Sports Physiotherapists Research Articles

Intelligent rehabilitation assistant: Application of deep learning methods in sports injury recovery

In recent years, sports injury rehabilitation has developed into a specialized field that has forced the combination of an orthopedic surgeon, sports physiotherapist, and sports physician. Determining the appropriate time for an injured athlete to resume practice or competition is regarded as sports rehabilitation. Discovering the best solutions to avoid injuries, maximize recovery, and enhance performance is crucial for sports activities. The study introduced an intelligent rehabilitation assistant (IRA) that leverages advanced deep learning (DL) methods to enhance sports injury recovery. In this study, the IRA incorporates redefined prairie dog optimized bidirectional long-short-term memory (RPDO-Bi-LSTM) to enhance accuracy, predicting sports injury recovery. The study collected data on the state of rehabilitation, physiological parameters, and general health using wearable sensors and movement patterns. The data was preprocessed using a median filter to remove noise from sensor data. Region-based segmentation using segmented images from preprocessed data. Convolutional neural networks (CNN) using extracted features from obtained data. The IRA provides personalized recovery plans and real-time feedback. The framework consists of the components, suggested models to create quality scores for motions, measurements to quantify motion performance, and scoring of performance measurement elements into numerical quality scores. The proposed method is implemented using Python software. RPDO-Bi-LSTM presentation is evaluated by various metrics, such as accuracy 94.2% recall 98.2%, precision 96.5%, and specificity 95.2%, f1 score 95.6%, he planned technique attained good performance and improved the accuracy of sports injury recovery.

Correlation between functional tests and biomarker in return to sport tests of athletes with injuries to the knee region

A sports injury is a condition where damage occurs to the body tissue caused by sports activities. Data in the United States shows a high incidence rate of sports injuries which reaches 1.5 million per year, with half being serious injuries. Injuries to the lower limbs can generally lead to decreased performance, often preventing athletes from continuing as professionals. The Sports Physiotherapist is responsible for aiding recovery and improving the athlete’s performance so that they can return to their sport. Assessing an athlete’s ability to return to sport (RTS) requires tests that can predict their ability after injury. There is currently no consensus from the literature on the decision to return to sport given the lack of standardization and objective criteria. This research is a quantitative descriptive research in the form of a correlation study to analyze the relationship between the functional test model and the bilogical test of the success of the post-injury sports therapy program. Bivariate analysis shows that that the sit and reach test, and the hexagonal test are correlated with TGF Beta 1 results. Where the value r = 0,194 p = 0,160 yng means that there is no meaningful relationship between the Single Leg stance and the Beta 1 TGF.

Intralimb Coordination Pattern of the Lower Limbs in Male Athletes With Allograft and Autograft Anterior Cruciate Ligament Reconstruction During Landing

Background and Objectives: Two common choices exist for anterior cruciate ligament (ACL) reconstruction, autograft and allograft. Hamstring tendon autografts and soft-tissue allografts are commonly used for ACL reconstruction. The outcomes between these two grafts are controversial. This research aims to quantify and compare lower limb joint coordination between two ACL reconstruction graft options and healthy individuals. Methods: Sixty-one athletes were enrolled after ACL reconstruction surgery (allograft, n=22; autograft, n=18). Furthermore, twenty-one healthy athletes were considered in the control group. The inclusion criteria included unilateral anterior cruciate ligament reconstruction surgery with allograft and autograft methods, male athletes with a minimum of 9 months and a maximum of two years since their surgery, successfully passing a series of quadriceps and hamstring strength tests and distance jumping before entering sports-specific activities under the supervision of a sports physiotherapist, and returning to pre-injury sports activities. Results: Autograft was not statistically different from matched healthy limbs in terms of joint coordination variability and magnitude (P>0.05). However, the magnitude of joint coordination was superior to the allograft group compared to the autograft reconstructed ACL (P<0.05). Conclusion: Although our result reported no significant difference between groups in joint coordination variability, having an insight into coordinative function after ACL reconstruction will help develop postoperative rehabilitation programs as well as minimize the re-injury risk among patients. We also suggest that scholars should conduct more robust trials with valid research designs to control the results of ACL reconstruction comparison with autograft and allograft.

Exploring athlete pain assessment experiences and priorities; a two-part qualitative series of athlete and physiotherapist interactions. Part Two. “Forging our future” - Athlete and physiotherapists' priorities for pain assessment and beyond

ObjectivesTo explore the priorities and directions of athlete upper and lower limb pain assessment by facilitating shared understandings of athletes and sport physiotherapists. DesignQualitative research using a hermeneutic phenomenological approach. MethodsWe carried out focus groups comprising a deliberate criterion sample using a constructivist perspective. At the end of each focus group, we used the nominal group technique method to generate a list of consensus-based priorities for future pain assessment. Our paper follows the consolidated criteria for reporting qualitative research (COREQ) guidelines. ResultsWe completed five focus groups, comprising twelve athletes (female, n = 5, male, n = 7) and four sport physiotherapists (male, n = 4). Two final themes (and six subthemes) were developed; I Enhanced Communication and Pain Descriptions (describing and representing pain, better communication, the role of technology, providing direction and setting the pace), and II Integrating Sport Specific and Multidimensional Assessments (broadening the pain assessment toolkit, the role of technology). We developed a set of thirteen practical priorities for pain assessment that span the subjective, objective, and general aspects of the athlete pain assessment. ConclusionsWe have presented stakeholder-generated perspectives, direction and priorities for athlete pain assessment. Athletes and physiotherapists must continue to work together to achieve a comprehensive sport-specific multidimensional pain assessment experience alongside their wider support networks to ensure optimal representation and communication. We have highlighted some available pain assessment tools and strategies and outlined how novel tools may address certain gaps. Researchers, clinicians, and athletes can consider the practical guidance we have provided to address these priorities.

Exploring athlete pain assessment experiences and priorities: A two-part qualitative series of athlete and physiotherapist interactions: Part One. “Gauging and discerning” — Athlete & physiotherapist pain assessment experiences and interactions

ObjectivesTo explore the content (subjective questions, objective tools and outcome measures) and discuss the nature (qualitative elements and wider considerations) of the athlete pain assessment by facilitating shared understandings of athletes and sports physiotherapists. DesignQualitative research using a hermeneutic phenomenological approach. MethodsWe carried out focus groups comprising a deliberate criterion sample using a constructivist perspective. We developed a topic guide and used reflexive thematic analysis. We developed codes, candidate themes and finalised themes iteratively, and employed a critical friend to add depth to our analysis. Our paper follows the consolidated criteria for reporting qualitative research guidelines. ResultsWe completed five focus groups comprising twelve athletes (five female, seven male) and four sports physiotherapists (four male). Three final themes (and eight subthemes) were created; (i) Measures, Scales and Dimensions (value and limitations of tools and scales, multidimensional methods, making sense and interpreting), (ii) Connect, Listen and Learn (the pain interview and athlete's story, forging the athlete–clinician connection), and (iii) Lighthouse in the Storm: providing direction for athletes in pain (information overload and indecision, a beacon of direction; the role of the physiotherapist, the burden of expectation; challenges for physiotherapists). ConclusionsWe described and explored the phenomena of pain assessment in sport including current pain assessment strategies. Comprehensive multidimensional assessment methods that preserve the athlete–clinician therapeutic relationship and facilitate optimal communication are priorities for future research and practice.

Photobiomodulation as Medicine: Low-Level Laser Therapy (LLLT) for Acute Tissue Injury or Sport Performance Recovery.

Background/Objectives: Low-level laser therapy (LLLT) has gained traction in sports and exercise medicine as a non-invasive therapeutic for preconditioning the body, exertion recovery, repair and injury rehabilitation. LLLT is hypothesized to modulate cellular metabolism, tissue microenvironment(s) and to decrease inflammation while posing few adverse risks. This review critically examines the evidence-base for LLLT effectiveness focusing on immediate care settings and acute/subacute applications (<6 months post-injury). Methods: A comprehensive literature search was conducted, prioritizing systematic reviews, meta-analyses and their primary research papers. Results: Findings are relevant to trainers and athletes as they manage a wide range of issues from superficial abrasions to deeper tissue concerns. LLLT parameters in the research literature include wide ranges. For body surface structures, studies show that LLLT holds promise in accelerating wound healing. In sport performance studies, LLLT is typically delivered pre-exercise and reveals beneficial effects on exertion recovery, improvements in muscle strength, endurance and reduced fatigue. Evidence is less convincing for acute, deep tissue injury models, where most studies do not report significant benefits for functional outcomes over conventional therapeutic modalities. Conclusions: Variability in LLLT delivery parameters and findings across studies underscores a need for clear treatment guidelines for the profession. Technical properties of laser light delivery to the body also differ materially from LED devices. Sport physiotherapists, team physicians, trainers and athletes should understand limitations in the current evidence-base informing photobiomodulation use in high-performance sport settings and weigh potential benefits versus shortcomings of LLLT use in the mentioned therapeutic contexts.

‘Another world of pain’—athlete and sport physiotherapist perspectives on the unique experience of pain in sport

Our objective was to explore athlete’s and sports physiotherapists’ experiences of sports-related pain in the upper and lower limb. Using a constructivist and pragmatic perspective, we carried out focus groups...

Comparison of Inter-Rater and Intra-Rater Reliability of Raters with Different Levels of Experience When Using Landing Error Scoring System (LESS) in Field-Based Screening of Professional Football Players.

It is essential for physical sports therapists to use reliable field-based tests to identify potential injury risk factors in athletes. The purpose of this study was to compare the inter- and intra-rater reliability of experienced and novice raters during use of the Landing Error Scoring System (LESS) in a field-based examination of professional football athletes. Thirty-seven male football athletes underwent pre-season LESS assessment. Two raters independently evaluated the recorded landing techniques at two separate intervals, two months apart, following the LESS standard protocol. Inter-and intra-rater values were calculated for the LESS total scores and individual scoring items. The overall LESS scores had excellent intra-rater reliability values for both the experienced (interclass correlation coefficient (ICC) = 0.95, 95% CI, 0.89-0.97; p < 0.001) and novice rater (ICC = 0.95, 95% CI, 0.90-0.97; p < 0.001), and very good to excellent inter-rater values for the first (ICC = 0.90, 95% CI, 0.77-0.95; p < 0.001) and second (ICC = 0.86, 95% CI, 0.71-0.93; p < 0.001) evaluation. Most of the individual scoring items ranged from moderate to perfect agreement. In conclusion, sports physical therapists, regardless of experience, can reliably use the LESS's total score, through video analysis of the regime. Individual scoring items can inform clinicians about impairments in the landing mechanism but data should be interpreted cautiously.

Clinical Sports physiotherapy practice in India- it’s time to upgrade with technology and evidence based practice

In India, the job of a sports physiotherapist is very demanding because, due to the increased number of injuries in all sports, it is claimed that athletes require complete care to recover and prevent injuries. At present, the general population in India, looking to lead a healthy life, also participates in recreational sports activities. So sports physiotherapy is also recommended for the general population.After finishing their education, physiotherapists play a crucial and essential role in the recovery of sports players. Sports physiotherapists' main duties include handling on-field injuries, preventing injuries, treating injuries in the outpatient setting, helping patients recover from arthroscopic surgery, and travelling with sports teams or individuals for short or infrequently longer contract periods. This article summarize the suggestions and solutions to improve the standards of sports physiotherapy practice in india.

Knowledge, Attitude, Beliefs, and Practice Related to Concussion Injury Among Sports Physical Therapists in Riyadh, Saudi Arabia. A Cross-sectional Analysis.

Sport-related concussions (SRC) are estimated to affect more than 55 million individuals annually. Physical therapists ought to have fundamental knowledge regarding the evaluation and treatment of SRC. Thus, this study aims to evaluate the knowledge, attitude, and practice of the physical therapists regarding SRC management in Riyadh, Saudi Arabia. The cross-sectional study enrolled 83 sports physical therapist who had atleast undergraduate degree and above in physical therapy from Riyadh region. The participants who worked outside the Riyadh region were excluded. A validated adopted questionnaire was used to evaluate the outcome measures. The study showed that sport physical therapists have a good understanding and knowledge about concussions having 3.91 ± 0.98 scores on the five-point Likert scale. In addition, participants were able to recognize concussion signs and symptoms correctly; however, they felt that they lacked confidence to make a decision regarding return to play. Our study revealed important knowledge gaps regarding the utilization of concussion severity scales, management of youth concussion, and/or the use of neurological imaging modalities for diagnosing concussion cases.

Screening for Relative Energy Deficiency in Sport and Female Athlete Triad: A Survey of Pediatric Sports Medicine Professionals

BACKGROUND: Relative Energy Deficiency in Sport, or RED-S, is a multi-scale physiological response to a mismatch between energy intake and exercise energy expenditure that affects up to 50% of adolescent athletes. RED-S symptomology was first described as the Female Athlete Triad (the Triad) and includes specifically low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density. Despite the wide impact of RED-S/the Triad, there is a lack of standardization of screening in adolescent athletes. Therefore, the purpose of this study was to assess if there are differences in practitioner demographics when screening for RED-S/the Triad in adolescent athletes. In addition, we sought to assess if providers’ screening habits differ based on specific patient characteristics. METHODS: We conducted a cross-sectional online questionnaire of members of the Pediatric Research in Sports Medicine (PRiSM) Society. PRiSM is an interdisciplinary group of professionals who are dedicated to advancing the research and medical care of young athletes. The questionnaire assessed screening tools that members used to assess for RED-S/the Triad, practices implemented when providers were concerned for RED-S/the Triad, demographic data, and type of training. RESULTS: Of 389 PRiSM members, 60 completed the survey and were included in subsequent analyses (15% response rate). Most participants were primary care sports medicine physicians (37%), orthopaedic surgeons (27%), or physical therapists (23%), and about half of respondents identified as a cis gender woman (55%). There was a trend toward more women screening for RED-S routinely than men (55% vs. 33%: p=0.10), and orthopaedic surgeons were less likely to screen than other specialties (25% vs. 52%, p = 0.06). Eating disorders (88%), menstrual dysfunction (76%), and bone stress injury (74%) were reported as specific red flags that make providers screen for RED-S/the Triad. Participants reported that lack of time (57%) and lack of resources (37%) were barriers to screen for RED-S/the Triad. The most commonly utilized tools to screen for RED-S/the Triad were the Female Athlete Screening Tool (FAST), Female Athlete Triad Risk Scale, Female Athlete Triad Consensus Panel Screening questions, and RED-S Specific Screening Tool (RST). CONCLUSION: Orthopaedic surgeons were less likely than other health care professionals to screen for RED-S/the Triad. Barriers that prevent healthcare providers from screening for RED-S/the Triad included limited time and resources. By describing current practices, we have identified gaps and areas of need to enhance screening for RED-S/the Triad across multiple sports medicine disciplines.

Exercise quantification from single camera view markerless 3D pose estimation

Sports physiotherapists and coaches are tasked with evaluating the movement quality of athletes across the spectrum of ability and experience. However, the accuracy of visual observation is low and existing technology outside of expensive lab-based solutions has limited adoption, leading to an unmet need for an efficient and accurate means to measure static and dynamic joint angles during movement, converted to movement metrics useable by practitioners. This paper proposes a set of pose landmarks for computing frequently used joint angles as metrics of interest to sports physiotherapists and coaches in assessing common strength-building human exercise movements. It then proposes a set of rules for computing these metrics for a range of common exercises (single and double drop jumps and counter-movement jumps, deadlifts and various squats) from anatomical key-points detected using video, and evaluates the accuracy of these using a published 3D human pose model trained with ground truth data derived from VICON motion capture of common rehabilitation exercises. Results show a set of mathematically defined metrics which are derived from the chosen pose landmarks, and which are sufficient to compute the metrics for each of the exercises under consideration. Comparison to ground truth data showed that root mean square angle errors were within 10° for all exercises for the following metrics: shin angle, knee varus/valgus and left/right flexion, hip flexion and pelvic tilt, trunk angle, spinal flexion lower/upper/mid and rib flare. Larger errors (though still all within 15°) were observed for shoulder flexion and ASIS asymmetry in some exercises, notably front squats and drop-jumps. In conclusion, the contribution of this paper is that a set of sufficient key-points and associated metrics for exercise assessment from 3D human pose have been uniquely defined. Further, we found generally very good accuracy of the Strided Transformer 3D pose model in predicting these metrics for the chosen set of exercises from a single mobile device camera, when trained on a suitable set of functional exercises recorded using a VICON motion capture system. Future assessment of generalization is needed.

ACHILLES RUPTURES AND RETURN TO SPORT IN GYMNASTICS: AN OVERVIEW

Achilles tendon ruptures in collegiate gymnastics have significantly increased in the past few years, with 20 ruptures in the first three weeks of competition alone in 2020 according to Bonanno et al., 2022. Female gymnasts are ten times more likely to tear their Achilles than any other college athletes, with an incidence of 16.73/100,000. Men’s basketball has the next highest incidence at 4.26/100,000 (Bonanno et al., 2022). Contributing factors for the increase in ruptures are not well researched or understood. This paper will explore the relevant literature on the risk factors of tears and return to sport protocols. It will touch on early rehab but mainly focus on return to sport testing and progression for gymnastics from a physical therapy perspective. It will explore topics discussed in interviews with numerous sports physical therapists with extensive gymnastics or collegiate athletics experience. Gymnastics is a very technical sport where each athlete has individual skills with different biomechanical requirements; therefore, needs vary between athletes. This paper aims to address the transition phase between the time when surgical protocols allow a return to sport and the actual return to performance during recovery. In this specific domain, there is an ongoing need for prospective, longitudinal studies to investigate testing and outcome measures tailored to gymnastics. These studies can play a crucial role in guiding athletes, trainers, coaches, and therapists in facilitating a safe and effective return to performance after surgery.

To allow or avoid pain during shoulder rehabilitation exercises for patients with chronic rotator cuff tendinopathy-Study protocol for a randomized controlled trial (the PASE trial)

BackgroundRotator cuff (RC) tendinopathy is the most reported shoulder disorder in the general population with highest prevalence in overhead athletes and adult working-age population. A growing body of evidence support exercise therapy as an effective intervention, but to date there are no prospective randomized controlled trials addressing pain as an intervention variable.MethodsA single-site, prospective, pragmatic, assessor-blinded randomized controlled superiority trial. Eighty-four patients aged 18–55 years with chronic (symptom duration over 3 months) RC tendinopathy are randomized 1:1 to receive shoulder exercise during which pain is either allowed or avoided. The intervention period lasts 26 weeks. During that period, participants in both groups are offered 8 individual on-site sessions with an assigned sports physiotherapist. Participants perform home exercises and are provided with a pain and exercise logbook and asked to report completed home-based exercise sessions and reasons for not completing sessions (pain or other reasons). Patients are also asked to report load and the number of sets and repetitions per sets for each exercise session. The logbooks are collected continuously throughout the intervention period. The primary and secondary outcomes are obtained at baseline, 6 weeks, 26 weeks, and 1 year after baseline. The primary outcome is patient-reported pain and disability using the Shoulder PAin and Disability Index (SPADI). Secondary outcomes are patient-reported pain and disability using Disability Arm Shoulder and Hand short-form (Quick DASH), and shoulder pain using Numeric Pain Rating Scale. Objective outcomes are shoulder range of motion, isometric shoulder muscle strength, pain sensitivity, working ability, and structural changes in the supraspinatus tendon and muscle using ultrasound.DiscussionThe results of this study will contribute knowledge about the treatment strategies for patients with RC tendinopathy and help physiotherapists in clinical decision-making. This is the first randomized controlled trial comparing the effects of allowing pain versus avoiding pain during shoulder exercises in patients with chronic RC tendinopathy. If tolerating pain during and after exercise proves to be effective, it will potentially expand our understanding of “exercising into pain” for this patient group, as there is currently no consensus.Trial registrationClinicalTrials.gov NCT05124769. Registered on August 11, 2021.

Assessment of Self-report, Palpation, and Surface Electromyography Dataset During Isometric Muscle Contraction

Measuring muscle fatigue involves assessing various components within the motor system. While subjective and sensor-based measures have been proposed, a comprehensive comparison of these assessment measures is currently lacking. This study aims to bridge this gap by utilizing three commonly used measures: participant self-reported perceived muscle fatigue scores, a sports physiotherapist’s manual palpation-based muscle tightness scores, and surface electromyography sensors. Compensatory muscle fatigue occurs when one muscle group becomes fatigued, leading to the involvement and subsequent fatigue of other muscles as they compensate for the workload. The evaluation of compensatory muscle fatigue focuses on nine different upper body muscles selected by the sports physiotherapist. With a cohort of 30 male subjects, this study provides a valuable dataset for researchers and healthcare practitioners in sports science, rehabilitation, and human performance. It enables the exploration and comparison of diverse methods for evaluating different muscles in isometric contraction.

Safeguarding in sports physiotherapy

Sports physiotherapists work in very close contact with athletes, both on and off the field of play. In this challenging sporting context, they often have to find a balance between pushing the limits in rehabilitation/training and staying within the limits of a safe and ethical proper management of the athletes. Sports physiotherapists have also access to a unique perspective of behaviours not only of the athlete, but of all other individuals interacting with the athlete. Therefore, recognition of potentially abusive behaviours is an important component of education, as well as developing the communication skills to address issues appropriately. Mentored practice may be the best training for sports physiotherapists to acquire the necessary skills and behaviours in the complex sporting environment.

Before hitting the slopes: athlete and staff perspectives on warm-up and activation in high-performance snowsports

To explore warm-up and activation (W&A) practices in high-performance snowsports to describe their importance, application and potential improvements based on the perspectives of elite-level athletes and staff members. Qualitative study...

Ab. No. 98 Development and Validation of a Questionnaire for Assessment of Awareness and Knowledge About Parasports Among Parents of Children With Disabilities

Introduction: Physiotherapists play a significant role in improving the overall well-being of children with disability by engaging them in exercise programs, sports, or recreational activities. To promote their participation in physical activity, para-sports is one of the avenues. Since parents are the primary caregivers, it is important to assess their level of awareness and knowledge about para-sports. As an initiative, it is crucial to develop and construct a standard tool that can measure the level of awareness and knowledge about parasports among the parents of children with disabilities. Methods: The panel members for questionnaire validation were Sports Medicine Physicians, Physiotherapists (Academicians and clinicians), Para-Athletes and Parents. The process of developing and constructing the questionnaire involved an extensive literature search, development of questionnaire structure and item generation. The questionnaire format, items format and questionnaire length were determined. The initial items were reviewed and revised later. After a preliminary pilot study, face validity and content validity were done. The face validation was done by three members and content validation was done by five members of the panel. Results: The identified domains under Awareness were sources, opportunity, eligibility, facility and under Knowledge were benefits, challenges, programs and events. After the validation process, the final questionnaire contained 16 questions under 8 domains with 2 closed-ended questions each. Conclusion: Based on the validators’ consensus, the questionnaire was considered understandable and relevant to measure the important aspects of awareness and knowledge about parasports in the targeted population. Implications: Subsequent validation can be processed and the questionnaire can be administered to assess the level of awareness and knowledge among the parents of children with disability.

Revolution of Sports Physiotherapist: A Brief Insights About Key Roles and Significance

Revolution of Sports Physiotherapist: A Brief Insights About Key Roles and Significance

Utilizing MSK Ultrasound for Comprehensive Assessment of the Femoral Trochlea: A Game Changer in Sports Medicine.

Musculoskeletal (MSK) ultrasound has emerged as a valuable tool for sports physical therapists in the assessment and treatment of various knee pathologies. Its ability to provide high-resolution images of soft tissue and superficial bone surfaces makes it especially useful for sports physical therapists and orthopedic clinicians. Specifically, MSK-ultrasound is increasingly recognized as a potent tool for the assessment of the femoral trochlea. Its non-invasive nature and dynamic imaging capabilities make it particularly suited for visualizing the femoral trochlea, a critical component in knee function and biomechanics. The use of MSK ultrasound in the evaluating the femoral trochlea provides sports medicine professionals with a dynamic, non-invasive, and cost-effective means to diagnose, and monitor knee-related injuries. This article delves into the utility of MSK ultrasound in the anatomical and functional assessment of the femoral trochlea, elucidating its benefits, limitations, and clinical implications for athletes.