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Rahman OF, Kunze KN, Yao K, Kwiecien SY, Ranawat AS, Banffy MB, Kelly BT, Galano GJ. Hip Arthroscopy Simulator Training With Immersive Virtual Reality Has Similar Effectiveness to Nonimmersive Virtual Reality. Arthroscopy 2024:S0749-8063(24)00207-X. [PMID: 38513878 DOI: 10.1016/j.arthro.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To (1) compare the efficacy of immersive virtual reality (iVR) to nonimmersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. METHODS Fourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n = 7; PrecisionOS) or non-iVR simulator (n = 7; ArthroS Hip VR; VirtaMed). After training, performance was assessed on a cadaver by 4 expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores. A cost analysis was performed using the transfer effectiveness ratio (TER) and a direct cost comparison of iVR to non-iVR. RESULTS Demographic characteristics did not differ between treatment arms or by training level, hip arthroscopy experience, or prior simulator use. No significant differences were observed in OSATS and ASSET scores between iVR and non-iVR cohorts (OSATS: iVR 19.6 ± 4.4, non-iVR 21.0 ± 4.1, P = .55; ASSET: iVR 23.7 ± 4.5, non-iVR 25.8 ± 4.8, P = .43). The absolute TER was 0.06 and there was a 132-fold cost difference of iVR to non-iVR. CONCLUSIONS Hip arthroscopy simulator training with iVR had similar performance results to non-iVR for technical skill and procedural knowledge acquisition after expert arthroscopic video assessment. The iVR platform had similar effectiveness in transfer of skill compared to non-iVR with a 132 times cost differential. CLINICAL RELEVANCE: Due to the accessibility, effectiveness, and relative affordability, iVR training may be beneficial in the future of safe arthroscopic hip training.
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Affiliation(s)
- Omar F Rahman
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A.; Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A..
| | - Kyle N Kunze
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kaisen Yao
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
| | - Susan Y Kwiecien
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Michael B Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Bryan T Kelly
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Gregory J Galano
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
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Kwiecien SY. Is it the End of the Ice Age? Int J Sports Phys Ther 2023; V18:547-550. [PMID: 37425111 PMCID: PMC10324284 DOI: 10.26603/001c.74273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
The use of the RICE (Rest, Ice, Compression, Elevation) protocol has been the preferred method of treatment for acute musculoskeletal injuries for decades. However, the efficacy of using ice as a recovery strategy following injury in humans remains uncertain, and there is a growing trend recommending against icing following injury. Animal models suggest that while ice can help to accelerate the recovery process, extreme muscle cooling might delay repair and increase muscle scarring. Despite the conflicting evidence, ice should not be dismissed as a potential treatment option. When considering what is known about the injury cascade, the optimal application window for ice is in the immediate acute stage following injury to reduce the proliferation of secondary tissue damage that occurs in the hours after the initial injury. Practitioners should tailor the application of ice based on the injury timeline and repair process, consistent with applications in 20-30 minute intervals within the first 12 hours post-injury. Until the evidence unanimously proves otherwise, the culture of icing injuries should remain a staple in sports medicine.
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Glace BW, Kremenic IJ, Hogan DE, Kwiecien SY. Incidence of concussions and helmet use in equestrians. J Sci Med Sport 2023; 26:93-97. [PMID: 36609086 DOI: 10.1016/j.jsams.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Equestrians have a high risk of concussions per hospital records. However, most concussions occur in private settings where concussions are not tracked. We determined concussion incidence by self-report, expressed per 1000 h of exposure, and determined helmet usage and concussion knowledge. DESIGN Descriptive epidemiological study. METHODS Equestrians were recruited using a snowball method of sampling in which enrolled participants recruited more equestrians. Participants completed a survey of equestrian experience and history of concussion, symptoms and provided estimates of hours spent in various equestrian activities. From these data, incidences of concussions were calculated. In addition, they answered questions regarding helmet usage and willingness to take risks when concussed. RESULTS 210 participants (203 women) reported 27 ± 14 years of equine experience and 728 concussions, 3.47 ± 5.34 per person (0-55). Incidence while riding was 0.19/1000 h which was greater than the incidence while driving (0.02/1000 h) or handling horses (0.03/1000 h). Riders were helmeted at the time of injury 85% of the time. While concussion knowledge was high, most reported willingness to risk permanent injury by continuing to work with horses while injured. CONCLUSIONS To our knowledge this is the first study to document incidence of concussions in equestrians: incidence is higher while riding than during football or rugby training. Helmets were far more commonly worn at the time of concussion than reported in hospital data, suggesting that helmets effectively reduce concussions severe enough to warrant urgent medical care.
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Affiliation(s)
- Beth W Glace
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health, USA.
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health, USA
| | - Daniel E Hogan
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health, USA
| | - Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health, USA
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O'Hara DJ, Tyler TF, McHugh MP, Kwiecien SY, Bergeron T. Use of a Non-Pharmacological Pain Relief Kit to Reduce Opioid Use Following Orthopedic Surgery: A Prospective Randomized Study. Int J Sports Phys Ther 2022; 17:915-923. [PMID: 35949389 PMCID: PMC9340831 DOI: 10.26603/001c.36625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Opioid prescription to treat pain among orthopedic surgery patients remains common practice in the United States but overprescribing opioids can lead to abuse. The purpose of this study was to determine the effect of a multimodal non-pharmacological 'pain relief kit' on pain, function, and opioid consumption in individuals recovering from orthopedic surgery. Hypothesis Patients provided with the pain relief kit would consume less opioid medication, report lower pain levels, and have better functional outcome scores than the control group. Level of Evidence 2b. Methods Fifty-three subjects (18 women, 35 men) having orthopedic surgery were randomly assigned to either receive the Pain Relief Kit (treatment) or control group. At the first postoperative physical therapy visit (within 1 week of surgery) the treatment group was provided elastic resistance bands, kinesiology tape, Biofreeze, and a hot/cold pack as part of the Pain Relief Kit. Patients completed the SF-36 and either the DASH or LEFS questionnaires consistent with their surgery at baseline and four weeks post-op. Both groups reported daily pain (Visual Analogue Scale), opioid use, and over the counter medication use. The treatment group also recorded daily kit modality use. Results There was no significant difference in total opioid use between the treatment (108±252 milligram morphine equivalents) and control groups (132±158 MME; p=0.696). Opioid use and pain declined from week one to four with no difference between groups (p<0.001). Outcome scores and SF-36 scores improved from week one to four with no difference between groups (p<0.001). Conclusion A non-pharmacological pain relief kit did not have an effect on opioid use in this patient population nor did it improve pain relief or function compared to controls.
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Kwiecien SY, Bloom L, Kessler RE, Nicholas EE, Kolodka EK, O'Hara DJ, Nicholas SJ. Do Pre-operative Activity Levels Affect Long Term Meniscectomy Outcomes? Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763804.00141.b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kremenic IJ, Hogan DE, Kwiecien SY, Orishimo KF, Glace BW. Physical Activity After Covid-19 Part 2: Symptoms Relating To Decreases In Physical Activity. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761344.92192.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glace BW, Hogan DE, Kwiecien SY, Kremenic IJ. Physical Activity After Covid-19 Part 1: Limited Recovery Of Physical Activity 9 Months Post-infection. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761336.43345.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kwiecien SY, McHugh MP. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. Eur J Appl Physiol 2021; 121:2125-2142. [PMID: 33877402 DOI: 10.1007/s00421-021-04683-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/05/2021] [Indexed: 01/08/2023]
Abstract
Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
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Mullaney MJ, McHugh MP, Kwiecien SY, Ioviero N, Fink A, Howatson G. Accelerated Muscle Recovery in Baseball Pitchers Using Phase Change Material Cooling. Med Sci Sports Exerc 2021; 53:228-235. [PMID: 32694373 DOI: 10.1249/mss.0000000000002447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to document recovery after a pitching performance and determine whether prolonged postgame phase change material (PCM) cooling of the shoulder and forearm accelerates recovery. METHODS Strength, soreness, and serum creatine kinase (CK) activity were assessed before and on the 2 d after pitching performances in 16 college pitchers. Pitchers were randomized to receive either postgame PCM cooling packs on the shoulder and forearm or no cooling (control). PCM packs were applied inside compression shirts and delivered cooling at a constant temperature of 15°C for 3 h. Strength was assessed for shoulder internal rotation (IR), external rotation (ER), empty can (EC) test, and grip. RESULTS Total pitch count was 60 ± 16 for 23 PCM cooling games and 62 ± 17 for 24 control games (P = 0.679). On the days after pitching, IR strength (P = 0.006) and grip strength (P = 0.036) were higher in the PCM cooling group versus control. One day after pitching, IR strength was 95% ± 14% of baseline with PCM cooling versus 83% ± 13% for control (P = 0.008, effect size d = 0.91) and 107% ± 9% versus 95% ± 10% for grip strength (P = 0.022, effect size d = 1.29). There was a trend for greater ER strength with PCM cooling (P = 0.091, effect size d = 0.51). The EC strength was not impaired after pitching (P = 0.147) and was therefore unaffected by PCM cooling (P = 0.168). Elevations in soreness and CK were not different between treatments (treatment-time CK P = 0.139, shoulder soreness P = 0.885, forearm soreness P = 0.206). CONCLUSION This is one of the first studies to document impairments in muscle function on the days after baseball pitching, and the first study showing a novel cryotherapy intervention that accelerates recovery of muscle function in baseball pitchers after a game.
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Affiliation(s)
| | | | | | - Neil Ioviero
- Athletics Department, Kean University, Union, NJ
| | - Andrew Fink
- Mullaney and Associates Physical Therapy, Matawan, NJ
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Kwiecien SY, McHugh MP, Howatson G. Don't Lose Your Cool With Cryotherapy: The Application of Phase Change Material for Prolonged Cooling in Athletic Recovery and Beyond. Front Sports Act Living 2020; 2:118. [PMID: 33345107 PMCID: PMC7739598 DOI: 10.3389/fspor.2020.00118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of 3-6 h with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.
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Affiliation(s)
- Susan Y. Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, United States
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Malachy P. McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, United States
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Water Research Group, North West University, Potchefstroom, South Africa
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Kwiecien SY, McHugh MP, Hicks KM, Keane KM, Howatson G. Prolonging the duration of cooling does not enhance recovery following a marathon. Scand J Med Sci Sports 2020; 31:21-29. [PMID: 32901996 DOI: 10.1111/sms.13822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Runners commonly utilize cryotherapy as part of their recovery strategy. Cryotherapy has been ineffective in mitigating signs and symptoms of muscle damage following marathon running and is limited by its duration of application. Phase change material (PCM) packs can prolong the duration of cooling. This study aimed to test the efficacy of prolonging the duration of cooling using PCM on perceptual recovery, neuromuscular function, and blood markers following a marathon run. Thirty participants completed a marathon run and were randomized to receive three hours of 15°C PCM treatment covering the quadriceps or recover without an intervention (control). Quadriceps soreness, strength, countermovement jump (CMJ) height, creatine kinase (CK), and high sensitivity C-reactive protein (hsCRP) were recorded at baseline, 24, 48, and 72 hours after the marathon. Following the marathon, strength decreased in both groups (P < .0001), with no difference between groups. Compared to baseline, strength was reduced 24 (P = .004) and 48 hours after the marathon (P = .008) in the control group, but only 24 hours (P = .028) in the PCM group. Soreness increased (P < .0001) and CMJ height decreased (P < .0001) in both groups, with no difference between groups. Compared to baseline, CMJ height was not reduced on any days in the PCM group but was reduced in the control group 24 (P < .0001) and 48 hours (P = .003) after the marathon. CK and hsCRP increased in both groups (P < .0001). Although the marathon run induced significant muscle damage, prolonging the duration of cooling using PCM did not accelerate the resolution of any dependent variables.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Kirsty M Hicks
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Karen M Keane
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Glyn Howatson
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Water Research Group, North West University, Potchefstroom, South Africa
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Kwiecien SY, McHugh MP, Hicks KM, Keane K, Howatson G. The Efficacy Of Prolonged Cooling Using Phase Change Material For Enhancing Recovery Following A Marathon. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670352.72651.5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Schmitt BM, Tyler TF, Kwiecien SY, Fox MB, McHugh MP. MAPPING TENDERNESS TO PALPATION PREDICTS RETURN TO PLAY FOLLOWING ACUTE HAMSTRING STRAIN. Int J Sports Phys Ther 2020; 15:421-428. [PMID: 32566378 PMCID: PMC7297001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION/PURPOSE Currently there is little evidence supporting the use of objective tests, measures, or imaging to help predict time to return to sport (RTS) following a hamstring strain. The purpose of this study is to investigate the predictive value of tenderness to palpation (TTP) as measured by area and location following hamstring strain. STUDY DESIGN Case Series. METHODS Nineteen male athletes (age 28 ± 9 yr) who sustained an acute hamstring strain underwent hamstring tenderness mapping on initial evaluation. The length and width of tenderness of the hamstring was identified with manual palpation, outlined in pen, and was then calculated as a percentage of the length and width of the posterior thigh. All patients underwent the same hamstring rehabilitation protocol with remapping performed at specific stages in rehabilitation. The association between mapping tenderness indices and RTS was assessed by linear regression. RESULTS The average length of the area of tenderness was 22 ± 12% with an average RTS of 43 ± 36 days. The length of the area of tenderness measured on initial evaluation was a strong predictor of RTS (R2 = 0.58, p<0.001; y = 2.3x - 6.2). Area of injury (R2 = 0.36, p = 0.006) and age (R2 = 0.27, p = 0.024) were also related to RTS, while width of injury (R2 = 0.006, p = 0.75) and location of injury were not (proximal-distal p = 0.62, medial-lateral p = 0.64). Adding age with length of injury into a multiple regression analysis improved the prediction of RTS (R2 = 0.73). The relationship between RTS and length of tenderness was relatively unchanged when the additional mapping indices taken during the course of rehabilitation were added to the analysis (R2 = 0.61, p<0.001; y = 2.3x - 4.4). This indicates that the regression equation can be used to estimate RTS regardless of when in the post injury/rehabilitation process the mapping is performed. CONCLUSIONS The length of the area of tenderness to palpation of the injured hamstring muscle was highly predictive of RTS time. Based on the regression equation a patient with a length of tenderness of 10% would have an estimated RTS time of 17 days, while a tenderness length of 30% would be estimated to return in 63 days. This hamstring mapping technique described was predictive of the RTS and may be a useful clinical tool. LEVEL OF EVIDENCE IIb.
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Affiliation(s)
| | - Timothy F Tyler
- The Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
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Kwiecien SY. Letter to the Editor re 'Volume of water added to crushed ice affects the efficacy of cryotherapy: a randomised, single-blind, crossover trial'. Physiotherapy 2020; 108:108-109. [PMID: 32241575 DOI: 10.1016/j.physio.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA; Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.
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Kwiecien SY, O'Hara DJ, McHugh MP, Howatson G. Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise. Eur J Appl Physiol 2019; 120:413-423. [PMID: 31828479 DOI: 10.1007/s00421-019-04285-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this investigation was twofold: (1) to examine the effect of prolonged phase change material (PCM) cooling following eccentric exercise of the quadriceps on indices of muscle damage, and (2) to elucidate whether application of PCM cooling blunted the acute adaptive response to eccentric exercise, known as the repeated bout effect (RBE). METHODS Twenty-six males (25 ± 6 years) performed an initial bout (B1) of 120 eccentric quadriceps contractions on each leg at 90% of their isometric strength and were then randomized to receive PCM packs frozen at 15 °C (treatment) or melted packs (control) worn directly on the skin under shorts for 6 h. The protocol was repeated 14 days later (B2) with all participants receiving the control condition. RESULTS PCM cooling provided protection against strength loss in B1 (P = 0.005) with no difference in strength between treatment groups in B2 (P = 0.172; bout by treatment by time P = 0.008). PCM cooling reduced soreness in B1 (P = 0.009) with no difference between treatment groups in B2 (P = 0.061). Soreness was overall lower following B2 than B1 (P < 0.001). CK was elevated in B1 (P < 0.0001) and reduced in B2 (P < 0.001) with no difference between treatments. The damage protocol did not elevate hsCRP in B1, with no difference between treatments or between bouts. CONCLUSIONS This work provides further evidence that PCM cooling enhances recovery of strength and reduces soreness following eccentric exercise. Importantly, these data show for the first time that prolonged PCM cooling does not compromise the adaptive response associated with the RBE.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 210 East 64 Street, 5th Floor, NISMAT, New York, NY, 10065, USA. .,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.
| | - Denis J O'Hara
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 210 East 64 Street, 5th Floor, NISMAT, New York, NY, 10065, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 210 East 64 Street, 5th Floor, NISMAT, New York, NY, 10065, USA.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Water Research Group, North West University, Potchefstroom, South Africa
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Kwiecien SY, McHugh MP, Goodall S, Hicks KM, Hunter AM, Howatson G. Exploring the Efficacy of a Safe Cryotherapy Alternative: Physiological Temperature Changes From Cold-Water Immersion Versus Prolonged Cooling of Phase-Change Material. Int J Sports Physiol Perform 2019; 14:1288-1296. [PMID: 30958051 DOI: 10.1123/ijspp.2018-0763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the effectiveness between cold-water immersion (CWI) and phase-change-material (PCM) cooling on intramuscular, core, and skin-temperature and cardiovascular responses. METHODS In a randomized, crossover design, 11 men completed 15 min of 15°C CWI to the umbilicus and 2-h recovery or 3 h of 15°C PCM covering the quadriceps and 1 h of recovery, separated by 24 h. Vastus lateralis intramuscular temperature at 1 and 3 cm, core and skin temperature, heart-rate variability, and thermal comfort were recorded at baseline and 15-min intervals throughout treatment and recovery. RESULTS Intramuscular temperature decreased (P < .001) during and after both treatments. A faster initial effect was observed from 15 min of CWI (Δ: 4.3°C [1.7°C] 1 cm; 5.5°C [2.1°C] 3 cm; P = .01). However, over time (2 h 15 min), greater effects were observed from prolonged PCM treatment (Δ: 4.2°C [1.9°C] 1 cm; 2.2°C [2.2°C] 3 cm; treatment × time, P = .0001). During the first hour of recovery from both treatments, intramuscular temperature was higher from CWI at 1 cm (P = .013) but not 3 cm. Core temperature deceased 0.25° (0.32°) from CWI (P = .001) and 0.28°C (0.27°C) from PCM (P = .0001), whereas heart-rate variability increased during both treatments (P = .001), with no differences between treatments. CONCLUSIONS The magnitude of temperature reduction from CWI was comparable with PCM, but intramuscular temperature was decreased for longer during PCM. PCM cooling packs offer an alternative for delivering prolonged cooling whenever application of CWI is impractical while also exerting a central effect on core temperature and heart rate.
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Kwiecien SY, McHugh MP, O'Hara DJ, Howatson G. Phase Change Material Cooling Reduces Indices of Muscle Damage and Does Not Inhibit Acute Adaptation. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562429.38904.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mullaney MJ, Kwiecien SY, Fink A, McHugh MP. Accelerated Recovery of Muscle Function in Baseball Pitchers Using Post-Game Phase Change Material Cooling. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562433.92269.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mathew S, Kwiecien SY, Howatson G, McHugh MP. The Effect of Icing with Varying Degrees of Compression on Quadriceps Intramuscular Temperature. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563111.16314.b8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kwiecien SY, Mathew S, Howatson G, McHugh MP. The effect of varying degrees of compression from elastic vs plastic wrap on quadriceps intramuscular temperature during wetted ice application. Scand J Med Sci Sports 2019; 29:1109-1114. [PMID: 30963633 DOI: 10.1111/sms.13430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate and compare the effectiveness of wetted ice bag, applied with high compression elastic wrap or held in place with low compression plastic wrap, on reducing vastus lateralis intramuscular temperature and skin surface temperature. Ten healthy male participants had wetted ice packs applied to a standardized area on the anterior aspect of the quadriceps simultaneously to both legs for 30 minutes. The ice pack was secured with high compression (elastic wrap) to the left anterior thigh (60.6 ± 8.1 mm Hg) and low compression (plastic wrap) to the right anterior thigh (15.5 ± 4.0 mm Hg). Intramuscular temperature (1 and 3 cm) and skin temperature of the vastus lateralis were measured continuously during a 10-minute baseline period, 30-minute treatment period, and a 60-minute recovery period. No difference was observed between treatments in terms of the magnitude of reduction in intramuscular temperature at both 1 and 3 cm and skin temperature regardless of compression pressure (P > 0.05). Temperature upon conclusion of elastic wrap treatment was as follows: 17.8 ± 5.2°C at 1 cm and 23.1 ± 4.9°C at 3 cm; plastic wrap treatment: 17.9 ± 4.4°C at 1 cm and 24.5 ± 6.7°C at 3 cm. Plastic wraps may offer a practical alternative to elastic wraps for clinicians as they may be disposed of by the patient or athlete without having to stay at the treatment facility.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York City, New York.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Stephen Mathew
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York City, New York
| | - Glyn Howatson
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Water Research Group, North West University, Potchefstroom, South Africa
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York City, New York.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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McHugh MP, Clifford T, Abbott W, Kwiecien SY, Kremenic IJ, DeVita JJ, Howatson G. Countermovement Jump Recovery in Professional Soccer Players Using an Inertial Sensor. Int J Sports Physiol Perform 2019; 14:9-15. [PMID: 29809065 DOI: 10.1123/ijspp.2018-0131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the utility of an inertial sensor for assessing recovery in professional soccer players. METHODS In a randomized, crossover design, 11 professional soccer players wore shorts fitted with phase change material (PCM) cooling packs or uncooled packs (control) for 3 h after a 90-min match. Countermovement jump (CMJ) performance was assessed simultaneously with an inertial sensor and an optoelectric system: prematch and 12, 36, and 60 h postmatch. Inertial sensor metrics were flight height, jump height, low force, countermovement distance, force at low point, rate of eccentric force development, peak propulsive force, maximum power, and peak landing force. The only optoelectric metric was flight height. CMJ decrements and the effect of PCM cooling were assessed with repeated-measures analysis of variance. Jump heights were also compared between devices. RESULTS For the inertial sensor data, there were decrements in CMJ height on the days after matches (88% [10%] of baseline at 36 h, P = .012, effect size = 1.2, for control condition) and accelerated recovery with PCM cooling (105% [15%] of baseline at 36 h, P = .018 vs control, effect size = 1.1). Flight heights were strongly correlated between devices (r = .905, P < .001), but inertial sensor values were 1.8 [1.8] cm lower (P = .008). Low force during countermovement was increased (P = .031) and landing force was decreased (P = .043) after matches, but neither was affected by the PCM cooling intervention. Other CMJ metrics were unchanged after matches. CONCLUSIONS This small portable inertial sensor provides a practical means of assessing recovery in soccer players.
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Kwiecien SY, McHugh MP, Goodall S, Hicks KM, Hunter AM, Howatson G. Effect of Cold Water Immersion versus Phase Change Material Cooling On Core and Intramuscular Temperature. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538194.56035.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McHugh MP, Clifford T, Abbott W, Kwiecien SY, Kremenic IJ, Devita JJ, Howatson G. Assessment of Countermovement Jump Performance Recovery in Professional Soccer Players Using an Inertial Sensor. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538642.92699.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McHugh MP, Kwiecien SY, Galina JM, Schmitt BM, Tyler TF. Limb Mass And Passive Muscle Tension Contributions To Knee Flexion Torque At Long Muscle Lengths. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518636.09879.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kwiecien SY, McHugh MP, Howatson G. The efficacy of cooling with phase change material for the treatment of exercise-induced muscle damage: pilot study. J Sports Sci 2017; 36:407-413. [PMID: 28391765 DOI: 10.1080/02640414.2017.1312492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Post-exercise cryotherapy treatments are typically short duration interventions. This study examined the efficacy of prolonged cooling using phase change material (PCM) on strength loss and pain after eccentric exercise. Eight adults performed 120 bilateral eccentric quadriceps contractions (90% MVC). Immediately afterwards, frozen PCM packs (15°C) were placed over the quadriceps, with room temperature PCM packs on the contralateral quadriceps. Skin temperature was recorded continually (6 h PCM application). Isometric quadriceps strength and soreness were assessed before, 24, 48, 72 and 96 h post-exercise. The protocol was repeated 5 months later, with room temperature PCM applied to both legs. There were three treatments: legs treated with 15°C PCM packs (direct cooling), legs treated with room temperature PCM packs contralateral to the 15°C PCM packs (systemic cooling), and legs tested 5 months later both treated with room temperature PCM packs (control). Skin temperature was 9°C-10°C lower with direct cooling versus systemic cooling and control (P < 0.01). Strength loss and soreness were less (P < 0.05) with direct cooling versus systemic cooling and control (strength 101%, 94%, 93%, respectively; pain 1.0, 2.3, 2.7, respectively). Six hours of PCM cooling was well tolerated and reduced strength loss and pain after damaging exercise.
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Affiliation(s)
- Susan Y Kwiecien
- a Nicholas Institute of Sports Medicine and Athletic Trauma , Lenox Hill Hospital , New York , NY , USA.,b Department of Sport , Exercise & Rehabilitation, Northumbria University , Newcastle upon Tyne , UK
| | - Malachy P McHugh
- a Nicholas Institute of Sports Medicine and Athletic Trauma , Lenox Hill Hospital , New York , NY , USA
| | - Glyn Howatson
- b Department of Sport , Exercise & Rehabilitation, Northumbria University , Newcastle upon Tyne , UK.,c Water Research Group , School of Environmental Sciences and Development, Northwest University , Potchefstroom , South Africa
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McHugh MP, Kwiecien SY. Tart Cherry Juice Consumption as a Potential Treatment for Migraine Headaches. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485732.68343.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kwiecien SY, McHugh MP. The Efficacy of Cooling with Phase Change Material for the Treatment of Exercise-Induced Muscle Damage. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487702.76991.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Monitoring pitch count is standard practice in minor league baseball but not in softball because of the perception that fast-pitch softball pitching is a less stressful motion. PURPOSE To examine muscle fatigue after fast-pitch softball performances to provide an assessment of performance demand. STUDY DESIGN Descriptive laboratory study. METHODS Bilateral strength measurements (handheld dynamometer) were made on 19 female softball pitchers (mean age [±SD], 15.2 ± 1.2 years) before and after pitching a game (mean number of pitches, 99 ± 21; mean innings pitched, 5 ± 1). A total of 20 tests were performed on the dominant and nondominant sides: forearm (grip, wrist flexion/extension, pronation/supination, elbow flexion/extension), shoulder (flexion, abduction/adduction, external/internal rotation, empty can test), scapula (middle/lower trapezius, rhomboid), and hip (hip flexion/extension, abduction/adduction). Fatigue (percentage strength loss) was categorized based on bilateral versus unilateral presentation using paired t tests: bilateral symmetric (significant on dominant and nondominant and not different between sides), bilateral asymmetric (significant on dominant and nondominant but significantly greater on dominant), unilateral asymmetric (significant on dominant only and significantly greater than nondominant), or unilateral equivocal (significant on dominant only but not different from nondominant). RESULTS Bilateral symmetric fatigue was evident for all hip (dominant, 19.3%; nondominant, 15.2%) and scapular tests (dominant, 19.2%; nondominant, 19.3%). In general, shoulder tests exhibited bilateral asymmetric fatigue (dominant, 16.9%; nondominant, 11.6%). Forearm tests were more variable, with bilateral symmetric fatigue in the elbow flexors (dominant, 22.5%; nondominant, 19.2%), and wrist flexors (dominant, 21.6%; nondominant, 19.0%), bilateral asymmetric fatigue in the supinators (dominant, 21.8%; nondominant, 15.5%), unilateral asymmetric fatigue in the elbow extensors (dominant, 22.1%; nondominant, 11.3%), and unilateral equivocal fatigue in the pronators (dominant, 18.8%; nondominant, 15.2%) and grip (dominant, 11.4%; nondominant, 6.6%). The mean (±SD) pitch velocity was 49 ± 4 mph, with a small loss of velocity from the first to last inning pitched (3.4% ± 5.0%, P < .01). CONCLUSION Fast-pitch softball pitching resulted in profound bilateral fatigue in the hip and scapular muscles, with more selective fatigue in the shoulder and arm muscles. CLINICAL RELEVANCE These findings emphasize the importance of strength in the proximal musculature to provide a stable platform for the arm to propel the ball.
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Affiliation(s)
| | | | | | - Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
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Kwiecien SY, Olinto L, Kim AH, Nicholas SJ, McHugh MP. G-Force Exposure and Functional Recovery in High School Ice Hockey Players. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000466212.96822.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Corben JS, Cerrone SA, Soviero JE, Kwiecien SY, Nicholas SJ, McHugh MP. The Performance Demand Of Softball Pitching. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496025.80272.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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