techniques and the advanced mean value method, a more computationally-efficient approach. Predicted distributions of peak ankle joint rotations, velocities, and moments borne by supporting passive structures agreed favorably with the deterministic model and with reports of real sprain biomechanics. Parameter sensitivities identified that predictions were most strongly influenced by drop height, subtalar joint posture at contact, invertor/evertor co-activation, and passive ankle stiffness. The advanced mean value method predicted confidence bounds comparable to a 1000-trial Monte Carlo simulation, and required only 14 model evaluations and 4-min processing time. The extended probabilistic simulation may be useful to virtually test new prophylactic strategies for ankle sprains, and is made available for open-source use (https://simtk.org/projects/sprain-sim).

Cryotherapy and compression in sports injury management: a scoping review

Background/AimsFor the management of sports injury, cryotherapy is commonly applied, yet modalities differ extensively in application including levels of compression. The aim of this study was to provide a comprehensive review of the current position in the literature on contemporary cryo-compression applications for musculoskeletal sports injury management.MethodsA total of eight databases were searched: Sport Discus, Science Direct, CINHAL, Scopus, PubMed, Cochrane, ProQuest and MEDLINE. Publications were restricted to 30 years and had to be in the English language. Medical subject headings, free-text words, and limiting descriptors for concepts related to cryotherapy and compression for sports injury were applied. Inclusion criteria determined at least one modality of cryotherapy treatment applied simultaneous to compression or as a comparison, relevant to sports injury management. Modalities included cryo-compressive devices and gel/ice packs, in association with concomitant compression. Male, female, healthy and injured participants were included. Two reviewers independently selected eligible articles, resulting in 22 studies meeting the inclusion criteria following full-text appraisal.ResultsInconsistent methodologies, low sample sizes and variability in outcome measures provided uncertainty over optimum protocols. A lack of previous understanding in the protocols in the available literature for isolated cryotherapy/compression applications prevents understanding of the therapeutic benefits of combined cryo-compression. No definitive agreement behind optimal cryo-compression applications were identified collectively from studies other than the consensus that compression aids the magnitude of cooling.ConclusionsAlthough compression appears a useful adjunct to cooling modalities for the management of sports injury, no definitive agreement on optimum compression concurrent with cooling protocols were drawn from the studies. This was because of several methodological gaps in reporting throughout studies, highlighting a lack of studies that represent applications of compression and cryotherapy within a sporting context or applied nature within the available research.

Acute Musculoskeletal Sports Injuries in School Age Children in Britain

ObjectivesTo determine the relative number of acute musculoskeletal injuries sustained by children due to different sports in a region of the UK, and assess the burden upon the NHS, through a cross sectional study. MethodsCollection of data for every child aged 6-18 seen at the Peterborough City Hospital fracture clinic, whose sports injury was from 1st September 2018 – 31st August 2019 (1 school year; n=689). Data was gathered throughout the year by three children's orthopaedic surgeons, who consulted the clinic records, notes and x-rays of all children who had attended clinic. ResultsBoys were 2.7 times more likely to sustain injury than girls. Children aged 6-9 had few injuries (mean 24 injuries each year group), 10-15 had a large number of injuries (mean 84), and 16-18 again had few injuries (mean 35). Football and rugby were responsible for the majority of injuries (61% between them), as well as the majority of physiotherapy appointments (72%). Sports with the highest likelihood that an injury will be sufficiently serious to require surgery were equestrian (42% of injuries required surgery), gymnastics (27%), ice skating (25%) and rugby (22%). Popular sports in which injuries were relatively rare include swimming, athletics, cricket, hockey, tennis and badminton. ConclusionThe sports that caused the most injuries were football and rugby. Considering relative participation in different sports, it is clear that rugby has a disproportionate number of musculoskeletal injuries in total, of severe injuries requiring surgery, and requiring rehab from physiotherapy.

A Literature Review on “Prevalence and Causes of Common Musculoskeletal Injuries in Badminton Players”

Background: The most injuries of badminton players involve a critical association between the movement tasks and training programs strategies. This review highlights on the common musculoskeletal injuries experienced by badminton players. The large majority of injuries, when recognized early on, can be prevented effectively with minor adjustments in the training programs, rehabilitation of essential muscles and flexibility. Objectives: To determine the common musculoskeletal injuries experienced by badminton players To determine some probable cause of musculoskeletal sports injuries experienced by badminton players. Methodology: A review was conducted on articles published between the year 2007 to 2018 to draw a conclusion on the prevalence and prevention of the common musculoskeletal injuries in badminton players. 20 studies including research articles was reviewed. The studies were critically appraised and cross references were checked. Results and Conclusion: According to the results of this research the incidence of injury in the lower and upper extremities are relatively high in badminton players. The implementation of custom fit physical fitness training programme, physiotherapy, continual medical supervision, considering scientific and practical principles to all level of athletes can be effective in the prevention of sports injuries. Discussion: Further studies to be conducted in a broader perspective way. Also, physical fitness training programme should be formulated based on the demand of the sport and the athlete.

Internal Training Load Measures in Elite Adolescent Ballet Dancers.

Training load has been identified as a risk factor for musculoskeletal injury in sport, but little is known about the effects of training load in dance. The purpose of this study was to describe adolescent dancers' internal training load (ITL) and compare objective and subjective measures of ITL using heart rate (HR) training impulse methods and session Rating of Perceived Exertion (sRPE), respectively. Fifteen female elite adolescent ballet dancers at a vocational dance school volunteered to participate in the study. Internal training load data using HR and sRPE were collected over 9 days of multiple technique classes at the midpoint of the dancers' training year. Heart rate data were quantified using Edwards' training impulse (ETRIMP) and Banister's training impulse (BTRIMP), and sRPE was estimated from the modified Borg 0 to 10 scale and class duration. Descriptive statistics (median [M], and interquartile range [IQR]) were determined in arbitrary units (AU), and were as follows for all classes combined: ETRIMP: M = 134 AU (IQR = 79 to 244 AU); BTRIMP: M = 67 AU (IQR = 38 to 109); sRPE: M = 407 AU (IQR = 287 to 836 AU). The association and agreement between objective and subjective ITL measures in ballet and pointe class was assessed using Spearman correlations (rs) and adjusted Bland-Altman 95% limits of agreement (LOA), respectively, with alpha set at 0.05. A significant moderate positive correlation was found between ETRIMP and BTRIMP in pointe class (rρ = 0.8000, p = 0.0031). The mean difference (LOA) between ETRIMP and BTRIMP was 121 AU (33 to 210 AU) in ballet and 43 AU (-3 to 88 AU) in pointe. It is concluded that some, but not all, measures of ITL in elite adolescent ballet dancers are comparable. Additional research is needed to examine the utilization of ITL measures for evaluating dance-related injury risk, as well as the application of ITL to inform the development of effective injury prevention strategies for this high-risk population.

Comparison of the Effectiveness of Chelleh Daghi Herbal Ointment and Piroxicam Gel on Ankle Sprains

Background and Aim: Ankle injuries are among the most common musculoskeletal injuries in sports, accounting for 10% to 15% of all injuries. Since controlling pain and inflammation in ankle sprains is one of the main goals of treatment, we decided to compare the therapeutic effects of Cheleh daghi Herbal ointment with a common therapeutic gel such as piroxicam. Methods &amp; Materials: This study was performed as a double-blinded clinical trial for 6 months from January 2019 to August 2019. After referral, all patients completed the consent form, and the patientchr('39')s details and study variables were recorded by the evaluator in the research form. To measure joint inflammation, we measured the ankle with a meter tape in the ankle area (cm) and recorded. A goniometer was also used to measure the degree of ankle movements. The symptoms of ankle ecchymosis were also checked by physical examination and observation and recorded in the checklist. Statistical analysis was performed in SPSS V. 18 using statistical tests (the Mann-Whitney U test, the Chi-square, and the independent t-test). Ethical Considerations: The Research Ethics Committee of Arak University of Medical Sciences approved the study (Code: IR.ARAKMU.REC.1396.55) and registered by the Clinical Trial (Code: IRCT2017071720258N53). Results: The Mean±SD age in the control group was 34.2±8.6 years, and in the case group was 35.4±8.9 years. There was no statistically significant difference according to the Mann-Whitney U test (P&lt;0.05). Also, the Mean±SD height in the control group was 1.7±0.12 m and in the case group was 1.72±0.11 m. The results also showed a statistically significant difference between the two groups studied before and after the intervention regarding the mean indicators of pain, swelling, and inflammation around the joints (P&lt;0.05). Conclusion: The results of our study showed that Cheleh daghi Herbal ointment for 3 weeks could be more effective in reducing local pain and inflammation than piroxicam gel treatment.

Dorsiflexion and dynamic postural control asymmetry in elite male volleyball players

Objective: Movement assymetry is considered a potential risk factor for musculoskeletal injury in sport. Sports such as volleyball are thought to cause movement assymetries due to specific sporting demands. Further, between limb comparisons are often used for return to sport decisions. Despite this, little information is available regarding the presence of assymetry in volleyball athletes. Therefore the purpose of this investigation was to determine the presence of assymetry in dorsiflexion range of motion (DFROM) and dynamic postural control variables, factors important in return to sport decisions, both the group and individual level in professional male volleyball players. Secondarly, we aimed to better understand the role of DFROM on the Star excursion balance test (SEBT), a measure of dynamic postural control. Method: Thirty-two Professional male volleyball players (age: 24.7±5.53 years, height: 190.6±7.63 cm., weight: 84.5±9.28 kg., BMI: 23.22±1.62 kg/m2) participated in this investigation. All participants reported for a single test session during which DFROM and the SEBT were assessed on both limbs. Results: There was a significant group difference (p <0.05) between limbs for the normalized anterior (landing leg: 73.3 ± 6.2%; non-landing leg: 71.4 ± 6.8% ) posteromedial (landing leg: 112.6±9.3%; non-landing leg: 107.6±10.8%) and posterolateral (landing leg: 114.5±8.1%; non-landing leg: 111.4±9.4%) SEBT reach direction. The anterior and posteriomedial but not the posteriolateral reach differences exceeded the minimal detectable change score for the SEBT. At the individual level, the vast majority of participants demonstrated minimal assymetry. Significant correlations were found between DFROM and the anterior SEBT reach (r = 0.36 to 0.39, p<0.04) as well as the posteriolateral SEBT reach (r= 0.47 to 0.50, p<0.01). Conclusions: Professional volleyball players do not have DFROM or dynamic postural control assymetries but DFROM can influence dynamic postural control.

Clinical applications of nuclear medicine in the diagnosis and evaluation of musculoskeletal sports injuries

Increased participation in sports and physical exercise are widely promoted as an approach to a physically active lifestyle which has a positive effect on healthy aging, in patients and athletes of all ages, beginners and experts, including amateur athletes and professional athletes. Unfortunately, this has caused a higher incidence of sports-related injuries. In the sports context, the early and accurate diagnosis of injuries is of the utmost importance in order to enable early treatment to achieve a full recovery. Imaging techniques are increasingly important for the successful diagnosis and management of the patient. The nuclear medicine techniques with bone tracers provide physiological and metabolic information in the early phases of musculoskeletal injuries, which often precede anatomical changes and they reflect changes in bone turnover. This allows early diagnosis, along with evaluation of the activity and phase of the injury. In this article, the applications of nuclear medicine techniques, focusing on bone scintigraphy, alongside the important contribution of hybrid studies (SPECT/CT), in the diagnosis of bone and soft tissue sports injuries, will be described. In addition, we explain their usefulness in the expression of the pathophysiology of these lesions and their scintigraphic patterns. The article will also describe biomechanical and physiopathological aspects, injury mechanisms and clinical presentations of bone and joint sports injuries, knowledge of this is essential for the correct diagnostic assessment of imaging studies.

Current trends in sport injury prevention

Participation in sport and recreation has important positive implications for public health across the lifespan; however, the burden of sport-related musculoskeletal injury is significant, with the greatest risk being in youth and young adults. Moving upstream to primary prevention of injury is a public health priority that will have significant implications for reducing the long-term consequences of musculoskeletal injury including early post-traumatic osteoarthritis. The primary targets for the prevention of musculoskeletal injury in sport include neuromuscular training (NMT), rule modification, and equipment recommendations. Currently, there is significant high-quality evidence to support the widespread use of NMT warm up programs in team and youth sport, with an expected significant impact of reducing the risk of musculoskeletal injury by over 35%. Policy disallowing body checking in youth ice hockey has led to a >50% reduction in injuries, and rules limiting contact practice in youth American football has significant potential for injury prevention. There is evidence to support the use of bracing and taping in elite sport to reduce the risk of recurrent ankle sprain injury but not for use to prevent the primary injury, and wrist guards are protective of sprain injuries in snowboarding. Future research examining the maintenance of NMT programs across real-world sport and school settings, optimization of adherence, additional benefit of workload modification, and evaluation of rule changes in other sports is needed.

Neuromuscular Mechanosensitivity in Subjects with Chronic Ankle Sprain: A Cross-Sectional Study.

Ankle sprain is one of the most common musculoskeletal injuries in sports, at work, and at home. Subjects who suffer from this injury may develop ankle instability. Functional instability has been associated with a high rate of resprain and impaired neuromuscular control in patients with ankle instability. Measurement of neural and muscular mechanosensitivity after ankle sprain injury and establishment of the relationship between these variables. A cross-sectional case-control study was performed with a sample of 58 students from Alcalá de Henares University (21 males and 37 females, mean age ± SD = 21 ± 3.7 years). Subjects were divided into two groups: a case group (N = 29, subjects with unstable ankle) and a control group (N = 29, healthy subjects). The pressure pain threshold (PPT) of the tibialis anterior, peroneus longus, and peroneus brevis muscles and mechanosensitivity of the common peroneus and tibial nerves were evaluated in all subjects through a manual mechanical algometer. Neuromuscular PPTs showed significant differences (P < 0.05) between both groups, such that, compared with the control group, the case group exhibited significantly lower PPT levels. In the case group, a strong positive correlation was observed between neural and muscular homolateral mechanosensitivity in both lower limbs. Participants with chronic ankle instability showed higher neuromuscular mechanosensitivity in muscles and nerves surrounding the ankle joint than healthy subjects. These findings indicate that low PPT values may be associated with symptoms that characterize this disease.

Preseason Dynamic Balance Performance in Healthy Elite Male Soccer Players.

Lower limb musculoskeletal injuries in sports are linked with balance abnormalities and altered postural control. Dynamic balance screening should be performed in order to identify athletes at risk. The purpose of the study was to evaluate the preseason dynamic balance performance and side-to-side asymmetry of healthy elite male soccer players, using modified Star Excursion Balance Test (mSEBT). Seventy-three elite soccer players (23.8 ± 5.4 years) were evaluated using the mSEBT. Normalized reach distances, side-to-side asymmetries, and composite scores were determined. The composite scores were 93.33% ± 8.99% for dominant leg and 93.36% ± 9.23% for nondominant leg. No significant differences were found between dominant and nondominant limb in any direction. The mSEBT is an easy-to-use tool to measure the dynamic balance performance in elite athletes. It can be applied successfully during preseason physical examinations. Future studies are needed to establish predictive cutoff points in order to increase mSEBT use in screening soccer players for dynamic balance abnormalities and identify those at risk for noncontact lower limb injuries.

Concussions Impair Listening-in-Noise Abilities

Concussions are diffuse, non-penetrating brain injuries following a sudden hit to the head or body, leading to neurologic and cognitive difficulties. One of the emerging ideas in concussion science is that neurosensory systems can be acutely affected, including vision and balance.Concussions, sportsThe potential for auditory processing deficits after a concussion has received less attention. Some studies have reported difficulties in tone-in-noise and dichotic listening tasks among patients with brain injuries (Brain Inj. 2017;31(9):1183). Additionally, as we have discussed in previous articles in the Hearing Matters column in The Hearing Journal, neurophysiological responses to sound can indicate if an adolescent has sustained a concussion (see Brainvolts, 2018). Do these neurophysiological processing deficits have a behavioral consequence? Thompson and colleagues tested this hypothesis in a recent study (Brain Inj. 2018; in press). They tested 20 adolescents recovering from a concussion in a sports medicine specialty clinic. As a control group, they recruited 20 patients from the same clinic who had musculoskeletal sports injuries such as joint sprains and bone fractures. This is an important strength of this study because it means that the demographics of the two groups were quite similar. Study participants from both groups completed the Hearing in Noise Test (HINT), which required them to repeat simple sentences presented in speech-shaped noise. Two conditions were tested: one where speech and noise emanated from the same location, and another where speech and noise were separated in space, making it easier to understand the sentences. Across both listening conditions, the group with a concussion had worse speech-in-noise performance than the control group, and performed more poorly relative to the HINT's norms. In the co-located condition, 70 percent of the concussion group performed at or below the 50th percentile on the HINT, compared with 35 percent of the control group. In the spatially separated condition, 100 percent of the concussion group performed at or below the 50th percentile on the HINT, compared with 65 percent of the control group. Thompson and colleagues also evaluated participants’ performance across multiple sentences in the HINT (each condition consisted of 10 sentences). The HINT is adaptive, meaning that if a patient successfully understands one sentence, the next sentence is more difficult to discern (the sentences get quieter, and vice versa, if the patient responds incorrectly). In the spatially separated condition, they observed a consistent pattern, where all children perceived the first few sentences correctly, which were the easiest. Both groups’ performance quickly leveled off, with participants with a concussion needing the sentences to be about 2-3 dB louder to achieve the same performance as the control group. In contrast, a distinct pattern emerged in the co-located condition. Once again, both groups responded to the first few sentences correctly. Whereas the control group continued to perform stably, the concussion group trailed off and their performance worsened over time. By the end of the task, they needed the sentences and noise to be at almost the same level, with the sentences nearly 4 dB louder than the control group required to achieve the same performance. While 4 dB may not sound like a lot, in speech-in-noise perception tasks, each 1 dB difference in signal-to-noise ratio corresponds to about 10 percent word intelligibility. These findings—impaired speech-in-noise perception following a concussion—have important ramifications for the clinical management of concussions: When is a patient ready to return to learn? Given that concussions can affect cognitive functions, such as the ability to maintain attention on a task for a prolonged period of time, children with a concussion often receive academic accommodations. Thompson, et al., suggested that the trail-off in the concussion group's performance reflected this cognitive fatigue. Speech-in-noise testing might provide a quick evaluation of whether a child can sustain cognitive energy on a task. Moreover, given that classrooms are noisy listening environments, testing for speech-in-noise deficits could indicate whether they need accommodations such as preferential seating to support their classroom listening. When is a patient ready to return to sports? Fields, courts, and arenas are complex listening environments. To safely play sports, an athlete needs to be able to follow signs from their teammates, coaches, and officials. If an athlete cannot effectively process sounds in noise, their ability to navigate a field might be compromised. In turn, their risk of additional injury could be elevated if they return too soon. This work provides additional evidence that concussions affect auditory processing. Speech-in-noise testing is a fast and reliable way to evaluate auditory function in children, and results can inform important questions in concussion management. These findings reinforce the idea that audiologists can play an active role in a clinical team managing children with concussions.

Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries.

Injuries are a common consequence of sports and recreational activity. The optimal management of symptoms is a crucial element of sports injury management. Acupressure has previously been shown to effectively decrease symptoms of musculoskeletal injury, thus may be considered a potentially useful intervention in the management of sport-related injuries. Therefore, this study was conducted to examine the effectiveness of acupressure in decreasing pain and anxiety in acutely injured athletes. A prospective 3-arm randomized placebo-controlled trial. A sports injury clinic, Dunedin, New Zealand. Seventy-nine athletes who sustained a sport-related musculoskeletal injury on the day. Three minutes of either acupressure, sham acupressure, or no acupressure. The primary outcomes of pain and anxiety intensity were measured before and immediately after the intervention on a 100-mm visual analog scale (VAS). Pain and anxiety relief, satisfaction with treatment, willingness to repeat a similar treatment, and belief in the effect of acupressure were secondary outcomes measured on Likert scales after the intervention. The acupressure group reported 11 mm less pain (95% CI: 5-17) on average than the sham acupressure group, and 9 mm less (95% CI: 3-16) than the control group as a result of the intervention (P < 0.05). There was no difference between groups in: anxiety levels, or in any of the secondary outcome measures. Three minutes of acupressure was effective in decreasing pain intensity in athletes who sustained an acute musculoskeletal sports injury when measured on the VAS, but did not change anxiety levels.

A Multisensor Integration-Based Complementary Tool for Monitoring Recovery Progress of Anterior Cruciate Ligament-Reconstructed Subjects

Anterior cruciate ligament (ACL) trauma, being one of the most common musculoskeletal injuries in sports, leads to knee joint instability and causes ambulation impairments. A careful monitoring of the progress of recovery after ACL reconstruction is crucial for minimizing postoperative complications and reinjuries. This research is aimed at designing a complementary tool to assess the recovery status and knee dynamics during the rehabilitation period after ACL reconstruction. The prototype includes wireless body-mounted motion sensors for kinematics measurements, surface electromyography system for muscle activity measurements, a video camera for recording trial activities and custom-developed intelligent system software that provides classification of the progress of the recovery and visual biofeedback during rehabilitation. The subjects’ recovery stages are classified based on combined features from sensors’ data, using an adaptive neuro-fuzzy inference system. The visual biofeedback provides monitoring of different signals simultaneously in order to help in detecting the intra and intersubject variability and correlation between the knee joint dynamics and muscle activities. The promising results of this initial study for assessing the ambulation at various speeds showcase the prospects of using the proposed system as part of existing rehabilitation monitoring procedures to achieve a more effective and timely recovery of ACL-reconstructed subjects.

Effects of immobilization and remobilization on the ankle joint in Wistar rats.

A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint.