Garrett F. Coughlan

Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis

Objective To examine whether people with recurrent ankle sprain, have specific physical and sensorimotor deficits. Design A systematic review of journal articles in English using electronic databases to September 2009. Included articles compared physical or sensorimotor measures in people with recurrent (≥2) ankle sprains and uninjured controls. Main outcome groups Outcome measures were grouped into: physical characteristics, strength, postural stability, proprioception, response to perturbation, biomechanics and functional tests. A meta-analysis was undertaken where comparable results within an outcome group were inconsistent. Results Fifty-five articles met the inclusion criteria. Compared with healthy controls, people with recurrent sprains demonstrated radiographic changes in the talus, changes in foot position during gait and prolonged time to stabilisation after a jump. There were no differences in ankle range of motion or functional test performance. Pooled results showed greater postural sway when standing with eyes closed (SMD=0.9, 95% CI 0.4 to 1.4) or on unstable surfaces (0.5, 0.1 to 1.0) and decreased concentric inversion strength (1.1, 0.2 to 2.1) but no difference in evertor strength, inversion joint position sense or peroneal latency in response to a perturbation. Conclusion There are specific impairments in people with recurrent ankle sprain but not necessarily in areas commonly investigated.

A Comparison Between Performance on Selected Directions of the Star Excursion Balance Test and the Y Balance Test

CONTEXT The Star Excursion Balance Test (SEBT) is a widely accepted method of assessing dynamic postural stability. The Y Balance Test (YBT) is a commercially available device for measuring balance that uses 3 (anterior, posteromedial, and posterolateral) of the 8 SEBT directions and has been advocated as a method for assessing dynamic balance. To date, no studies have compared reach performance in these tests in a healthy population. OBJECTIVE To determine whether any differences exist between reach distance performance for the anterior, posteromedial, and posterolateral directions of the SEBT and the YBT. DESIGN Descriptive laboratory study. SETTING University motion analysis laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 healthy active male participants (age = 22.50 ± 3.05 years, height = 1.78 ± 0.82 m, weight = 79.48 ± 11.32 kg, body mass index = 24.96 ± 2.56 kg/m²). INTERVENTION(S) Participants carried out 3 trials in each reach direction on each leg on the SEBT and the YBT a minimum of 1 week apart. MAIN OUTCOME MEASURE(S) The means of the 3 trials in each direction on each leg on both tests were calculated. Data were collected after 4 practice trials in each direction. Paired t tests and Bland-Altman plots were used to compare reach distances between the SEBT and the YBT. RESULTS Participants reached farther in the anterior direction on the SEBT than on the YBT. No differences were observed in the posteromedial and posterolateral directions. CONCLUSIONS Differing postural-control strategies may be used to complete these tasks. This finding has implications for the implementation and interpretation of these dynamic balance tests.

Congenital diaphragmatic hernia in the newborn

A ten year review (1980–1989) of 59 neonates presenting with congenital diaphragmatic hernia (CDH) to Our Lady’s Hospital for Sick Children, the main referral centre for neonatal surgery in Ireland, is presented to determine the outcome and make suggestions for improvements. CDH was more common in males (34M, 25F). The hernia was present on the left side in 47 cases and 11 cases were right sided. Overall mortality was 35.6%, with increased mortality for right-sided hernia (54.5%). Mean gestation period for survivors was 39 weeks and for non-survivors was 36 weeks. Fifty-two (88.1%) patients presented with symptoms within first six hours after birth. Nineteen of 59 patients (32%) did not have their airways secured with an endotracheal tube at the time of arrival in the hospital. Recurrent chest infections and gastro-oesophageal reflux were the most common long term complications. The prognosis was better for late presenters. A period of prolonged ventilatory stabilisation with appropriate inotropic support to help correct acidosis before surgery improved results. Surgery should be postponed until ventilatory stabilisation is established. A protocol for safe transport of patients to the referrral centre is recommended. It is advisable that all patients with congenital diaphragmatic hernia be intubated as soon as the diagnosis is made and that a doctor accustomed to airway management accompanies the patient to the neonatal surgical centre.

Physical Game Demands in Elite Rugby Union: A Global Positioning System Analysis and Possible Implications for Rehabilitation

STUDY DESIGN Descriptive. OBJECTIVES To evaluate the physical demands of an international Rugby Union-level game using a global positioning system (GPS). BACKGROUND Elite Rugby Union teams currently employ the latest technology to monitor and evaluate physical demands of training and games on their players. METHODS GPS data from 2 players, a back and a forward, were collected during an international Rugby Union game. Locomotion speed, total body load, and body load sustained in tackles and scrums were analyzed. RESULTS Players completed an average distance of 6715 m and spent the major portion of the game standing or walking, interspersed with medium- and high-intensity running activities. The back performed a higher number of high-intensity sprints and reached a greater maximal speed. Body load data revealed that high levels of gravitational force are sustained in tackling and scrum tasks. CONCLUSION The current study provides a detailed GPS analysis of the physical demands of international Rugby Union players. These data, when combined with game video footage, may assist sports medicine professionals in understanding the demands of the game and mechanism of injury, as well as improving injury rehabilitation.

The thigh adductor squeeze test: 45° of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values.

The thigh adductor squeeze test is commonly used in the diagnosis of groin injuries. Currently no reports exist in the published literature which, detail the level of activation of the adductor musculature during the test as well as concomitant pressure values. Thus the aim of the present study was to investigate adductor muscle activity and concomitant pressure values during the performance of the thigh adductor squeeze test at 0°, 45°, and 90° of hip flexion. Eighteen Gaelic games athletes without any history of groin injury participated. Each participant performed 3 repetitions of the thigh adductor squeeze test in the three positions of 0°, 45°, and 90° of hip flexion. Adductor musculature surface electromyographic activity (bilateral) and pressure values quantified using a commercially available sphygmomanometer were recorded for each test. The greatest pressure values were observed in the 45° of hip flexion test position (0°: 202.50 ± 57.28 mmHg; 45°: 236.76 ± 47.29 mmHg; 90°: 186.11 ± 44.01 mmHg; P < 0.05). Similarly, the greatest amount of adductor muscle activity was observed in the 45° of hip flexion test position (P < 0.05). The combined results of the present study suggest that the 45° of hip flexion test position is the optimal thigh adductor squeeze test position for eliciting adductor muscle activity and maximum pressure values.

Intrarater Reliability of the Adductor Squeeze Test in Gaelic Games Athletes

CONTEXT Groin pain is commonly experienced by athletes involved in field-based sports and is particularly prevalent in Gaelic Games athletes. The adductor squeeze test is commonly used in the assessment of groin pain and injuries. To date, no evidence in the literature provides the reliability of the adductor squeeze test using a sphygmomanometer in assessing the adductor muscle integrity of Gaelic Games athletes. Given the high proportion of groin pain encountered in Gaelic Games athletes, establishing the reliability of the adductor squeeze test will allow clinicians to monitor injury responses and to assess return-to-play criteria. OBJECTIVE To evaluate the intrarater reliability of a commercially available sphygmomanometer for measuring adductor squeeze values in Gaelic Games athletes and to determine if different squeeze values are associated with the 3 commonly used test positions. DESIGN Descriptive laboratory study. SETTING University clinical skills laboratory. PATIENTS OR OTHER PARTICIPANTS Eighteen male Gaelic Games athletes without any previous or current history of groin or pelvic pain. INTERVENTION(S) Each participant performed the adductor squeeze test in 3 positions of hip joint flexion (0°, 45°, and 90°) on 2 test days separated by at least 1 week. MAIN OUTCOME MEASURE(S) Adductor squeeze test values (mm Hg) quantified by a commercially available sphygmomanometer. RESULTS Intrarater reliability intraclass correlation values ranged from 0.89 to 0.92 (intraclass correlation coefficients were 0°, 0.89; 45°, 0.92; and 90°, 0.90). The highest squeeze values were recorded in the 45° of hip flexion test position, and these values differed from those demonstrated in the 0° and 90° hip flexion test positions (P < .05). CONCLUSIONS A commercially available sphygmomanometer is a reliable device for measuring adductor squeeze test values.

Increased Aerobic Fitness After Neuromuscular Electrical Stimulation Training in Adults With Spinal Cord Injury

OBJECTIVES To evaluate the efficacy of a novel neuromuscular electrical stimulation (NMES) system for improving aerobic fitness in individuals with spinal cord injury (SCI). It was hypothesized that training with this NMES system would increase peak oxygen consumption (Vo(2)peak) and peak heart rate (HRpeak) in a sedentary adult SCI population. DESIGN Prospective cohort study. SETTING All testing took place at a university human performance laboratory. PARTICIPANTS Volunteer participants with SCI (N=16; T4-11 American Spinal Injury Association Impairment Scale grades A and B) were recruited from the national SCI outpatient and outreach service databases. All completed the training program, but results from 2 participants were excluded because posttraining tests were invalid. Therefore, 14 participants (11 men, 3 women) completed the program and testing. INTERVENTIONS Four electrodes (175cm(2)) were placed bilaterally on the quadriceps and hamstrings muscle groups, and subtetanic contractions were elicited using an NMES device. Training was undertaken unsupervised at home for 1 hour, 5d/wk for 8 weeks. MAIN OUTCOME MEASURES An incremental treadmill wheelchair propulsion exercise test with simultaneous cardiopulmonary gas exchange analysis was used to determine Vo(2)peak and HRpeak. RESULTS A statistically significant increase in Vo(2)peak (P=.001) and HRpeak (P=.032) between baseline and follow-up was observed. CONCLUSIONS This novel form of NMES is an effective method of improving aerobic fitness in an SCI population. Results are comparable to those with current functional electrical stimulation exercise systems.

Therapeutic Exergaming

Exercise therapy is prescribed by physiotherapists and rehabilitation practitioners as part of the treatment programme for many movement impairment disorders. Poor adherence and inadequate exercise technique often result in poor outcomes for these patients and delays their return to full physical function. Therapeutic exergaming, which is the use of computer games and body-worn motion tracking sensors to teach therapeutic exercise programmes to patients, may offer solutions to these problems. In this paper we describe one such system, known as FlyFit, which offers a sensor-driven flight game environment that allows physiotherapists to intuitively design game levels that will induce patients to correctly carry out their exercises programme. A 4-week pilot study to investigate the training effect of the system compared to a conventional exercise training approach is described. Results suggest these exergaming systems may induce improvements in balance and strength similar to the conventional programme along with increased levels of intrinsic motivation but further research is warranted.

Objective Classification of Dynamic Balance Using a Single Wearable Sensor

4th International Congress on Sport Sciences Research and Technology Support 2016, Porto, Portugal, 7-9 November 2016

Normative adductor squeeze test values in elite junior rugby union players.

Objective:To establish normative adductor squeeze test (AST) values in elite junior rugby union players and investigate if differences existed between field position units and categorizations. Design:Cross-sectional study. Setting:National underage screening camp. Participants:One hundred four healthy players attending an under-19 and under-18 national musculoskeletal and fitness screening camp. Players had no history of surgery, no self-reported history of groin or pelvic pain in either limb and no other lower limb injury in the past 3 months, and no pain reported during the testing procedure. Main Outcome Measures:The AST in 3 positions of hip flexion (0, 45, and 90 degrees), position unit, and categorizations. Results:The highest AST values were observed at 45 degrees of hip flexion in all field position categories. No differences were observed between position units and categorizations. Conclusions:Normative AST values in an elite junior rugby union population were established in this investigation. Clinically, the sports medicine professional may use these results in making decisions on the management of both symptomatic and asymptomatic players.