December 2019 SYSTEMATIC REVIEW – META ANALYSIS Duration of Myofascial Rolling for Optimal Recovery, Range of Motion, and Performance: A Systematic Review of the Literature. Authors: Hughes GA, Ramer LM Knowledge of the body’s response to and recovery from exercise is rapidly increasing. State-of-the-art equipment and facilities allow recreationally active adults to seek innovations to enhance performance and shorten recovery time. Myofascial rolling (MR) is a relatively new practice, providing acute benefits for muscle pain and range of motion (ROM). However, there is no consensus on optimal MR duration. The purpose of this systematic review was to determine the optimal MR duration using a foam roller or a roller massager for muscle pain, ROM, and athletic performance via qualitative review. The most evidence-based benefit of MR is the alleviation of muscle soreness and a minimum dose of 90 seconds per muscle appeared beneficial. While ten of 17 studies involving ROM showed acute improvements, the results were inconsistent and highly variable. No significant effects on performance were detected. Available data indicate that MR for 90 seconds per muscle group may be the minimal duration to achieve a short-term reduction in pain/soreness, with no upper limit found. Results do not support increases in chronic ROM or performance, and data are insufficient to provide a conclusive recommendation for impacting acute ROM. The heterogeneity of the literature highlights the need for additional research to determine optimal dose of MR. Abstract | Full Article (subscribers only) | Purchase Article ORIGINAL RESEARCH The Effect of An Anti-Gravity Treadmill on Running Cadence. Authors: Stockland J, Giveans MR, Ames P Running cadence, or step rate, is often measured in running gait analysis and manipulated in gait retraining. A lower body positive pressure treadmill, or anti-gravity treadmill, allows users to walk/run in a reduced gravity environment. The primary purpose of this study was to determine how natural running cadence is affected by running on an anti-gravity treadmill compared to a standard treadmill in a healthy, active population, and the secondary purpose was to determine if natural and increased cadence is affected by amount of body weight support. Thirty participants were recruited to run on an anti-gravity treadmill (AlterG Anti-Gravity Treadmill™ M320) at their pre-determined, self-selected, comfortable treadmill speed. Cadence was recorded at nine randomized body weight conditions, ranging from 100 percent of body weight to 20 percent of body weight, in ten percent increments. An additional nine participants were recruited to try to replicate their natural, standard treadmill cadence, as well as increase it by five percent and ten percent, while on an anti-gravity treadmill with the same randomized body weight conditions. Thirty participants, nineteen females and eleven males, mean age 27.3 years (range, 22-45), completed Part 1 of the study protocol, while nine additional participants (two females and seven males) with a mean age of 29.6 years old (range, 25-40 years) completed Part 2 of the protocol. There was a significant effect of natural running cadence on the anti-gravity treadmill at reduced body weight percentages (p<.01). Post-hoc t-tests revealed that every 10 percent body weight interval had significantly lower cadence than the previous ten percent interval (p<.01) on the anti-gravity treadmill, with cadence decreases ranging from 1.5-3.5 percent between intervals. Seven of the nine (77.8 percent) participants in Part 2 were able to replicate and increase their cadence at all body weight levels on the anti-gravity treadmill. Decreasing body weight level on an anti-gravity treadmill yields a significant and linear decrease in running cadence when performed at a self-selected, moderate intensity pace. Further, the vast majority of participants were able to successfully replicate and increase cadence at all levels of body weight percentage. Abstract | Full Article (subscribers only) | Purchase Article The Influence of Heel Height on Muscle Electromyography of the Lower Extremity During Landing Tasks in Recreationally Active Females: A Within Subjects Randomized Trial. Authors: Lindenberg KM, Lefever CR, Andreyo K, Vaughan R An increased risk of ACL injury has been shown in female athletes who land from jumping maneuvers with knee angles close to extension and in those who demonstrate a hamstring-to-quadriceps muscle recruitment imbalance. The purpose of this study was to determine if added heel lift height would alter electromyography (EMG) magnitude and timing of the quadriceps (vastus medialis, vastus lateralis), hamstrings (semitendinosus, biceps femoris) and gastroc (medial gastroc, lateral gastroc) musculature during forward jump and drop-rebound jump landing tasks in females. The authors hypothesized increased heel lift height would promote recruitment of the hamstring and gastrocnemius muscles and increase the time to peak muscle activity in the quadriceps muscles. Sixty recreationally active females participated. Participants performed five repetitions of forward jump and drop-rebound jump landing tasks while wearing different heel lifts heights (0, 12, 18, 24 mm) placed on the under-side of an athletic shoe. Task order and heel lift height were randomized. Dependent measures were average magnitude of muscle recruitment (AMR), peak magnitude of muscle recruitment (PMR), and time to reach PMR for six lower extremity muscle groups as measured by surface EMG. Repeated measures ANOVAs were used to determine the influence of heel lift height on the dependent measures. There were no signficant differences in the AMR, PMR, or time to reach PMR with the four different heel heights during the landing maneuvers, with one exception. A significant difference was found in the time to achieve PMR in the semitendinosis muscle during a forward jump landing (p=.024). Post hoc analysis found significant differences with both the 18mm and 24mm heel lift height compared to 0mm. The authors concluded that the utilization of larger heel lifts (18mm and 24mm) to influence landing biomechanics may be of potential benefit; however, only when performing forward jump landing tasks. Further investigation into the protective effects of a quicker onset of semitendinosis peak magnitude is warranted. Abstract | Full Article (subscribers only) | Purchase Article Accuracy of the Functional Movement Screen (FMS™) Active Straight Leg Raise Test to Evaluate Hamstring Flexibility in Soccer Players. Authors: Medeiros DM, Miranda LPL, Marques VB, Ribeiro-Alvares JB, Baroni BM Poor flexibility is considered a risk factor for the hamstring strain injury, and the active straight leg raise (ASLR) test proposed as a part of the Functional Movement Screen™ (FMS™) has been used to screen athletes hamstring flexibility. However, the accuracy of this screening test remains undescribed. The purpose of this study was to examine the accuracy of the FMS™ ASLR test for assessment of hamstring flexibility in soccer players. One-hundred and one male soccer players (age, 21±3 years; height, 179±7 cm; weight, 75±9 kg) were bilaterally evaluated. All players performed a gold standard test for hamstring flexibility evaluation: the passive straight leg raise (PSLR) test measured using a gravitational inclinometer. All players also performed the ASLR test and were scored using the criteria proposed by the FMS™. Of the 202 lower limbs evaluated, 17.82 percent scored a 1 on the ASLR [mean passive flexibility: 80.44±14.69 degrees (55-110 degrees)], 50.99 percent scored a 2 on the ASLR [mean passive flexibility = 84.60±10.59 degrees (56-115 degrees)], and 31.18 percent scored a 3 on the ASLR [mean passive flexibility = 92.32±11.53 degrees (70-120 degrees)]. Limbs with FMS™ score of 3 presented significantly higher values for passive flexibility than limbs with scores of 1 and 2 (p <0.05), but there was no significant difference between limbs with scores of 1 and 2 (p> 0.05). The score obtained in the FMS™ ASLR test does not satisfactorily stratify the level of hamstring flexibility in soccer players. Abstract | Full Article (subscribers only) | Purchase Article Prevalence of Hamstring Injuries in Summer League Baseball Players. Authors: Zachazewski J, Silvers H, Li B, Pohlig R, Ahmad C, Mandelbaum B Hamstring injuries (HSI) occur more commonly in baseball than are often appreciated and can impact the potential career of a player. Little is known about the historical incidence of these injuries in summer league players preparing for their upcoming collegiate season or being drafted by major league team(s). Summer league baseball players have a high historical incidence of HSI which are often unknown at the start of their summer league play. The purpose of this study was to administer a validated questionnaire to assess various factors regarding the prevalence of prior hamstring injuries, current symptoms of posterior thigh pain or hamstring injuries in amateur summer league baseball players, and to provide details on the injury history, time lost from injury, injury reocurrence, position, individual player physical characteristics and physical activities that might be associated with those injuries. A self-reported, validated questionnaire regarding the history, prevalence, reoccurrence and functional impact of HSI and posterior thigh pain was administered to and completed by 201 out of 251 summer league baseball players associated with the Cape Cod League and the Northwoods League at the start of the 2013-2015 seasons. The questionnaire was administered by certified athletic trainers associated with each team. Participation was voluntary and informed consent was obtained from all players. Forty seven out of 201 players surveyed reported a HSI history. Sixty-six percent of these players (N=31) reported unilateral injuries and 34% (N=16) reported bilateral injuries. Reoccurrence rate was 27.7% across all players. Approximately 1/3rd of all position players (catchers 33.3 percent, infielders 32.6 percent and outfielders 31.6 percent) reported a HSI history compared to 12.9 percent of all pitchers. Significant differences (p<.05) existed between the HSI and in the non-HSI history group, players who batted left and threw right reported the most injuries. The authors found that a large number of position players and pitchers who report for summer league baseball had a history of posterior thigh pain and HSI. Those with prior injuries had a high reoccurrence rate. Position players had a higher incidence of injury than did pitchers. Abstract | Full Article (subscribers only) | Purchase Article The Immediate Effects of a Total Motion Release® Warm-Up on Active Rotational Hip Range of Motion in Overhead Athletes. Authors: Dexter RR, Loftis TK, Pettaway AN, Baker RT Reductions in hip range of motion (ROM) correlate with lower extremity injury and alterations in shoulder mechanics in overhead athletes. Such shifts in kinetic-chain dynamics may lead to additional stresses at common injury sites of the upper and lower extremities. Researchers have suggested that Total Motion Release® (TMR®) increases shoulder ROM more effectively than traditional warm-up methods. It is plausible that similar methods may produce increases in ROM at the hip. The purpose of this study was to explore the effects of a TMR® based intervention on active hip rotational ROM in overhead athletes compared to a traditional athletic warm-up.Twenty-two secondary school, NCAA Division I, III, and Club student-athlete participants (sex: thireen females, nine males; sport: nine javelin, seven volleyball, seven baseball; age= 19.3 ± 1.1 years; height= 178 ± 11.4 cm; weight = 76.4 ± 11.2 kg.) were randomly assigned to TMR® (TMRG; n=11) and traditional warm-up (TWG; n=11) groups. The TMRG performed three sets of forward flexed trunk twist and seated straight leg raise held for 20 seconds each to the side of ease with a 30-second rest interval. Active hip internal and external rotation was measured using the Clinometer smartphone application immediately before and after intervention. The TMRG experienced significant immediate increases in active dominant hip ER, active non-dominant hip ER, active dominant total hip rotational ROM, and active nondominant total hip rotational ROM (mean change = +6.27 degrees, +12.2 degrees, +4.8 degrees, and +11.9 degrees), compared to the TWG (mean change = +0 degrees, +1.9 degrees, -1 degrees, and 1 degrees) respectively. The authors concluded that using TMR® motions and principles as a warm-up produced meaningful changes in active hip rotational ROM bilaterally in overhead athletes. Abstract | Full Article (subscribers only) | Purchase Article The Association Between the Functional Movement Screen™, Y-Balance Test, and Physical Performance Tests in Male and Female High School Athletes. Authors: Kramer TA, Sacko RS, Pfeifer CE, Gatens DR, Goins JM, Stodden DF Poor balance, lack of neuromuscular control, and movement ability are predictors of performance and injury risk in sports and physical activity participation. The Functional Movement Screen™ (FMS™) and lower quarter Y-Balance Test (YBT) have been used by clinicians to evaluate balance, functional symmetry, and static and dynamic movement patterns, yet little information exists regarding the relationship between the FMS™, YBT, and physical performance tests (e.g., vertical jump) within the high school population. The purpose of this study was to investigate the relationship between the FMS™, dynamic balance as measured by the YBT and physical performance tests (standing long jump, vertical jump, Pro Agility Test) in male and female high school athletes. Fifty-six high school athletes (28 females, 28 males; mean age 16.4 ± 0.1) who participated in organized team sports were tested. Participants performed the FMS™, YBT, and three physical performance tests (standing long jump, vertical jump, Pro Agility Test). Females outperformed males on the FMS™ and YBT, while males outperformed females on the performance tests. In both sexes, the composite FMS™ score was positively correlated with the left and composite YBT scores. Agility was negatively correlated with composite FMS™ in males (p < 0.05) and the left and composite YBT in females (p < 0.05). The authors found that the FMS™ and YBT may evaluate similar underlying constructs in high school athletes, such as dynamic balance and lower extremity power. Additionally, the results of this study demonstrate the utility of the FMS™and YBT to relate multiple constructs of muscular power to an individual’s ability to balance. Utilization of multiple field-based tests may provide the first step for the development of injury prevention strategies and long-term athlete development programs. Abstract | Full Article (subscribers only) | Purchase Article No Differences in Hip Range of Motion Exists Between Baseball Players with an Ulnar Collateral Ligament Tear and Healthy Baseball Players. Authors: Garrison JC, Hannon J, Conway J Restrictions in hip rotational motion of the baseball athlete can alter throwing mechanics in a manner that is inefficient and increases risk of injury. The purpose of this study was to assess for differences in hip external rotation (ER) and internal rotation (IR) range of motion (ROM) between baseball players with an ulnar collateral ligament (UCL) tear and healthy baseball players. Eighty-seven baseball players with a UCL tear (UCL) were compared with 87 age, experience, and position-matched healthy baseball players (CONT). UCL were enrolled at the initial visit to the outpatient sports medicine facility while CONT were measured before their baseball season. Passive hip ROM (ER and IR) of the stance and lead limbs was measured in the prone position using a bubble goniometer. Hip total range of motion (TRM) was calculated by adding ER and IR of each limb. Independent t-tests were run to compare mean group differences for hip ROM (p<0.05). No differences between groups were discovered for hip ER on the stance (UCL = 33.9 degrees ±9.9 degrees, CONT =34.3 degrees ±10.6 degrees, p = 0.8) or lead (UCL = 32.9 degrees ±9.9 degrees, CONT = 34.4 degrees ±10.0 degrees, p = 0.3) limbs. Similarly, there were no group differences in hip IR on the stance (UCL = 30.6 degrees ±10.5 degrees, CONT = 29.6 degrees ±9.5 degrees, p = 0.5) or lead (UCL = 33.5 degrees ±17.5 degrees, CONT = 29.5 degrees ±9.0 degrees, p = 0.1) limbs. The groups were also similar in hip TRM on the stance (UCL = 64.5 degrees ±13.7 degrees, CONT = 64.0 degrees ±17.2 degrees, p = 0.8) and lead (UCL = 66.4 degrees ±17.4 degrees, CONT = 63.9 degrees ±15.6 degrees, p = 0.3) limbs. The authors found that when measured in the prone position, hip passive ROM is not different between baseball players with a UCL tear compared to a matched healthy cohort. Abstract | Full Article (subscribers only) | Purchase Article Reliability and Minimal Detectable Change of the Upper Quarter Y-Balance Test in Healthy Adolescents Aged 12 to 17 Years. Authors: Schwiertz G, Brueckner D, Schedler S, Kiss R, Muehlbauer T There are a few studies investigating the reproducibility of the Upper Quarter Y Balance Test (YBT-UQ) in adults. However, no study has determined test-retest reliability and the minimal detectable change of the YBT-UQ in adolescents from different age cohorts. The aim of the present study was to establish test-retest reliability and minimal detectable change of the YBT-UQ in a sample of healthy adolescents. In a school setting, 111 students (59 female, 52 male) aged twelve to seventeen years performed the YBT-UQ twice, separated by one week. Normalized maximal reach distances (percent arm length) for all three directions (i.e., medial, inferolateral, superolateral) and the composite score were used as outcome measures. Intraclass correlation coefficient (ICC3,1) and standard error of measurement (SEM) were calculated to assess both relative and absolute test-retest reliability. In addition, the minimal detectable change (MDC95%), an index that is defined as the minimal amount of change in performance that falls outside the measurement error or performance changes due to variability was determined. Irrespective of age cohort, reach arm, and reach direction, the measure of relative reliability ranged from "moderate-to-good" to "excellent" ICC values and the proxy of absolute reliability was rather small (i.e., SEM ≤ 7.6 percent). The MDC95% needed to identify relevant effects in repeated measurements of the YBT-UQ performance ranged between 4.8 percent and 21.1 percent, depending on age, reach arm, and reach direction. The authors conclusded that the detected values imply that the YBT-UQ is a reliable field test that can be used to detect changes of upper quarter mobility/stability in healthy adolescents aged twelve to seventeen years. Abstract | Full Article (subscribers only) | Purchase Article Scapular Muscle Electromyographic Activity during Abduction Exercises in the Scapular Plane in Three Positions. Authors: Tsuruike M, Ellenbecker TS Hyperactivity of the anterior deltoid (AD) has been shown to produce adverse effects on subacromial space width as a result of humeral head superior translation during rehabilitation exercises used with overhead athletes. Also, the importance of the ratio of upper trapezius (UT) to lower trapezius (LT) muscle activity has been examined during rehabilitation exercises particularly for those who develop scapular dyskinesis. The purpose of this study was to investigate the level of LT and SA muscle activity during scapular plane elevation (scaption) in three positions while maintaining a moderate level of AD muscle activity. A secondary purpose was to identify the ratio of UT to LT muscle activity during the varied scaption exercises. The authors hypothesized that the activation of these two important muscles and the UT/LT ratio would vary with exercise position and throughout the range of scapular plane elevation. Fourteen active young subjects performed scaption exercises in three different positions: standing (STAN), quadruped (QUAD), and prone (PRON) with three different weight loads: 0 kg, 1.8 kg, and 4.1 kg. Surface electromyography (EMG) was used to record muscular activity. Tested muscles included the UT, LT, SA, AD, and posterior deltoid muscles on the dominant side. QUAD scaption exercises with a load of 1.8 kg at 4 sec after the initial movement activated the LT muscle up to 49 percent of maximum voluntary isometric contraction (MVIC) while maintaining a moderate level of AD muscle activity (30 percent MVIC). STAN scaption exercises with the weight load of 1.8 kg at three seconds after the initial movement activated 43 percent MVIC of the SA muscle while maintaining a moderate level of AD muscle activity (39 percent MVIC). The PRON condition generated significantly less SA muscle activity with both 1.8 and 4.1 kg weight loads than during the QUAD condition. The ratios of UT to LT muscle activity were significantly less in QUAD than those of STAN up to four seconds after the initial movement. No significant difference was observed in the UT/LT ratio between QUAD and PRON conditions. The authors found that QUAD scaption exercise effectively activated both LT and SA muscles without over activating the AD and produced favorable ratios of UT to LT muscle activity. Abstract | Full Article (subscribers only) | Purchase Article Pain Sensitivity in Chronic Achilles Tendinopathy. Authors: Eckenrode BJ, Kietrys DM, Stackhouse SK Achilles tendinopathy is a common overuse injury sustained by athletes (including runners) that often becomes chronic. There is evidence that chronic musculoskeletal pain conditions exhibit signs of nervous system sensitization. The objective of this study was to compare pain sensitivity (pressure pain threshold [PPT], heat pain threshold [HPT], and heat temporal summation [HTS]) between active healthy adults with and without chronic Achilles tendinopathy in order to determine if signs of peripheral and/or central sensitization exist in chronic Achilles tendinopathy. Seventeen participants with chronic (≥ 3 months) Achilles tendinopathy (39.0 years ± 10.81) and 24 healthy controls (31.83 years ± 8.92) were included. All participants completed the Pain Catastrophizing Scale (PCS). Participants in the Achilles group also completed the Lower Extremity Functional Scale (LEFS) and the Victorian Institute of Sport Assessment-Achilles (VISA-A). Pain processing was quantified using PPT, HPT and HTS tests. There were no significant differences in PCS scores between groups. In the Achilles tendinopathy group, the mean VISA-A score was 58.5 ± 18.4; the mean LEFS was 63.7 ± 8.0. Primary hyperalgesia (decreased pain threshold at injury site) was detected in the Achilles tendinopathy group, as evidenced by lower PPT (p<0.0001) and lower HPT (p=0.028). Mechanical secondary hyperalgesia, a sign of central sensitization, was found in the Achilles tendinopathy group at the tibialis anterior (p=0.042) and non-involved Achilles (p=0.025), but not at the thenar eminence (p=0.276). The degree of HTS was not different between groups (p=0.981). Active participants with chronic Achilles tendinopathy showed signs of both peripheral and central sensitization; however, widespread hyperalgesia into the upper extremities and elevated temporal summation were not observed. Evidence of differences in pain sensitivity lend support to the theory for a multifactorial model of tendinopathy, which consists of an impaired motor system, local tendon pathology, and changes in the pain/nociceptive system. Physical therapy management of chronic Achilles tendinopathy may need to address potential changes in the nervous system. Interventions used to treat chronic tendinopathies should be investigated for their potential to resolve peripheral and central sensitization. Abstract | Full Article (subscribers only) | Purchase Article Iliac Crest Height Difference and Other Running-Related Variables’ Relationship With Running Injury. Authors: Cahanin RL, Jefferson JR, Flynn TW, Goyeneche N Leg-length inequality (LLI) is a common condition that may contribute to various spinal, pelvic, and lower extremity dysfunctions. Iliac crest height difference (ICHD) has been demonstrated to be a good estimate for LLI and may be a useful measure for identifying individuals who are at risk for injury. The purpose of the this study was to investigate the relationship between ICHD and other running-related variables with running injury. An observational retrospective case-control design was used. Data were collected via questionnaire and physical examination from a purposive sample of 100 runners and were analyzed using chi-squared tests of independence. The prevalence of ICHD ≥ 5mm reported by subjects via questionnaire was ~40%. There was no difference in report of injury between subjects with ICHD > 5mm and those with ICHD < 5mm (χ2=0.02, p=0.88); however, lifetime history of injury (χ2=15.68, p = 0.00) and the number of running events participated (χ2=3.09, p = 0.04) were significant factors associated with injury; although not significant, there was a trend towards relationship with gender (χ2=3.2, = 0.07). The authors concluded that a small ICHD is not associated with running injury among recreational runners. There appears to be an increased risk of running injury among runners who participate in more than one running event annually and those that have had a past history of running injury. Also, males may be at slightly greater risk of sustaining a running injury compared to females. Abstract | Full Article (subscribers only) | Purchase Article Changes in Pelvic Tilt during Three Different Reciprocal Stance Positions in Patients with Sacroiliac Joint Regional Pain.< Authors: Cibulka MT, Morr B, Wedel J, Bohr Z, Jones G, Herman C, Strube MJ Essential to the successful management of patients with sacroiliac joint pain (SIJP) is understanding how these joints move. The innominates tilt together in the same direction with symmetrical activities (i.e. forward-bending) but move opposite of one another when performing asymmetrical activities (i.e. walking). How they move in patients with SIJP is unknown. The purpose of this study was to examine inter-innominate movement (tilt) when assuming three different stance positions to describe how the innominate bones move in those with and without SIJP. Twenty-eight participants were classified into two groups; SIJP with low back pain (LBP), and no SIJP or LBP. SIJP participants were further classified into groups with left or right pelvic tilt. Pelvic tilt was measured during neutral standing and in both left-sided and right-sided reciprocal stance, with a full-stride (one hip fully flexed the other fully extended) and in a half-stride position, which mimics the double-stance phase of gait. A repeated measure ANOVA assessed for differences between Groups (Level, Left or Right Pelvic Tilt), stance side position (left/right), and stride length (full/half). The was a significant Group main effect (F [2, 25] = 130.2, p < 0.0001), and a significant Side main effect (F [1, 25] = 429.7, p < 0.0001), qualified by a significant Side x Group interaction (F [2, 25] = 19.9 p < .0001). Follow-up comparisons showed that pelvic tilts for right and left stance were significantly different (p < 0.05) for each group (Level, left and right pelvic tilt). For the right stance condition, all groups were significantly different from each other (p < 0.05). For the left stance position, the right pelvic tilt and level pelvic tilt means were not different from each other (p > 0.05), but each was different from the mean for the left pelvic tilt group (p < 0.05). The authors concluded that when assuming an asymmetrical stance position, the innominates tilt opposite of each other in those without SIJP. In patients with SIJP they behave in the normal fashion in one asymmetrical stance position but not the other. Instead of tilting opposite, as expected, the innominates remain symmetrical, dependent on the side of the presenting pelvic tilt. Abstract | Full Article (subscribers only) | Purchase Article CLINICAL COMMENTARY Benefits and Use of Aquatic Therapy During Rehabilitation After ACL Reconstruction - A Clinical Commentary. Authors: Buckthorpe M, Pirotti E, Villa FD This clinical commentary describes how the application of the properties of water can support the functional recovery process after ACLR. The authors propose that the main properties (density, hydrostatic pressure, buoyancy and viscosity) of water, if applied correctly to rehabilitation practices during aquatic therapy, can be used to achieve six primary goals after ACLR : 1) assist in the reduction of pain and swelling; 2) support the recovery of gait; 3) support the maintenance and/ or development of cardiovascular fitness; 4) help accelerate and optimize motor pattern retraining; 5) allow for earlier introduction of plyometrics and power training and 6) support the between session recovery and optimal load management, particularly in the later phases of rehabilitation. If implemented correctly, the presented phased protocol can support practitioners in implementing or delivering aquatic therapy rehabilitation services to their injured athletes. To support implementation, the authors have provided a specific protocol and supplementary videos for the use of aquatic therapy after ACLR. Abstract | Full Article (subscribers only) | Purchase Article Flywheel training in Musculoskeletal Rehabilitation: A Clinical Commentary. Authors: Wonders J Flywheel training is a relatively new method used to train the human body with continuous resistance and eccentric overload. The performed exercises result in improvements of strength and power, hypertrophy, muscle activation, muscle length, and tendon stiffness. Other positive effects of flywheel training are athletically relevant improvements in things such as speed, jump height and change of direction. The positive results can be explained by the eccentric and power characteristics of the training, making flywheel training ideal for use in musculoskeletal rehabilitation. Flywheel training can be used for injury prevention, training after a period of unloading, tendon and muscle rehabilitation, as part of post-operative rehabilitation, during late stage sport specific rehabilitation as well as for fall prevention and treatment of sarcopenia among elderly. The purpose of this commentary is to inform physical therapists about the use of flywheel training in musculoskeletal rehabilitation. Abstract | Full Article (subscribers only) | Purchase Article Third World Congress of Sports Physical Therapy Abstracts The International Journal of Sports Physical Therapy is pleased to publish abstracts of the 3rd World Congress of Sports Physical Therapy which took place in Vancouver BC October 4-5, 2019. The theme of the Congress was “High Performance to Clinical Practice.” The variety of presentations during this congress are examples of the contemporary sports physical therapy research activities taking place around the world. The abstracts presented were selected by the Congress Scientific Committee, which included members from Sport Physiotherapy Canada and from the International Federation of Sports Physical Therapy. Each abstract presents only a brief summary of a research project / presentation and does not permit full assessment of the scientific rigor with which the work was conducted. While the abstract offers only preliminary results that may require further refinement and future validation, they do serve an important role of sharing new research ideas from around the world. It should be noted that abstracts have not been reviewed by the Editorial Board, Associate Editors or Editor-in-Chief of the International Journal of Sports Physical Therapy. IJSPT-14_6-16-Abstracts Notice: The abstracts are presented as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. Minor edits for language were made to some abstracts.