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Context: After anterior cruciate ligament (ACL) reconstruction (ACLR), athletes commonly undergo prolonged rehabilitation (eg, 9-12 months), but few actually return to preinjury sports activities. The nature (composition, configuration) of an ACL rehabilitation program (ACL-RP) is an important factor in determining rehabilitation outcomes; however, details about the nature of ACL-RPs are reported inconsistently in research studies. To guide future research reporting to support clinical translation and implementation of ACL-RPs, it is necessary to describe the nature, reporting, and outcomes of ACL-RPs in the current literature. Objective: The purpose of this scoping review was to understand the nature and reporting of various ACL-RPs that address musculoskeletal, biomechanical, functional, or patient-reported outcome measures in adult and pediatric athletes with ACLR. Data Sources: Articles were selected from searches in 5 electronic databases (PubMed, EbscoHost [MEDLINE, SportDiscus, CINAHL Plus], PROQuest, Cochrane, and Embase). Study Selection: Studies were included if they evaluated a post-ACL-RP that implemented strength, balance, plyometric, change of direction running, and/or agility running and included self-reported physical function, quality of life, or pain outcomes. Study Design: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Level of Evidence: Level 4. Data Extraction: Data were extracted and synthesized to evaluate the reporting of acute program variables (APVs) and exercise descriptors (EDs); 17 studies were included in the final synthesis. Results: Studies reported between 0% and 67% of the APVs and EDs combined. Only 2 studies were considered to have adequate reporting of both APVs and EDs. Conclusion: Inadequate reporting of APVs and EDs in past studies restricts the translation and implementation of existing research-based ACL-RPs to present-day clinical contexts. [ABSTRACT FROM AUTHOR]

Context: Single- versus double-leg landing events occur the majority of the time in a netball match. Landings are involved in large proportions of netball noncontact knee injury events. Of all landing-induced anterior cruciate ligament injuries, most occur during single-leg landings. Knowledge of whether different single-leg functional performance tests capture the same or different aspects of lower-limb motor performance will therefore inform clinicians' reasoning processes and assist in netball noncontact knee injury prevention screening. Objective: To determine the correlation between the triple hop for distance (THD), single hop for distance (SHD), and vertical hop (VH) for the right and left lower limbs in adult female netball players. Design: Cross-sectional. Setting: Local community netball club. Participants: A total of 23 players (age 28.7 [6.2] y; height 171.6 [7.0] cm; mass 68.2 [9.8] kg). Interventions: There were 3 measured trials (right and left) for THD, SHD, and VH, respectively. Main Outcome Measures: Mean hop distance (percentage of leg length [%LL]), Pearson intertest correlation (r), and coefficient of determination (r2). Results: Values (right and left; mean [SD]) were as follows: THD, 508.5 (71.8) %LL and 510.9 (56.7) %LL; SHD, 183.4 (24.6) %LL and 183.0 (21.5) %LL; and VH, 21.3 (5.2) %LL and 20.6 (5.0) %LL. All correlations were significant (P ≤.05), r/r2 values (right and left) were THD–SHD,.91/.83 and.87/.76; THD–VH,.59/.35 and.51/.26; and SHD–VH,.50/.25 and.37/.17. A very large proportion of variance (76%–83%) was shared between the THD and SHD. A small proportion of variance was shared between the THD and VH (25%–35%) and SHD and VH (17%–25%). Conclusion: The THD and SHD capture highly similar aspects of lower-limb motor performance. In contrast, the VH captures aspects of lower-limb motor performance different to the THD or SHD. Either the THD or the SHD can be chosen for use within netball knee injury prevention screening protocols according to which is reasoned as most appropriate at a specific point in time. The VH, however, should be employed consistently alongside rather than in place of the THD or SHD. [ABSTRACT FROM AUTHOR]

Introduction: Quadriceps muscle weakness is implicated in the onset and persistence of patellofemoral joint (PFJ) pain, which commonly manifests during the early stance-phase of gait when eccentric quadriceps muscle performance (ecc- QMP) is required to decelerate momentum and shock-absorb forces away from articular tissues. Therefore, assessment of eccQMP is prudent in PFJ primary and secondary injury prevention, but reliable measurement procedures are scarce in the literature. Objective: To assess critical psychometric properties of a new isokinetic eccQMP assessment procedure linked closely to the biomechanics of gait during stair and hill descent, using a specific knee range-of-motion and velocity-of-motion (specificity of testing1). It was hypothesised that procedures would demonstrate good intra-rater reliability (intraclass correlation coefficient [ICC] ≥0.75). Study design: Between-day (D1/D2) repeated measures. Setting: biomechanics laboratory. Study population: eight athletes volunteered (male n=6, female n=2, age 23.0±3.6yr; height 157.0±35.8cm; mass 86.0±36.4kg). Assessment: athletes were seated on an isokinetic dynamometer set to eccentric mode. For specificity of testing, dynamometer configuration was knee flexion/extension range-of-motion 10-80° and velocity-of-motion 60°/s then 120°/s. Three maximal-effort knee flexion (eccQMP) trials were performed for both velocities. Peak torque (PT; Newton-metres [Nm]) and time-to-peak torque (TTPT; milliseconds [ms]) were measured. Limb order was ran- domised for D1 then repeated D2. Main outcome measurements: relative reliability (ICC 2,1) and absolute reliability (standard error of measurement (SEM)). Results: For 60°/s: PT ICC/SEM, right 0.95/13.5Nm, left 0.98/10.2Nm; TTPT ICC/SEM, right 0.12/1121.0ms, left 0.12/666.3ms. For 120°/s: PT ICC/SEM, right 0.85/23.8Nm, left 0.96/15.1Nm; TTPT ICC/SEM, right 0.76/174.4ms, left 0.05/694.7ms. Conclusion: For both 60°/s and 120°/s, eccentric PT consistently demonstrated good relative reliability (ICC>0.75) but TTPT did not (ICC<0.75). The SEM was consistently lowest when the highest ICCs were evident. The new isokinetic eccentric quadriceps PT assessment procedures demonstrate psychometric properties that qualify them for potential use in PFJ primary and secondary injury prevention. [ABSTRACT FROM AUTHOR]

Introduction: Noncontact anterior cruciate ligament (ACL) injuries occur frequently during change-of-direction/landing tasks when eccentric muscle performance is required to decelerate momentum and shock-absorb forces away from noncontractile tissues. Therefore, assessment of knee eccentric muscle performance is prudent in noncontact ACL injury prevention screening, but reliable measurement procedures are scarce in the literature. Objective: To assess critical psychometric properties of a new knee isokinetic eccentric muscle performance assessment procedure linked closely to noncontact ACL injury mechanisms and using a specific knee range-of-motion and velocity-of-motion (specificity of testing.1,2 It was hypothesised that procedures would demonstrate good intra-rater reliability (intraclass correlation coefficient [ICC] ≥0.75). Study design: Between-day (D1/D2) repeated measures. Setting: biomechanics laboratory. Study population: 12 agility-sport athletes volunteered (male n=7, female n=5, age 23.5±4.6yr; height 170.0±10.1cm; mass 75.7±12.3kg). Assessment: athletes were seated on an isokinetic dynamometer set to eccentric mode. For specificity of testing, dynamometer configuration was knee flexion/extension range-of-motion 0-60° and velocity-of-motion 240°/second. Five maximal-effort knee flexion (eccentric quadriceps) and extension (eccentric hamstrings) trials were performed. Peak torque (PT; Newton-metres [Nm]) and time-to-peak torque (TTPT; milliseconds [ms]) were measured. Limb order was randomised for D1, the order repeated for D2. Main outcome measurements: relative reliability (ICC 2,1), absolute reliability (standard error of measurement [SEM]). Results: For eccentric quadriceps PT ICC/SEM: right 0.76/22.8Nm, left 0.78/19.0Nm. For eccentric quadriceps TTPT ICC/SEM: right 0.07/213.0ms, left 0.13/316.3ms. For eccentric hamstrings PT ICC/SEM: right 0.92/13.7Nm, left 0.96/8.0Nm. For eccentric hamstrings TTPT ICC/SEM: right 0.74/12.5ms, left 0.41/16.6ms. Conclusion: For both eccentric quadriceps and hamstrings, PT consistently demonstrated good relative reliability (ICC>0.75) but TTPT did not (ICC<0.75). Interestingly, right and left eccentric hamstring TTPT absolute reliability (SEM) were <17.0ms. These new knee isokinetic eccentric PT assessment procedures possess critical psychometric properties that qualify them for use in ACL injury prevention screening systems with adult agility-sport athletes. [ABSTRACT FROM AUTHOR]

Context: The cervical spine can be divided into upper and lower units, each making a different contribution to the magnitude of rotation and proprioception. However, few studies have examined the effect of the cervical-rotation positions on proprioception. Objective: To compare cervical-spine rotation active joint-position sense (AJPS) near midrange of motion (mid-ROM; 30°) and near end-ROM (60°). Design: Cross-sectional study. Setting: Human performance research laboratory. Participants: 53 military helicopter pilots (age 28.4 ± 6.2 y, height 175.3 ± 9.3 cm, weight 80.1 ± 11.8 kg). Main Outcome Measures: A motion-analysis system was used to record cervical-rotation kinematics. Subjects sat in a chair wearing a headband and blindfold. First, they actively rotated the head right or left to a target position (30760°), with real-time verbal cues provided by the tester. Subjects held the target position for 5 s and then returned to the start position. After this, they replicated the target position as closely as possible. Five trials were performed in both directions to both target positions (R30/R60/L30/L60). Order of direction/position was randomized. The difference between target and replicated positions was calculated and defined as absolute error (AE), and the mean of 5 trials was used for analyses. Wilcoxon signed-ranks tests were used to compare AJPS at the different target positions (P< .0125 with Bonferroni adjustments). Results: End-ROM AEs were significantly more accurate than mid-ROM AEs (P = .001). Conclusion: Cervical-spine-rotation AJPS is more accurate near end-ROM than mid-ROM. Both target positions should be used to examine cervical-spine-rotation AJPS of both the upper and lower units. [ABSTRACT FROM AUTHOR]

Netball is a team sport played worldwide. High-risk landing events containing biomechanical potential for noncontact knee soft-tissue injury (STI) occur frequently. Subsequently, noncontact knee STI is common after knee abduction collapse during landing tasks. Lower-limb mobility, strength, balance, movement, and hop test characteristics (intrinsic, modifiable risk factors) are associated with high-risk landing biomechanics and noncontact knee STI events. Such risk factors should be considered in netball-specific noncontact knee STI prevention preparticipation screening. Corresponding training methods should be included as indicated in netball-specific multimodal noncontact knee STI prevention programs. This article provides insight into noncontact knee injury-related aspects of netball and gives detailed suggestions for injury prevention screening and programming. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal issues facing military helicopter pilots. It is clinically important to identify differences in musculoskeletal characteristics between pilots with and without a LBP history for formulating effective interventions. OBJECTIVE: To compare lumbar spine and hip flexibility and trunk strength in pilots with and without a LBP history. METHODS: A total of 30 pilots with a LBP history were matched with pilots without a LBP history. An isokinetic dynamometer and a digital inclinometer were used to evaluate trunk and hip strength and a range-of-motion (ROM), respectively. All tests were performed bilaterally, if applicable, and agonist/antagonist ratios and side-to-side (low/high) symmetries were calculated. Paired t-tests or Wilcoxon tests were used to assess group differences (p < 0.050). RESULTS: The LBP group demonstrated significantly lower trunk extension strength and trunk extension/flexion strength ratio (p < 0.008). The LBP group demonstrated significantly less lateral flexion ROM as well as greater lateral flexion and rotation side-to-side asymmetry (p < 0.009). The LBP group demonstrated significantly greater total hip rotation side-to-side asymmetry (p = 0.037). CONCLUSIONS: Given the results, specific exercises that are targeted to improve trunk strength, ROM, and side-to-side symmetries could be developed to reduce LBP in helicopter pilots. [ABSTRACT FROM AUTHOR]

Background: Firefighter physical fitness (PF) plays a crucial role in mitigating health issues and supporting occupational performance. The influence of rank on firefighter PF remains understudied and previous research is often limited by small sample sizes of firefighters volunteering for research studies, potentially biasing results towards fitter firefighters not representative of entire departments., Objective: To examine the PF profile of firefighters in a large urban fire department and the influence of age and rank on PF., Methods: Data, including muscular fitness, estimated aerobic capacity (VO2max), and body fat percentage (BF%) measures from 1361 firefighters (90% male; age: 37.4±10.1yrs; 60 recruits, 973 firefighters, 290 lieutenants/captains, 38 chiefs) were analyzed. Correlation and ANCOVAs were conducted to examine the impact of rank on PF while controlling for age. Score distributions were scrutinized to profile the PF of the department., Results: Age was negatively associated with pull-ups (r = - 0.39), sit-ups (r = - 0.39), and push-ups (r = - 0.32), but positively associated with relative VO2max (r = 0.17) and BF% (r = 0.39). Rank had a statistically significant, but trivial effect size, on pull-ups (p = 0.028, η2 = 0.007) and sit-ups (p = 0.034, η2 = 0.005). Firefighters with lower PF levels were older, had higher BF%, lower fat-free mass, and were a greater proportion of females., Conclusions: Firefighters exhibited diverse levels of PF. Age, not rank, appeared to influence firefighters' PF. The findings that firefighters who were older, female, with poorer body composition are more likely to have lower PF levels highlights the need for individualized PF training to enhance occupational performance and health across the fire department.

Little is known about knee function after anterior cruciate ligament reconstruction in the vital activities of walking and stair use. Gait analysis was done on patients 6 months (n = 8) and 12 months (n = 9) after reconstruction of the anterior cruciate ligament. Paired t tests were used to compare the injured and uninjured knees. During level walking, the patients placed external flexion torques on their injured knees throughout midstance, indicating the absence of quadriceps avoidance gait. The peak external flexion torque (resisted by the knee extensor muscles) placed on the injured knee was significantly less than that of the uninjured knee when ascending stairs (at 12 months, 68.4 and 85.3 N-m in the injured and uninjured knees, respectively) and also when descending stairs (at 12 months, 70.8 and 81.7 N-m in the injured and uninjured knees, respectively). The injured knee produced significantly less power than the uninjured knee when ascending stairs, but this difference was not significant when descending stairs. These findings indicate that asymmetric gait patterns persisted up to 1 year after surgical reconstruction and were more pronounced during stair ascent and descent than in level walking. These results indicate that clinicians should include specific interventions targeted at improving knee function during stair use to restore normal function after anterior cruciate ligament reconstruction.