bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Implementation of Therapeutic Alliance in the Rehabilitation of an Elite Pediatric Athlete with Salter-Harris Fracture: A Case Report
Authors: VanEtten Lucas , Briggs Matthew , DeWitt John , Mansfield Cody , Kaeding Christopher 
Published: April 2021

Background/Purpose Although research on the value of therapeutic alliance is prominent in other areas of health care, physical therapy research is limited. The purpose is to describe the incorporation of therapeutic alliance concepts throughout the rehabilitation of an elite pediatric athlete with a complicated recovery following a fracture to the distal femoral epiphysis. Case Description A 14-year-old male was referred to physical therapy following an open reduction and internal fixation to address a type IV Salter-Harris fracture of the right distal femoral epiphysis. Post-operative care included immobilization in a brace for six weeks and he initiated physical therapy for four weeks (post-op weeks 6-10). At 10-weeks post-injury his range of motion and strength were severely limited compared to expected post-operative milestones. Due to these deficits an arthroscopic debridement of the subject’s right knee, hardware removal, and manipulation under anesthesia was performed. The subject then reported to the physical therapist on post-operative day three for evaluation and treatment without bracing or weight-bearing restrictions. Outcomes The episode of care spanned 17 weeks and included 25 physical therapy sessions. To facilitate therapeutic alliance with the subject, clear communication and easily measurable goals were established and connected to the subject’s relevant needs as an athlete. The plan of care was divided into three phases using “chunking” techniques to establish the rehabilitation priorities. The subject demonstrated improved range of motion, strength and was able to return to hydroplane racing and won a national championship in his age group. Discussion The unique aspect of this case was the incorporation of therapeutic alliance concepts and techniques into the rehabilitative management of a subject with a complicated fracture to the distal femoral epiphysis. The physical therapist built trust with the subject and facilitated a successful return to elite hydroplane boat racing. Level of Evidence 4 Study Design Case Report
Post-operative Rehabilitation for Scapular Muscle Reattachment: A Case Report
Authors: Burke Wendy , Kibler W Ben , Uhl Tim L 
Published: April 2021

Background and Purpose Scapular muscle detachment is a rare orthopedic problem that has been described in the literature in patients following traumatic events involving traction, direct trauma, or a motor vehicle accident. The purpose of this case report is to describe the post-operative rehabilitation following scapular muscle reattachment surgery. Unique to this case report is the patient’s perspective, an orthopedic physical therapist with 25 years of experience. Case Description A 47-year-old female physical therapist experienced a traction injury to bilateral upper extremities during a medical procedure resulting in bilateral rhomboid, and bilateral lower trapezius muscles were detached from the medial scapular border. Reconstruction of the left scapulothoracic musculature occurred five and one-half years post-injury with the right repaired one year later. This case report describes the rehabilitation program that took one-year to recover for each arm with a period of protected motion for 16-weeks and gradual return to function as a manual physical therapist over a period of one-year. Outcomes The American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form and pain-free range of motion was used pre- and postoperatively. Left and right shoulder pre-operative ASES scores were 68 and 72, respectively. At the one-year post-operative the left shoulder was rated at 82 and the right shoulder was 90. Pain-free range of motion was achieved in both arms by one year. Functional limitations requiring strength overhead were the slowest to return and were not completely back at one year following either surgery. Discussion Rehabilitation protocols for scapular muscle reattachment surgery are not commonly available to allow physical therapists to guide their patients and structure a rehabilitation program. This case report provides a sample pre-operative set of educational guidelines and a post-operative protocol for use after scapular reattachment surgery. This case report is unique because it offers a patient perspective who is a physical therapist and underwent this surgery twice. Therefore, providing insight on how to prepare for such a unique operation. The slow recovery is due to three issues 1) the prolonged time from injury to diagnosis created significant muscle wasting and muscular imbalance of surrounding tissues, 2) once this tissue was repaired it requires months of protection to recover, 3) the involved scapulothoracic muscle have to regain adequate strength as the foundation for upper extremity functions. Level of evidence Level 5
Proximal Hamstring Tendinopathy: A Systematic Review of Interventions
Authors: Nasser Anthony Michael , Vicenzino Bill , Grimaldi Alison , Anderson Jay , Semciw Adam Ivan 
Published: April 2021

Background Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management. Purpose/Hypothesis To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy. Study design Systematic review Methods Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials [RCT]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines. Results Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term. Conclusions There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies. Level of evidence Level 2a
Comparison of Common Methodologies for the Determination of Knee Flexor Muscle Strength
Authors: Ogborn Dan I , Bellemare Alix , Bruinooge Brittany , Brown Holly , McRae Sheila , Leiter Jeff 
Published: April 2021

Background Knee flexion strength may hold important clinical implications for the determination of injury risk and readiness to return to sport following injury and orthopedic surgery. A wide array of testing methodologies and positioning options are available that require validation prior to clinical integration. The purpose of this study was to 1) investigate the validity and test-retest reliability of isometric knee flexion strength measured by a fixed handheld dynamometer (HHD) apparatus compared to a Biodex Dynamometer (BD), 2) determine the impact of body position (seated versus supine) and foot position (plantar- vs dorsiflexed) on knee flexion peak torque and 3) establish the validity and test-retest reliability of the NordBord Hamstring Dynamometer. Study Design Validity and reliability study, test-retest design. Methods Forty-four healthy participants (aged 27 ± 4.8 years) were assessed by two raters over two testing sessions separated by three to seven days. Maximal isometric knee flexion in the seated and supine position at 90o knee flexion was measured with both a BD and an externally fixed HHD with the foot held in maximal dorsiflexion or in plantar flexion. The validity and test-retest reliability of eccentric knee flexor strength on the NordBord hamstring dynamometer was assessed and compared with isometric strength on the BD. Results Level of agreement between HHD and BD torque demonstrated low bias (bias -0.33 Nm, SD of bias 13.5 Nm; 95% LOA 26.13 Nm, -26.79 Nm). Interrater reliability of the HHD was high, varying slightly with body position (ICC range 0.9-0.97, n=44). Isometric knee flexion torque was higher in the seated versus supine position and with the foot dorsiflexed versus plantarflexed. Eccentric knee flexion torque had a high degree of correlation with isometric knee flexion torque as measured via the BD (r=0.61-0.86). The NordBord had high test-retest reliability (0.993 (95%CI 0.983-0.997, n=19) for eccentric knee flexor strength, with an MDC95 of 26.88 N and 28.76 N for the left and right limbs respectively. Conclusion Common measures of maximal isometric knee flexion display high levels of correlation and test-retest reliability. However, values obtained by an externally fixed HHD are not interchangeable with values obtained via the BD. Foot and body position should be considered and controlled during testing. Level of Evidence 2b
Sex and Age Comparisons in Neuromuscular And Biomechanical Characteristics of the Knee in Young Athletes
Authors: Pletcher Erin R , Dekker Travis J , Lephart Scott M , Sell Tim C 
Published: April 2021

Background The identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs. Hypothesis/Purpose This study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes. Study Design Cross-sectional Methods Forty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic knee flexion and extension strength tests, single-leg static balance and single-leg vertical stop jump tasks. Results High school athletes were significantly stronger (~67% and 35% stronger for males and females, respectively) and jumped higher (regardless of sex) compared to school age athletes. High school males had worse balance (~28%) compared to their younger counterparts. High school females had lower strength (~23%) compared to males but had better balance (~46%). Conclusion: Maturation had different effects on the variables analyzed and sex differences were mainly observed after maturation. These differences may be minimized through appropriate age and sex specific training programs. Levels of Evidence 3a Clinical Relevance Neuromuscular and biomechanical differences between sex and age groups should be accounted for in injury prevention and rehabilitation. Inadequate training may be a primary factor contributing to injuries in a young athletic population. When designing training programs for long term athlete development, programs should be dependent on decrements seen at specific time points throughout maturation. What is known about the subject: Generally, both males and females get stronger and jump higher as they get older but the results comparing balance and biomechanics between genders or across age groups have been mixed. What this study adds to existing knowledge: The current study looks at multiple neuromuscular and biomechanical variables in male and female participants at different maturation statuses. The current data supports the significant changes observed in strength and jump height, as both genders age, but the data also demonstrates significant differences in balance between age groups in males and between genders in balance and knee flexion angles.
Hip Abduction Strength: Relationship to Trunk and Lower Extremity Motion During A Single-Leg Step-Down Task in Professional Baseball Players
Authors: Zipser M. Christopher , Plummer Hillary A , Kindstrand Nathan , Sum Johnathan C , Li Bernard , Michener Lori A 
Published: April 2021

Background The single-leg step down task (SLSD) is a clinical tool to assess movement and control of the lower extremity and trunk. Hip abduction weakness may impact movement quality during the SLSD, however the relationships between movement and strength are unclear. Purpose To determine the relationship between hip abduction isometric strength and movement during the SLSD of trunk lean, pelvic drop, knee valgus, and hip flexion. Study Design Cross sectional, cohort study Methods One hundred-eighteen Minor League baseball players (age=21.6 ± 2.0 years; n=68 pitchers, n=50 position players) participated. Bilateral hip abduction isometric strength was measured using a handheld dynamometer (HHD), and then multiplied by distance from the greater trochanter to the HHD and expressed as hip abduction torque. Video cameras captured the SLSD, with participants standing on one leg while lowering their contralateral heel to touchdown on the floor from a 0.203m (8in.) step. Trunk lean, trunk flexion, pelvic drop, knee valgus, and hip flexion were measured using Dartfish at heel touchdown. A value of 180° indicated no knee valgus. Pearson correlations examined the relationships between hip abduction torque and SLSD motions. Results There were no significant correlations for position players. For pitchers, on the lead leg increased hip abduction torque weakly correlated with a decrease in knee valgus (r= 0.24, p=0.049). Also for pitchers on the trail leg, increased hip abduction torque weakly correlated with decreased pelvic drop (r= -0.28, p=0.021). Conclusion Hip abduction strength contributes to dynamic control of the trunk and legs. Specifically in pitchers, hip abduction weakness was related to increased movement of the lower extremity and lumbopelvic regions during the dynamic SLSD task. These deficits could translate to altered pitching performance and injury. Levels of Evidence 2.
Time Course of Acute Hip Adduction Range of Motion Changes Following Foam Rolling
Authors: D’Amico Anthony , Silva Kevin , Gallo Joseph 
Published: April 2021

Background With the increased popularity of foam rolling (FR), it is important to establish the exact manner in which the practice is useful. Purpose The purpose of this study was to examine the impact of FR the iliotibial (IT) band on hip adduction range of motion (ROM) and the short-term time course of any ROM changes that may occur. Method In a within-subject design, 34 subjects (21 female, 13 male) (female mean age 24.67 ± 8.6 yrs, height 161.4 ± 9.8 cm, mass 67.3 ± 12.3 kg; male mean age 22 ± 2.5 yrs, height 170.2 ± 8.2 cm, mass 76.3 ± 21.9 kg) underwent a baseline Ober’s test to measure hip adduction ROM prior to the FR and control conditions. Subjects rolled the lateral portion of each thigh for 3 bouts of 20 seconds. A tempo of 3 seconds down and 3 seconds up the leg was maintained across FR bouts. A 5-minute walk served as the control condition. The Ober’s test was repeated at less than 1 minute, 3 minutes, 10 minutes, 15 minutes, and 20 minutes following the FR bouts and the control to assess changes in hip adduction ROM over time. A blinded clinician conducted the Ober’s test. A two-way analysis of variance was used to assess differences by condition and time. Results No differences in hip adduction ROM were found at baseline between FR and CON within subjects (27.9 cm ± 7.5 vs. 27.7 cm ± 6.6, p > .05). Ober’s test ROM was significantly greater in FR compared to CON immediately post-treatment (24.2 cm ± 6.3 vs. 28.2 cm ± 6.3, p = .00, d = .59), and 3 minutes post (24.6 cm ± 7.6 vs. 28.3 cm ± 5.9, p = .00, d = .56). No differences were observed 10 minutes post, 15 minutes post, or 20 minutes post FR or CON (p > .05). Discussion Compared to walking, FR the IT band significantly increased hip adduction ROM as measured by the Ober’s test. These increases appear to dissipate between 3 and 10 minutes post-FR. Conclusion An acute bout of 3 sets of 20 seconds of FR may be effective for transiently increasing ROM. Whether these short-term increases have implications for chronic flexibility changes is unclear. Level of evidence 2
Comparative Pitching Biomechanics Among Adolescent Baseball Athletes: Are There Fundamental Differences Between Pitchers and Non-pitchers?
Authors: Bullock Garrett , Hulburt Tessa C , Collins Gary , Waterman Brian R , Nicholson Kristen F 
Published: April 2021

Background Approximately 25% of youth baseball players pitch, with most young athletes predominately playing multiple positions. While some youth baseball players may primarily pitch, other players may only pitch on occasion, potentially creating a pitching skill level discrepancy. Understanding potential kinematic and kinetic differences between pitching and non-pitching baseball players can inform injury risk reduction strategies for amateur athletes. Purpose/Hypothesis To analyze differences in pitching biomechanics for fastballs, breaking balls, and change-ups in adolescent youth baseball players that identify as pitchers and non-pitchers. Study Design Retrospective cross-sectional study Methods Baseball players were designated as pitchers or non-pitchers, who then threw fastballs (FB), breaking balls (BB), and change-ups (CH) during a biomechanical assessment. T-tests, Mann-Whitney U tests, and ANOVAs with Bonferroni correction, and effect sizes (ES) were performed. Results Sixty baseball players (pitchers = 40; non-pitchers = 20; Age: 15.0 (1.1); Left-handed: 15%; Height 1.77 (0.09) m; Weight: 70.0 (12.5) kg) threw 495 pitches (FB: 177, BB: 155, CH: 163) for analysis. Pitchers threw 2 m/s faster and produced greater trunk rotation velocity (ES: 0.71 (95% CI: 0.39, 1.30, p<0.0001) than non-pitchers. Furthermore, pitchers demonstrated greater ground reaction force for FB compared to CH (ES: 0.48 (95% CI: 0.01, 0.94), p<0.0001). No other biomechanical differences were observed between pitchers and non-pitchers or between pitch types. Conclusion Despite throwing at greater velocity for all pitch types, baseball players that identify primarily as pitchers had overall similar kinematics and kinetics in comparison to baseball players that primarily identify as non-pitchers. Self-identified pitching baseball athletes have improved force transfer strategies for ball propulsion, utilizing different force production and attenuation strategies across different pitch types when compared to non-pitchers. Coaches should consider that novice pitchers may potentially have dissimilar trunk and ground reaction strategies in comparison to primary pitchers when designing appropriate pitch loading and recovery strategies. Level of Evidence 3
Screening to Detect Hip and Groin Problems in Elite Adolescent Football (Soccer) Players – Friend or Foe?
Authors: DeLang Matthew D , Garrison J. Craig , Thorborg Kristian 
Published: April 2021

Injury prevention strategies in team settings should not overlook early detection and secondary prevention. Monitoring systems may be an effective approach to detect common and troublesome injuries, such as hip and groin pain in football (soccer) players. The purpose of this International Perspective is to share our experiences with monitoring hip and groin pain in youth academy football and discuss challenges that surfaced. We consider why players may not accurately report pain, their perceptions of groin pain, and whether all groin pain is clinically meaningful. Level of Evidence 5
Lower Extremity Kinematics of the Y-Balance Test in Healthy and ACL Injured Adolescent Females
Authors: Bulow Alison , Bellemare Alixandra , Anderson Judy E , Leiter Jeff R S , MacDonald Peter B , Peeler Jason D 
Published: April 2021

Background Adolescent females are at significant risk for sustaining an ACL injury. The Y-Balance Test (YBT) is frequently used to evaluate neuromuscular control and lower extremity function. However, few studies have quantified 2D lower extremity kinematics during performance of the YBT, and there is an absence of kinematic data specific to at-risk adolescent females. Purpose To examine lower extremity joint kinematics during execution of the YBT by healthy and ACL-injured adolescent females. Study Design Prospective cohort. Methods Twenty-five healthy and ten ACL-injured (mean time from injury 143 days) adolescent females were assessed using the YBT. Sagittal and frontal plane knee and ankle motion was video recorded during execution of the YBT anterior reach movement. Ankle dorsi-flexion, knee flexion, and knee valgus angles were quantified via kinematic analysis. ANOVAs with a post hoc Bonferroni correction were used to compare YBT scoring (%LL) and kinematic data between groups. Pearson product-moment correlations determined the relationship between kinematic data and YBT scoring. Results Healthy and ACL-injured subjects demonstrated similar YBT scores and lower extremity kinematic data. Healthy subjects demonstrated a weak positive correlation between ankle dorsiflexion and YBT scoring, and a weak negative correlation between knee valgus and YBT scoring. These relationships did not exist for ACL-injured subjects. Kinematic data for both groups also demonstrated a large degree of variability, regardless of YBT score. Conclusions Adolescent females frequently utilize a variety of lower extremity movement strategies when performing a functional movement task, and scoring on the YBT offers limited insight regarding lower extremity joint kinematics and ACL-injury risk in a physically active adolescent female population. Level of Evidence Level 3.