Background:Criterion-based assessment of shoulder function includes screenings, such as the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), to help identify deficits in stability, neuromuscular control, and proprioception. However, normative performance for the CKCUEST has been predominantly established in elite and collegiate athletes, and it has been shown that arm length, sex, and weight may influence performance. Purpose:To compare performance and establish agreement between standard versus arm-length-normalized testing positions in adolescent athletes and establish population-specific reference values. Study Design:Cross Sectional. Methods:Healthy athletes (ages 14-18 years) recruited from local teams, clubs, and youth sports organizations performed two conditions of the CKCUEST, standard and arm-length-normalized. Performance differences were evaluated using a Wilcoxon signed-rank test, with effect sizes (r), while agreement between conditions was assessed using intraclass correlation coefficients and Bland-Altman analysis. Spearman correlations were used to assess associations with participant demographics and Mann-Whitney U tests were performed to compare contact versus overhead athletes. Results:One hundred fifty-four athletes (120 male, 16.5±1.2 years, 75.8±18.0 kg) participating in baseball, football, lacrosse, volleyball, basketball, water polo, and tennis were included for analysis. Performance was greater on the arm-length-normalized condition (standard: 23.0±5.8 taps; normalized: 23.9±5.5 taps, p<0.001). Agreement between conditions was good (ICC=0.86, 95%CI=0.80-0.90). The average change between conditions was -0.86±2.92 [-12.00-8.00], and 53.9% of participants performed better on the arm-length-normalized condition. Contact athletes performed more taps (standard: 25.0±6.0 taps; normalized: 25.3±5.9 taps) than overhead (standard: 20.2±4.2 taps; normalized: 21.9±4.5 taps, p<0.001) athletes. Conclusion:Performance on the arm-length-normalized condition was greater than performance at the standard distance condition in healthy adolescent athletes. The influence of arm length, body mass, and sport type suggests the arm-length-normalized condition is more suitable for assessment and differences between sport types highlights the importance of population-specific measures and reference values. Level of Evidence:3.
# Background Calcific tendinopathy can be difficult to diagnose and manage from a traditional, non-invasive physical therapy perspective. However, there is preliminary evidence supporting the use of diagnostic ultrasound and dry needling interventions to evaluate and treat the pain and disability associated with this chronic condition. The purpose of this case report was to describe the integration of diagnostic ultrasound in the successful evaluation and multi-modal treatment of a patient with calcific patellar tendinopathy. # Case Presentation A 46-year-old active female with a six-week history of anterior knee pain, presented to the physical therapy clinic for a direct-access evaluation. The history and physical examination were consistent with the diagnosis of patellar tendinopathy. Diagnostic ultrasound confirmed the presence of patellar tendinopathy with multiple calcifications at the inferior pole of the patella. Treatment progression included spinal/extremity manipulation, ultrasound guided needle fenestration, electrical dry needling, and exercise. Outcomes included the numeric pain rating scale (NPRS), lower extremity functional scale (LEFS), Global Rating of Change (GROC), strength, and assessment of tissue healing with diagnostic ultrasound. # Outcomes The patient was treated for 18 visits over 24 weeks. The multi-modal intervention resulted in clinically meaningful reductions in the NPRS and LEFS, with optimal recovery to strength training. Reductions in calcific foci and tendon tissue healing was also confirmed with diagnostic ultrasound. Outcomes were tracked at 3, 6, 9, and 11-months.
# Background Peroneal muscles are the primary stabilizers against ankle inversion movements associated with lateral ankle sprains. Individuals with chronic ankle instability (CAI) demonstrate peroneal muscle deficits including decreased strength, slower nerve conduction velocity, and reduced cross-sectional area. Ultrasound (US) imaging provides a valid, cost-effective method to assess peroneal muscle size and quality following rehabilitation. # Hypothesis/Purpose To determine peroneal muscle size and quality changes using US imaging following impairment-based rehabilitation in patients with CAI. # Study Design Prospective cohort study. # Methods Twenty-six patients with CAI (age: 21.9 ± 3.5 years; 18 females, 8 males) completed an 8-session, 4-week impairment-based rehabilitation program addressing range of motion, balance, strength, and functional performance deficits with emphasis on peroneal activation exercises. US imaging assessed peroneal muscle cross-sectional area (CSA) in sidelying and bipedal stance positions and echogenicity (a measure of muscle quality) in bipedal stance for both limbs before and after rehabilitation. Paired t-tests were used to compare pre- and post-rehabilitation values. # Results Significant (p < 0.01) increases in CSA were observed in the trained limb during sidelying (3.44 ± 0.99 to 3.72 ± 0.98 cm²) and bipedal stance (3.46 ± 1.05 to 4.31 ± 0.98 cm²) positions. Similar CSA increases occurred in the untrained limb. Echogenicity significantly decreased in the trained limb (70.2 ± 9.91 to 65.7 ± 8.68, p = 0.01), indicating improved muscle quality, with no significant changes in the untrained limb. # Conclusion An 8-session, 4-week impairment-based rehabilitation program resulted in significant peroneal muscle CSA increases in patients with CAI, with cross-education effects observed in the untrained limb. Muscle quality, as measured by echogenicity, improved in the trained limb, supporting neuromuscular benefits of targeted rehabilitation. Impairment-based rehabilitation should be incorporated into CAI management programs. # Level of Evidence 3
The glenoid labrum surrounds the glenoid fossa augmenting its depth and diameter. Along with the glenohumeral capsule and ligaments, it is crucial for shoulder stability. Glenoid labral injuries are very common due to both sports and trauma to the shoulder. When torn the labrum can cause shoulder instability, pain and dysfunction, causing a limitation of function for many essential shoulder movements used in daily living. Lesions of the glenoid labrum require an accurate diagnosis so that decisions about conservative versus surgical treatment can be determined. An accurate diagnosis of labral tears is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) has become an imaging modality that is widely used in the assessment of several shoulder pathologies. It offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating glenoid labral tissue. In fact, almost the entire labrum can be visualized using MSKUS. This manuscript will review the utility of MSKUS in evaluating glenoid labrum tissue quality, sonographic techniques, and clinical implications for those in the rehabilitation profession. By integrating MSKUS into clinical practice, providers can improve the accuracy of diagnosis, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to optimal patient outcomes for those with glenoid labral injuries.
# Background Handheld dynamometry (HHD) has been recommended in return-to-play (RTP) assessments following shoulder injuries; however, variations in testing methods limits interpretation of results. In contrast, isokinetic dynamometry is considered gold-standard for assessment of strength but is less accessible than HHD. Further assessment is needed to identify which shoulder HHD testing positions best reflect isokinetic dynamometry values and can be used to guide RTP practices in adolescent athletes. # Purpose To compare HHD strength values of shoulder internal rotators (IR) and external rotators (ER) to isokinetic values in healthy youth athletes. # Study Design Cross Sectional # Methods Healthy, youth athletes aged 14-18 years with no history of upper extremity musculoskeletal or neuromuscular conditions or injuries in the prior six months were recruited from local teams, clubs, and youth sports organizations. Participants completed strength testing on dominant (DOM) and non-dominant (NON) limbs in three HHD testing positions: prone, seated, and supine. Isokinetic testing (Biodex) was completed seated at 60 degrees/second. Differences between Biodex measures and HHD conditions, as well as between HHD conditions, were evaluated using Wilcoxon signed-rank tests with effect sizes (r) and intraclass correlation coefficients (ICCs). # Results A total of 64 participants (37 male; 16.8±1.0 years) participating in primarily football, baseball, lacrosse, volleyball, and basketball were included for analysis. Seated HHD for IR differed from Biodex on both limbs (p<0.001) and from prone on the non-dominant limb (p<0.001). Between HHD positions for the IR's, seated differed from prone and supine bilaterally (DOM: p<0.001; NON: p<0.001). For the ER’s, HHD measures differed from Biodex in all positions (DOM: p<0.001; NON: p<0.001). Between ER HHD positions, seated differed from prone and supine bilaterally (DOM: p<0.001; NON: p<0.001). Agreement between Biodex and HHD positions was consistently small for ER (DOM: ICCs=0.28-0.43; NON: 0.29-0.38) and was strongest in prone for IR (DOM: ICC=0.81, 95%CI=0.69-0.88; NON: ICC=0.84, 95%CI=0.65-0.92). # Conclusion This study demonstrated that HHD shows agreement with isokinetic dynamometry for strength of the shoulder IR’s in adolescent athletes when assessed in prone or supine; however, HHD is poorly correlated with isokinetic strength measures of the ER’s. # Level of Evidence 3
Adductor-related athletic groin pain (ARAGP) is a common condition in athletes participating in multidirectional, high-intensity sports. It is challenging to diagnose and manage due to complex regional anatomy and overlapping clinical presentations. ARAGP represents the most frequently reported subtype of athletic groin pain and contributes substantially to time loss from play and performance limitation. This clinical commentary synthesizes current evidence related to the anatomy, risk factors, pathomechanics, imaging considerations, prevention strategies, rehabilitation principles, and return-to-sport decision-making in athletes with ARAGP. Established risk factors include prior groin injury, reduced eccentric hip adduction strength, hip adduction-to-abduction strength imbalances, and reduced hip range of motion. Diagnostic imaging, including magnetic resonance imaging and ultrasound, plays an important role in confirming injury location and severity when clinical findings are equivocal. Current evidence supports progressive strengthening, eccentric loading, neuromuscular training, and structured prevention programs in reducing injury incidence and facilitating safe return to participation. While movement assessment and strength profiling may aid clinical decision-making, further research is needed to clarify injury mechanisms and optimize screening and prevention strategies. The purpose of this clinical commentary is to provide clinicians and sports performance professionals with an evidence informed framework for the recognition, management, and risk reduction of adductor related athletic groin pain (ARAGP). # Level of Evidence 5
Background:The Functional Lower Extremity Evaluation (FLEE) is a validated assessment tool designed to assess lower limb function and symmetry. There is a gap in knowledge in return to sport (RTS) regarding the application of the FLEE in RTS rehabilitation protocols following hip arthroscopy. The purpose of this case series was to assess the utility of the FLEE in guiding RTS rehabilitation protocols for collegiate athletes after hip arthroscopy and to evaluate lower limb symmetry using FLEE components. Hypothesis:Among collegiate athletes recovering from hip arthroscopy, the Functional Lower Extremity Evaluation (FLEE) will detect measurable differences in limb symmetry and will provide clinically meaningful guidance for return-to-sport rehabilitation. Study design: Retrospective case series. Methods:A retrospective review of collegiate athletes who had undergone hip arthroscopy for femoroacetabular impingement (FAI) was performed at a single institution between January 2012 to January 2024. Inclusion criteria were completion of post-operative rehabilitation with full FLEE testing at return-to-sport clearance. The eight-task FLEE assessment was administered postoperatively beginning at 4 months. Percent limb symmetry was calculated for each component. RTS, re-injury and re-operations rates were monitored for a mean of 52.9 weeks postoperatively. Descriptive statistics were calculated for demographic variables, FLEE component scores, and percent limb symmetry. Continuous variables were summarized as means and standard deviations, while categorical variables were presented as frequencies and percentages. Results:Four collegiate athletes (3 males, 1 female; mean age - 19 years) were included, representing football (n=2), basketball (n=1) and swimming and diving (n=1). Athletes demonstrated improvements in all FLEE components following rehabilitation, achieving RTS clearance at a mean of 5.75 months ± 1.44 months. All athletes returned to competitive sports at the same or higher level. No re-injuries or re-operations occurred at a mean follow-up of 52.89 months. Limb symmetry ranged from 97.95% to 110.04% across FLEE components. Conclusion:The FLEE may be a valuable instrument for assessing lower extremity function and symmetry in college athletes undergoing RTS rehabilitation after hip arthroscopy. These findings suggest that the FLEE may aid in guiding individualized rehabilitation programs and monitoring progress towards RTS goals. Larger, prospective studies are warranted to validate these findings. Level of Evidence:Level IV Case Series.
Background:Current recommendations for quadriceps and hamstring peak torque normalized to body mass after anterior cruciate ligament reconstruction are derived from athletes in the second and third decades of life. There is a paucity of literature exploring the relationship between sex, age, and peak torque normalized to body mass. Purpose:The purpose of this study was to examine the relationship between age and isokinetic quadriceps and hamstring peak torque normalized to body mass, as well as the hamstrings-to-quadriceps ratio (H:Q ratio), and to evaluate differences between sexes, using the uninvolved limb from pre-ACLR testing. Study Design:Retrospective review of prospectively collected data. Methods:Three hundred twenty-one athletes were identified in the UW Health Sports Rehabilitation Database that had a planned anterior cruciate ligament reconstruction and had undergone pre-operative isokinetic testing of their quadriceps and hamstrings at 60°/sec on their uninvolved limb between July 2021 and January 2026. For reporting purposes, athletes were grouped into the following age groups: 10-14, 15-19, 20-29, 30-39, 40-49, and 50+. Linear regression models were used to examine the relationships between age (continuous), sex (binary), and their interaction on quadriceps peak torque normalized to body mass (Nm/kg), hamstring peak torque normalized to body mass (Nm/kg), and the H:Q ratio. Results:There is a linear decrease in quadriceps (β = -0.016 Nm/kg per year, p < 0.001) and hamstring (β = -0.009 Nm/kg per year, p < 0.001) peak torque normalized to body mass with age. Males have higher mean quadriceps and hamstring peak torque normalized to body mass at all ages compared to females, although this difference was not statistically significant. Age explained 25% and 24% of the variance in normalized peak torque for the quadriceps and hamstrings, respectively. H:Q ratios stayed relatively the same with age and sex. Conclusion:As athletes age, their quadriceps and hamstrings peak torque normalized to body mass decreases. Clinicians should acknowledge these differences when making recommendations throughout anterior cruciate ligament reconstruction rehabilitation. Level of Evidence:Level 3.
The additional value of neuromuscular electrical stimulation (NMES) during contract-relax proprioceptive neuromuscular facilitation (PNF-CR) stretching remains unclear, particularly in adolescent athletes. It is also unknown whether combining PNF-CR with motor-threshold NMES improves hamstring flexibility more than a sensory-threshold comparator without impairing vertical jump performance. # Purpose To compare the acute effects of PNF-CR combined with motor-threshold NMES versus sensory-threshold NMES on hamstring flexibility and to assess the impact of both interventions on vertical jump performance. # Study Design Randomized controlled trial. # Methods Forty-seven youth soccer players (mean age: 13.2 ± 1.8 years) were randomly assigned to one of two groups. Both groups received the same single-session PNF-CR stretching protocol. The experimental group (n = 23) received motor-level NMES during the contraction phases, whereas the placebo group (n = 24) received sensory-level NMES during the same PNF-CR protocol. Hamstring flexibility was assessed using the Popliteal Angle (PA) and Sit-and-Reach (SR) tests, while vertical jump performance was evaluated via the Countermovement Jump (CMJ) test. Analyses followed an intention-to-treat approach. Time, group, and time × group effects were examined using two-way repeated-measures ANOVA with Bonferroni-adjusted post hoc comparisons; CMJ was additionally analyzed using ANCOVA adjusted for baseline values. # Results Both groups showed statistically significant pre-post improvements in SR and PA scores. Specifically, PA decreased in the experimental group by 4.0° (95% CI: 1.4 to 6.5; p = 0.003) and by 3.1° (95% CI: 0.5 to 6.0; p = 0.018) in the placebo group. SR increased by 2.7 cm (95% CI: 1.9 to 3.6; p < 0.001) in the experimental group and 2.8 cm (95% CI: 1.9 to 3.7; p < 0.001) in the placebo group. No significant between-group differences were found for either flexibility outcome. Regarding CMJ, no significant intra- or intergroup changes were observed (p > 0.05). # Conclusion The addition of motor-threshold NMES to a PNF-CR stretching protocol does not yield superior acute flexibility gains. Moreover, neither intervention negatively affected jump performance in this athletic population, supporting their safe and potentially beneficial application in pre-training contexts for adolescent soccer players. # Level of Evidence 1b.
# Background Recovery after anterior cruciate ligament reconstruction (ACLR) involves both physical and psychological challenges. Although psychological readiness for return to sport (RTS) is increasingly recognized as important, less is known about how patients experience psychological barriers during rehabilitation and how interactions with physiotherapists (PTs) may shape this process. # Purpose To explore how patients recovering from ACLR navigate potential psychological barriers, what helps them overcome these barriers, and how they experience the role of PTs in enhancing their psychological readiness. # Study Design Qualitative interview # Methods Nine patients (5 women, 4 men), aged 19-45 years, from Norway and the Netherlands, 5-9 months post-ACLR, were recruited for individual semi-structured interviews. Data were analyzed using systematic text condensation. # Results Three themes emerged: (1) The Mental Landscape of Rehabilitation - confidence builds through physical progress amidst emotional setbacks; (2) Pillars of Support - professional and social support, especially from PTs, helps manage fear and build trust; (3) Lessons Learned Along the Way - patients develop insight, resilience, and personalized strategies for mental recovery. Psychological readiness was experienced as a dynamic process shaped by physical progress, emotional responses, support systems, and interactions with PTs. # Conclusion Psychological readiness should be viewed as an evolving component of ACLR recovery, shaped by patients’ experiences, support systems, and interactions with PTs. These findings highlight the importance of a holistic and individualized rehabilitation approach that acknowledges mental barriers, supports confidence-building, and considers referral to mental health professionals when needed. # Level of evidence 5 (Qualitative Study)
# Background Golf is commonly regarded as a low-impact sport, yet the golf swing generates multiplanar loads across both knees. No validated return-to-golf protocol after anterior cruciate ligament reconstruction (ACLR) has been published, and general return-to-sport timelines do not address golf-specific swing volume, club progression, lead- versus trail-knee demands, or return-to-course exposure. # Purpose The purpose of this clinical commentary is to synthesize the available golf-biomechanics and ACLR-rehabilitation evidence and present an evidence-informed, criteria-based progression from putting through unrestricted course play. # Study Design Clinical Commentary/Current Concept Review. # Methods A targeted narrative search of PubMed/MEDLINE and reference lists was performed through June 2026 for literature addressing golf and knee biomechanics, golf-swing modifications, ACLR rehabilitation and return-to-sport criteria, and graft healing. Recommendations were classified as direct golf-biomechanics evidence, indirect ACLR-rehabilitation evidence, or author-consensus guidance when direct evidence was unavailable. # Results No study prospectively evaluated a staged return-to-golf protocol after ACLR. Available evidence indicates that both knees experience meaningful loading throughout the golf swing, with the lead knee subjected to substantial frontal-plane moments and transverse-plane rotational loading during impact and follow-through, while the trail knee also experiences meaningful loading during the backswing and transition. Longer clubs, greater clubhead speed, and larger or faster pressure shifts may increase loading demands across both lower extremities. A six-phase progression is proposed using universal symptom and range-of-motion requirements, objective strength and movement criteria, prescribed swing volumes, lead- and trail-knee considerations, and a separate return-to-course phase. # Conclusion Return to golf after ACLR should be managed as a continuum rather than a single clearance decision. Time from surgery provides a biologic safeguard but should not replace assessment of effusion, pain, motion, gait, strength, movement quality, workload tolerance, and confidence. The proposed protocol is intended to guide clinical decision-making and requires prospective validation. # Level of Evidence 5
The carpal tunnel is a fibro-osseous canal at the wrist that is formed by the retinaculum and bony structures. The superficial border is composed of the flexor retinaculum, the floor of the tunnel is formed by the carpal bones, the medial (ulnar) border by the hamate, and the lateral (radial) border by the trapezium. Contents that originate in the forearm and run distally through the carpal tunnel include the finger and thumb flexors and the median nerve. Carpal tunnel syndrome, when the median nerve becomes compressed or entrapped, occurs due to various issues that will be discussed in this paper. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating the size of the carpal tunnel and median nerve at the level of the wrist. MSKUS is excellent at detecting changes in carpal tunnel size, median nerve composition, thickness, and continuity. This manuscript will review the utility of MSKUS in evaluating carpal tunnel syndrome, including anatomy, common injury mechanisms, sonographic techniques, and clinical implications for those in the rehabilitation profession. Due to the confined area within the carpal tunnel and the number of structures that traverse through it, it is a very common site of pathology and symptoms. With a proper medical history and clinical examination, diagnosis is straightforward for this pathology. By integrating MSKUS into clinical practice, providers can improve the accuracy of diagnosis, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to optimal patient outcomes for those with carpal tunnel overuse or injury.
# Background Hip muscle strength is considered an important parameter to assess in patients with hip and groin pain. However, hip extension and flexion strength measures are often performed in hip angles suboptimal for force production and do not allow for calculating meaningful strength ratios. # Purpose The objective was to evaluate the test-retest reliability of testing maximal isometric strength in extension and flexion in a semi-standing position with 60° hip flexion. # Study Design Observational reliability study # Methods Thirty healthy subjects (mean age 27 (SD 7), 43% women) were recruited. An anchored dynamometer was used to measure maximal isometric force production in hip extension and flexion in a semi-standing position with the hip at 60° flexion. One tester performed the tests on two separate occasions. For relative reliability, intraclass correlation (ICC2,1, (Two-way mixed effects, single measurement, absolute agreement) was used. For absolute reliability, standard error of measurement (SEM%), and minimal detectable change at both group (MDC%group), and individual level (MDC%ind) was used. # Results No statistically significant differences between test sessions were observed (p≥0.193). The results showed good to excellent relative reliability for extension (ICC 0.933) and flexion (ICC 0.884) and moderate relative reliability for strength ratio (ICC 0.694). For absolute reliability SEM% for extension was 8.2%, flexion 9.1%, and strength ratio 10.6%, MDC%group ranged from 4.2% to 5.6%, and MDC%ind ranged from 22.6% to 29.5%. # Conclusion Assessing isometric hip extension and flexion strength with the hip at 60° flexion in a semi-standing position demonstrated good intra-tester reliability in healthy young adults. The method appears suitable for detecting changes at the group level, while the relatively large individual-level variability should be considered when interpreting changes over time in individual subjects. # Level of Evidence 3
Background:Excessive contralateral trunk tilt (CLT), the lateral flexion angle of the trunk during pitching, increases torque on the shoulder and elbow. Although core muscle strength is known to influence CLT, the relationship between limited trunk rotational mobility and throwing injuries is unclear. Purpose:To compare trunk rotational mobility and compensatory lateral flexion between pitchers with high and low CLT, and to examine the relationships between these factors, player characteristics, ball velocity, and elbow valgus torque. Study design:Cross-sectional comparison study. Methods:This study evaluated 19 male adolescent pitchers (aged 15-18 years) with ≥1 year of experience and no pain or surgical history. Participants were stratified into high (>30°) and low (≤30°) CLT groups based on two-dimensional analysis. Trunk rotational mobility was assessed using inclinometers in hand-to-knee and lumbar-locked positions. Compensatory contralateral trunk flexion during rotation was analyzed photographically in the hand to knee position. Primary outcomes compared were differences in trunk rotational mobility and compensatory trunk flexion between groups; secondary outcomes were correlations between primary outcomes and ball velocity and elbow valgus torque. Results:No significant differences were observed between the high (n = 9) and low (n = 10) CLT groups in trunk rotational mobility in the LLP position on the dominant (62.8° ± 11.5° vs 64.5° ± 11.2°, p = 0.745) and non-dominant (58.3° ± 9.0° vs 60.0° ± 8.5°, p = 0.684) sides, nor in compensatory contralateral trunk flexion during rotation on the dominant (17.1° ± 7.6° vs 18.0° ± 2.5°, p = 0.705) and non-dominant (18.2° ± 7.6° vs 20.1° ± 6.5°, p = 0.576) sides. CLT at MER moderately correlated positively with ball velocity (r = 0.47, p = 0.004), which correlated strongly with elbow valgus torque (r = 0.69, p < 0.001). Conclusion:Excessive CLT at MER in adolescent pitchers is not associated with limited trunk rotation or compensatory lateral trunk flexion. Level of Evidence:3.
Muscle strain injuries are a leading cause of time loss in elite sport. While lower-limb muscle strains are well documented, full-thickness lateral abdominal wall tears involving the external oblique, internal oblique, and transversus abdominis are rare in elite sprinting, with limited evidence to guide rehabilitation or return-to-sport decision-making. The purpose of this case report was to describe the rehabilitation and return-to-competition process following a full-thickness lateral abdominal wall tear in an elite international sprinter. # Case Description A 22-year-old elite international sprinter sustained a full-thickness tear of the external oblique, internal oblique, and transversus abdominis during block acceleration. Rehabilitation commenced two days post-injury and emphasized early optimal loading, objective monitoring using trunk force profiling and sprint kinematic assessment, and collaborative decision-making across the medical, coaching, and performance teams. Progression was guided by athlete response and objective performance data rather than predetermined time-based criteria. # Outcomes Pain-free sprinting was achieved within 16 days, unrestricted training resumed by Day 18, and the athlete returned to competition on Day 28, recording a lifetime personal best of 10.08 seconds in the 100 m. Persistent asymmetries remained in selected trunk force measures despite successful return to competition. # Discussion This case report provides a descriptive example of individualized, data-informed rehabilitation following a severe abdominal wall injury and may contribute to ongoing discussion regarding the role of objective monitoring, clinical reasoning, and symmetry restoration in return-to-sport decision-making. # Level of Evidence 4.
Background/Purpose:Sports injury induces peripheral and central neurophysiological alterations that influence motor control and recovery. The mixed-nerve silent period (SP), a transient suppression of voluntary muscle activity after electrical stimulation, reflects multilevel neural inhibitory mechanisms involving spinal and cortical pathways. This study aimed to elucidate central nervous system (CNS) excitability during muscle output regulation and explore neurophysiological characteristics in healthy athletes and contrast with findings from an athlete with delayed return to play. Study type:Case report with observational reference data. Methods:Fourteen female university basketball players participated; The thirteen participants are healthy individuals, able to play without any problems, and one was three months post-meniscal repair who was unable to run since her surgery. All participants were instructed to maintain 25% maximal voluntary isometric contraction of knee extensors for 60 s without visual feedback while seated on the seat of the isokinetic muscle strength measurement device. During the task, SP was recorded from the ipsilateral opponens pollicis muscle. SP was compared between dominant and nondominant leg conditions among healthy participants and contrasted with the postoperative case. Differences between limbs were analyzed using paired t-tests, and the postoperative case was compared with healthy athletes using a Crawford-Howell modified t-test (p < 0.05). Results:The SPs in healthy athletes were 106.3 ± 7.5 and 103.2 ± 6.5 ms for the dominant and nondominant sides, with no significant difference between sides. In the postoperative case, the injured (dominant) side exhibited prolonged SP (123.7 ms), deviating by >2 SD from healthy values, whereas the noninjured side remained within the normal range. Conclusion:Prolonged SP may reflect enhanced cortical or brainstem inhibition associated with neuromuscular control impairment. SP assessment may serve as a neurophysiological indicator for evaluating central recovery and readiness to return to sport following injury.However, larger prospective studies are needed to confirm its clinical utility. Level of Evidence:4.
# Background Masters athletes inevitably face age-related neuromuscular alterations, such as dynapenia, where the loss of muscle strength and power exceeds the loss of muscle mass. In sprinters, the selective loss of neural drive to the posterior chain impairs performance and increases injury risk. This condition often resembles a functional analogue of arthrogenic muscle inhibition, occurring even without structural damage. This case report highlights the application of real-time visual feedback (VFB) to overcome functional neuromuscular inhibition in a masters sprinter. # Case Description The 41-year-old participant had struggled with hamstring activation failure during Romanian deadlifts for two decades, a phenomenon resembling learned non-use despite the absence of structural injury. A wireless electromyography (EMG) system was used to provide real-time visual feedback of hamstring muscle activity. # Outcomes Following VFB intervention, the participant exhibited a dramatic increase in hamstring EMG amplitude compared to the control condition (without VFB). The muscle activity demonstrated a dramatic surge, rising from a negligible baseline (~ 0.014 mV) to ~0.574 mV. # Conclusion This 40-fold increase suggests that VFB can facilitate higher EMG output and re-recruit high-threshold motor units. These findings underscore the potential of VFB as a neuro-cognitive intervention to facilitate higher EMG output in aging athletes exhibiting functional inhibition. # Level of Evidence 4
Background:The International Hip Outcome Tool 12 (iHOT-12) is commonly utilized to track outcomes in individuals with acetabular dysplasia (AD). Clinically important outcome values (CIOVs) of the iHOT-12 in individuals with AD are not yet defined. Purpose:To define the minimal clinically important difference (MCID), patient acceptable symptom state (PASS) change score, absolute PASS threshold, and maximal outcome improvement (MOI) value for the iHOT-12 in individuals undergoing physiotherapy (PT) for AD. Study Design:Prospective cohort; psychometric property analysis. Methods:This prospective study included individuals aged 10-35 years with a clinical and radiographic diagnosis of AD who were referred for conservative management at two centers between December 2023 and February 2025. At baseline assessment and after 8-10 weeks of PT, individuals completed the iHOT-12. At 8-10-week follow-up, individuals also completed three anchor questions on satisfaction and function. The MCID was calculated utilizing 0.5 times the standard deviation of baseline iHOT-12 scores. Receiver operator curve analysis was utilized to determine the PASS change score, absolute PASS threshold, and MOI value. Results:Forty-five patients (42 females, mean age 16.5 + 7.8) met the inclusion criteria. After 8-10 weeks of PT (mean follow-up time = 69 days), 25 (55.6%) participants were in the "improved" group and 20 (44.4%) were in the "not improved" group. The MCID was 8.5 points. A PASS change score of 15.2 was calculated for individuals who were satisfied with high sensitivity (.77) and specificity (.78) with an AUC = .76 (95% CI: .59-.93). An absolute PASS iHOT-12 threshold score of 62 (sensitivity = .62, specificity = .87) identified those who were satisfied with their hip function after a trial of PT with an AUC = .82 (95% CI: .67-.97). An MOI threshold of 22.9% was also calculated with high sensitivity (.69) and specificity (.88) with an AUC = .78 (95% CI: .61-.95). Conclusion:This study defines MCID, PASS change score, absolute PASS threshold, and MOI threshold for the iHOT-12 in patients with AD after 8-10 weeks of PT. While most individuals reported improvement in symptoms, only half of individuals were satisfied with their current level of function. Level of Evidence:Level 2.
# Background “T-Junction” or distal musculotendinous junction (DMTJ) hamstring injuries have become a true enigma for clinicians as demonstrated by the high recurrence rate. Magnetic Resonance Imaging (MRI) can sometimes fail to provide an accurate assessment of these injuries, probably because of the dynamic function that this structure provides to offer stability at the synchronous movement of the two heads of biceps femoris. The aim of the present case report was to describe a novel method for dynamic ultrasound evaluation of the DMTJ performed during functional loading exercises and to explore its potential role in return-to-play (RTP) decision-making. # Study design Case Report # Case description A 23-year-old male elite football player sustained a DMTJ injury. MRI revealed a complete rupture of the superficial portion (myotendinous) and the deep portion (myoaponeurotic) of the T-Junction. The injury occurred initially during high speed non-linear running action. The initial diagnosis was made using a 3T MRI scan. Subsequently, three dynamic ultrasound evaluations were performed at weeks 3, 6 and 9 during two different gym-based exercises: the single-leg barbell Romanian deadlift and the single-leg hamstrings slider with ipsilateral trunk rotation. Additional 3Tesla MRIs were conducted to assess healing and structural changes at weeks 5,8 and 14. # Outcomes The player returned to competitive activity 10 weeks after the injury and experienced no re-injury during the subsequent 4-month follow-up period. Improvements in the synchronous movement between BFlh and BFsh were seen on the progressive evaluations as well as the scar healing progression. Dynamic ultrasound assessment during the SL-RDL appeared to provide clearer visualization of interhead hamstring movement than during the slider exercise. Further investigation in larger cohorts is warranted to establish the reliability, validity, and prognostic utility of this novel assessment modality for athletes with this injury. # Conclusions In this single case, dynamic ultrasound of the DMTJ provided valuable information regarding interhead synchrony of the biceps femoris. This approach may complement MRI and support informed return to play decision-making following T-Junction hamstring injuries. # Level of Evidence 5
Background:Intrinsic foot muscles (IFMs) contribute to plantar stiffness regulation and force transmission during dynamic tasks. Although the short-foot exercise (SF-ex) is commonly prescribed to strengthen IFMs, its immediate effects on muscle morphology and reactive performance remain unclear. Purpose:To examine the acute effects of an elastic toe-tube exercise (Tube-ex) on IFM cross-sectional area (CSA) and reactive strength compared with SF-ex and a control condition. Study Design:Randomized crossover study. Methods:Twenty healthy recreationally active young men completed three conditions (Tube-ex, SF-ex, and control) in randomized order with a washout period of at least one week. Ultrasound-derived CSA of the abductor hallucis, flexor hallucis brevis, and flexor digitorum brevis was assessed before and immediately after each condition. Reactive performance was evaluated using the reactive strength index (RSI) obtained from repeated rebound jump tests. Two-way repeated-measures analysis of variance was used to examine time × condition effects. Results:Significant time × condition interactions were observed for all IFMs (p ≤ 0.019, partial η² = 0.21-0.61), with the greatest increases following Tube-ex (approximately 6-13%). CSA changes exceeded minimal detectable change thresholds after Tube-ex. A significant interaction was also found for RSI (p = 0.035, partial η² = 0.16), with improvement observed only after Tube-ex (Cohen's d = 0.66-0.80). Conclusion:Tube-ex elicited greater acute increases in IFM size and reactive strength than SF-ex and control. These findings support its potential as a practical neuromuscular priming strategy for athletic preparation and early-stage rehabilitation. Level of Evidence:Level 2.
