| 1. |
- Ardern, Clare, 1985-, et al.
(författare)
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2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern
- 2016
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:14, s. 853-864
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Tidskriftsartikel (refereegranskat)abstract
- Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.
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| 2. |
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| 3. |
- Hébert-Losier, Kim
(författare)
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An Investigation of the Influence of Knee Flexion Angle on the Activity of the Triceps Surae Muscles during the Heel-Raise Test
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The heel-raise test (HRT) is used in clinical practice and research to assess the triceps suare (TS) muscles. The test involves repetitive unilateral heel-raises in upright stance. The test is administered with the knee straight for gastrocnemius medialis (GM) and lateralis (GL), and with the knee bent for soleus (SOL). The maximum number of heel-raises which can be performed is utilised as a clinical outcome measure and informs clinical decisions. The use of knee flexion (KF) to direct HRT assessment towards SOL or GAST currently relies on fundamental principles and has a limited evidence-base. Aims: The primary aim of this research was to investigate the influence of KF angle on SOL, GM, and GL activity and fatigue during the HRT. Secondary aims were to explore the total number of heel-raises completed, and the influence of age group on TS muscle activity and fatigue. Methods: Specific literature reviews were undertaken to contextualise the HRT within a comprehensive anatomical and biomechanical framework, and the experimental research involved a sequence of biomechanical studies. Seventeen subjects participated in a preliminary study that involved heel-raise testing to fatigue in two KF positions and generalised estimation equations were used to determine whether select KF angles were maintained. Forty-eight subjects, stratified by age and gender, participated in the main experimental study. Surface electromyography (EMG) activity of SOL, GM, and GL during maximum voluntary isometric contractions (MVIC) was collected in 0°KF, 45°KF, and 90°KF to inform EMG normalisation. Subjects then completed 10 unilateral heel-raises in 0°KF and 45°KF to investigate EMG amplitudes (% of MVIC) and heel-raises to fatigue for power spectrum analysis (median frequency and normalised slope). Mixed-effects models and stepwise regressions were used for the main analysis. Results: The preliminary study identified that select KF angles were reasonably well maintained during testing and subjects completed an average of 40 heel-raises in the two KF positions. The investigation of (EMG) muscle activity during MVIC developed a normalisation protocol specific to capturing SOL, GM, and GL peak activity. Data collected from heel-raises demonstrated higher SOL (p=.005) and lower GM (p<.001) and GL (p<.001) amplitudes in 45°KF rather than 0°KF; however, KF did not influence fatigue of the individual TS muscles. GM and GL fatigued at the same rate (p=.088), to the same extent (p=.385), and faster than SOL (p<.001) in both angles. GM (p=.008), but not GL (p=.118), fatigued more than SOL. Similar maximum numbers of heel-raises were performed in 0°KF (n=45) and 45°KF (n=48). Age did not influence any of the variables analysed. Conclusion: The research results question the common utilisation of KF to direct the HRT towards SOL or GAST assessment. Although influences of KF on EMG amplitudes were statistically significant, they may not be clinically meaningful. KF did not influence TS fatigue or the total number of heel-raises. While these findings do not imply the absence of clinical or rehabilitative benefits from HRT procedures in select KF positions, the evidence challenges the common perceptions and definitions that the test assesses SOL with the knee bent and GAST with the knee straight.
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| 4. |
- Hébert-Losier, Kim, et al.
(författare)
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Analysis of knee flexion angles during 2 clinical versions of the heel raise test to assess soleus and gastrocnemius function.
- 2011
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 41:7, s. 505-13
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Controlled laboratory study, using a repeated-measures, counterbalanced design. OBJECTIVES: To provide estimates on the average knee angle maintained, absolute knee angle error, and total repetitions performed during 2 versions of the heel raise test. BACKGROUND: The heel raise test is performed in knee extension (EHRT) to assess gastrocnemius and knee flexion (FHRT) for soleus. However, it has not yet been determined whether select knee angles are maintained or whether total repetitions differ between the clinical versions of the heel raise test. METHODS: Seventeen healthy males and females performed maximal heel raise repetitions in 0° (EHRT) and 30° (FHRT) of desired knee flexion. The average angle maintained and absolute error at the knee during the 2 versions, and total heel raise repetitions, were measured using motion analysis. Participants' kinematic measures were fitted into a generalized estimation equation model to provide estimates on EHRT and FHRT performance applicable to the general population. RESULTS: The model estimates that average angles of 2.2° and 30.7° will be maintained at the knee by the general population during the EHRT and the FHRT, with an absolute angle error of 3.4° and 2.5°, respectively. In both versions, 40 repetitions should be completed. However, the average angles maintained by participants ranged from -6.3° to 21.6° during the EHRT and from 22.0° to 43.0° during the FHRT, with the highest absolute errors in knee position being 25.9° and 33.5°, respectively. CONCLUSION: On average, select knee angles will be maintained by the general population during the select heel raise test versions, but individualized performance is variable and total repetitions do not distinguish between versions. Clinicians should, therefore, interpret select heel raise test outcomes with caution when used to respectively assess and rehabilitate soleus and gastrocnemius function.
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| 5. |
- Hébert-Losier, Kim, et al.
(författare)
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December 2011 Letters to the Editor-in-Chief : Differentiating the Soleus From the Gastrocnemius With the Heel Raise Test
- 2011
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - 0190-6011 .- 1938-1344. ; 41:12, s. 983-7
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Tidskriftsartikel (refereegranskat)abstract
- Letters to the Editor-in-Chief of JOSPT as follows:"Early Prognostic Factors in Patients With Whiplash" and Author's Response "Staying Current in the Use of Ultrasound Imaging" and Author's Response"Differentiating the Soleus From the Gastrocnemius With the Heel Raise Test" and Author's ResponseJ Orthop Sports Phys Ther 2011;41(12):983-987. doi:10.2519/jospt.2011.0202.
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| 6. |
- Hébert-Losier, Kim, et al.
(författare)
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December 2011 Letters to the Editor-in-Chief.
- 2011
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 41:12, s. 983-7
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Tidskriftsartikel (refereegranskat)abstract
- Letters to the Editor-in-Chief of JOSPT as follows:"Early Prognostic Factors in Patients With Whiplash" and Author's Response "Staying Current in the Use of Ultrasound Imaging" and Author's Response"Differentiating the Soleus From the Gastrocnemius With the Heel Raise Test" and Author's ResponseJ Orthop Sports Phys Ther 2011;41(12):983-987. doi:10.2519/jospt.2011.0202.
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| 7. |
- Hébert-Losier, Kim, et al.
(författare)
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Influence of knee flexion angle and age group on triceps surae muscle fatigue during heel-raises.
- 2012
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Ingår i: Journal of Strength and Conditioning Research. - 1064-8011 .- 1533-4287. ; 26:11, s. 3134-3147
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Tidskriftsartikel (refereegranskat)abstract
- The triceps surae muscle-tendon unit is one of the most commonly injured in elite and recreational athletes, with high prevalence in middle-age adults. Performing maximal numbers of unilateral heel-raises is used to assess, train, and rehabilitate triceps surae endurance; and conventionally prescribed in 0° knee flexion for gastrocnemius and 45° for soleus. However, the extent of muscle-selectivity conferred through change in knee angle is lacking for heel-raises performed to volitional fatigue. This study investigated the influence of knee angle on triceps surae muscle fatigue during heel-raises and determined whether fatigue differed between middle-age and younger-age adults. Forty-eight healthy individuals of 18-25 and 35-45 years performed maximal numbers of unilateral heel-raises in 0° and 45° knee flexion. Median frequencies and linear regression slopes were calculated from soleus, gastrocnemius medialis, and gastrocnemius lateralis surface electromyographic signals. Stepwise mixed-effect regressions were used for analysis. Subjects completed an average of 45 and 48 heel-raises in 0° and 45° knee flexion; respectively. Results indicated that the three muscles fatigued during testing as all median frequencies decreased and regression slopes were negative. Consistent with muscle physiology and fiber typing, fatigue was greater in gastrocnemius medialis and lateralis than soleus (p<.001). However, knee angle did not influence triceps surae muscle fatigue parameters (p=.814), with similar soleus and gastrocnemius fatigue in 0° and 45° knee flexion. These findings contrast with the traditionally described clinical use of heel-raises in select knee angles for gastrocnemius and/or soleus. Furthermore, no difference in triceps surae fatigue between the two age groups was able to be determined, despite the reported higher prevalence of injury in middle-age individuals.
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| 8. |
- Hébert-Losier, Kim, et al.
(författare)
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Peak triceps surae muscle activity is not specific to knee flexion angles during MVIC.
- 2011
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Ingår i: Journal of Electromyography & Kinesiology. - : Elsevier BV. - 1050-6411 .- 1873-5711. ; 21:5, s. 819-26
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Tidskriftsartikel (refereegranskat)abstract
- There is limited research on peak activity of the separate triceps surae muscles in select knee flexion (KF) positions during a maximum voluntary isometric contraction (MVIC) used to normalize EMG signals. The aim of this study was to determine how frequent peak activity occurred during an MVIC for soleus (SOL), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in select KF positions, and if these peaks were recorded in similar KF positions. Forty-eight healthy individuals performed unilateral plantar-flexion MVIC in standing with 0°KF and 45°KF, and in sitting with 90°KF. Surface EMG of SOL, GM, and GL were collected and processed in 250 ms epochs to determine peak root-mean-square amplitude. Peak activity was most frequently captured in standing and rarely in sitting, with no position selective to SOL, GM or GL activity. Peak GM and GL activity was more frequent in 0°KF than 45°KF, and more often in similar KF positions than not. Peak SOL activity was just as likely in 45°KF as 0°KF, and more in positions similar to GM, but not GL. The EMG amplitudes were at least 20% greater in positions that captured peak activity over those that did not. The overall findings support performing an MVIC in more than one KF position to normalize triceps surae EMG. It is emphasized that no KF position is selective to SOL, GM, or GL alone.
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| 9. |
- Hébert-Losier, Kim, 1985-, et al.
(författare)
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Raising the standards of the calf-raise test : a systematic review.
- 2009
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Ingår i: Journal of science and medicine in sport / Sports Medicine Australia. - : Elsevier BV. - 1878-1861 .- 1440-2440. ; 12:6, s. 594-602
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Tidskriftsartikel (refereegranskat)abstract
- The calf-raise test is used by clinicians and researchers in sports medicine to assess properties of the calf muscle-tendon unit. The test generally involves repetitive concentric-eccentric muscle action of the plantar-flexors in unipedal stance and is quantified by the number of raises performed. Although the calf-raise test appears to have acceptable reliability and face validity, and is commonly used for medical assessment and rehabilitation of injuries, no universally acceptable test parameters have been published to date. A systematic review of the existing literature was conducted to investigate the consistency as well as universal acceptance of the evaluation purposes, test parameters, outcome measurements and psychometric properties of the calf-raise test. Nine electronic databases were searched during the period May 30th to September 21st 2008. Forty-nine articles met the inclusion criteria and were quality assessed. Information on study characteristics and calf-raise test parameters, as well as quantitative data, were extracted; tabulated; and statistically analysed. The average quality score of the reviewed articles was 70.4+/-12.2% (range 44-90%). Articles provided various test parameters; however, a consensus was not ascertained. Key testing parameters varied, were often unstated, and few studies reported reliability or validity values, including sensitivity and specificity. No definitive normative values could be established and the utility of the test in subjects with pathologies remained unclear. Although adapted for use in several disciplines and traditionally recommended for clinical assessment, there is no uniform description of the calf-raise test in the literature. Further investigation is recommended to ensure consistent use and interpretation of the test by researchers and clinicians.
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| 10. |
- Hébert-Losier, Kim, et al.
(författare)
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Scientific bases and clinical utilisation of the calf-raise test.
- 2009
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Ingår i: Physical Therapy in Sport. - : Elsevier BV. - 1466-853X .- 1873-1600. ; 10:4, s. 142-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Athletes commonly sustain injuries to the triceps surae muscle-tendon unit. The calf-raise test (CRT) is frequently employed in sports medicine for the detection and monitoring of such injuries. However, despite being widely-used, a recent systematic review found no universal consensus relating to the test's purpose, parameters, and standard protocols. OBJECTIVES: The purpose of this paper is to provide a clinical perspective on the anatomo-physiological bases underpinning the CRT and to discuss the utilisation of the test in relation to the structure and function of the triceps surae muscle-tendon unit. DESIGN: Structured narrative review. METHODS: Nine electronic databases were searched using keywords and MESH headings related to the CRT and the triceps surae muscle-tendon unit anatomy and physiology. A hand-search of reference lists and relevant journals and textbooks complemented the electronic search. SUMMARY: There is evidence supporting the clinical use of the CRT to assess soleus and gastrocnemius, their shared aponeurosis, the Achilles tendon, and the combined triceps surae muscle-tendon unit. However, employing the same clinical test to assess all these structures and their associated functions remains challenging. CONCLUSIONS: Further refinement of the CRT for the triceps surae muscle-tendon unit is needed. This is vital to support best practice utilisation, standardisation, and interpretation of the CRT in sports medicine.
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| 11. |
- Mendonca, Luciana De Michelis, et al.
(författare)
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Sports injury prevention programmes from the sports physical therapists perspective: An international expert Delphi approach
- 2022
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Ingår i: Physical Therapy in Sport. - Oxford, United Kingdom : Elsevier. - 1466-853X .- 1873-1600. ; 55, s. 146-154
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports.Design: Delphi.Setting: LimeSurvey platform.Participants: Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries.Main outcome measures: Factors related to sports IPP planning, organization and implementation.Results: We included 305 participants from 32 countries. IPP planning should be based on an athletes injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athletes age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement).Conclusion: Strong consensus was reached on (1) IPP based on the athletes injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athletes age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.
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| 12. |
- Schneiders, Anthony G, et al.
(författare)
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Functional movement screenTM normative values in a young, active population
- 2011
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Ingår i: International journal of sports physical therapy. - 2159-2896. ; 6:2, s. 75-82
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Functional Movement ScreenTM (FMSTM) is a screening instrument which evaluates selective fundamental movement patterns to determine potential injury risk. However, despite its global use, there are currently no normative values available for the FMSTM. Objectives: To establish normative values for the FMSTM in a population of active, healthy individuals. Secondary aims were to investigate whether performance differed between males and females, between those with and without a previous history of injury, and to establish real-time inter-rater reliability of the FMSTM. Methods: Two hundred and nine (108 females and 101 males) physically active individuals, aged between 18 and 40 years, with no recent (<6 weeks) history of musculoskeletal injury were recruited. All participants performed the FMSTM and were scored using the previously established standardized FMSTM criteria. A representative sub-group participant sample (28%) determined inter rater reliability. Results: The mean composite FMSTM score was 15.7 with a 95% confidence interval between 15.4 and 15.9 out of a possible total of 21. There was no statistically significant difference in scores between females and males (t 207= .979, p = .329), or those who reported a previous injury and those who did not (t207 = .688, p= .492). Inter-rater reliability (ICC 3,1) for the composite FMSTM score was .971, demonstrating excellent reliability. Inter-rater reliability (Kappa) for individual test components of the FMSTM demonstrated substantial to excellent agreement (0.70 — 1.0). Discussion and Conclusion: This cross-sectional study provides FMSTM reference values for young, activeindividuals, which will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors.
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| 13. |
- Schneiders, Anthony G., et al.
(författare)
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The effect of footwear and sports-surface on dynamic neurological screening for sport-related concussion
- 2010
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Ingår i: Journal of Science and Medicine in Sport. - : Elsevier BV. - 1440-2440 .- 1878-1861. ; 13:4, s. 382-386
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Tidskriftsartikel (refereegranskat)abstract
- The Sport Concussion Assessment Tool (SCAT) is a standardised global assessment for the identification of sport-related concussion (SRC). An integral component of the SCAT is the neurological screen, which contains the assessment of motor performance including gait evaluation. However, it is not known how performance of gait is affected by the surface/footwear interactions encountered in various sporting environments. The purpose of this study was to investigate the effect of footwear and sporting surface on the time to perform a standardised Tandem Gait (TG) task. One hundred and eight amateur athletes were recruited, and three common sports-surfaces (grass, hardwood court, artificial turf) were compared. All groups were tested barefoot and with sports-surface specific footwear. Mixed model ANOVA, controlling for covariates and including a post hoc Bonferroni procedure, was used to investigate the influence of footwear and sports-surface on TG time. The study demonstrated that times for a defined TG task in healthy athletes depended on footwear, sports-surface, and the specific athletic population. The study demonstrated a significant interaction (F(2.104) = 3.35, p = 0.039) between groups (grass, hardwood court and artificial turf), and times were faster wearing footwear compared to barefoot (F(2.138) = 26.31, p = 0.001). In contrast to the footwear conditions, there was no statistical difference between the barefoot conditions on any of the sport-surfaces. These findings suggest that clinicians should standardise footwear and the testing surface at baseline in order to accurately assess motor performance tests when SRC is suspected.
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