Advancing Biomechanics: Enhancing Sports Performance, Mitigating Injury Risks, and Optimizing Athlete Rehabilitation

Introduction: This systematic review summarizes the efficacy of conservative treatment strategies on pain and function in runners with iliotibial band syndrome (ITBS), a prevalent running injury constituting about 10% of all running-related injuries. The multifactorial nature of ITBS necessitates diverse treatment approaches; yet, a consensus on an optimal conservative regimen remains unreported. This review seeks to update and expand upon existing literature with recent rehabilitative approaches.

Methods: A systematic search was conducted in Medline, Web of Science, and CINHAL databases, from inception to June 31, 2024. Inclusion criteria were: (1) reporting of conservative treatments for ITBS in adult runners and (2) pain and function defined as main outcome parameters. The methodological quality was evaluated using the NIH Quality Assessment Tool.

Results: Thirteen out of 616 records met the inclusion criteria (201 participants), including five randomized controlled trials, one case-control study, one pre-test post-test study, and six case studies. Different active and passive treatment strategies were applied as single (five studies) or combined (eight studies) treatments. The average methodological quality was deemed good. Large between-study heterogeneity was present, impeding a meta-analysis to be performed. Hip abductor strengthening (HAS) exercise emerged as a common strategy. The intervention effects on pain reduction ranged from 27% to 100%, and functional improvement from 10% to 57%, over 2 to 8 weeks.

Conclusion: A conservative treatment approach incorporating HAS exercises, possibly augmented by shockwave or manual therapy, is effective for mitigating pain and enhancing function in ITBS-afflicted runners. Finally, the potential of emerging strategies like gait retraining requires further exploration through rigorous trials and comprehensive evidence. Addressing these gaps could refine ITBS management, enhancing treatment outcomes and facilitating runners’ return to sport.

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Torque output of trunk muscles during 2-minute AO task, expressed as a percentage of their maximum voluntary contraction during MVC5: (A) trunk flexor muscles (during eccentric trunk extension), (B) trunk extensor muscles (during eccentric trunk flexion). Light grey lines represent the torque output of each participant, solid black lines represent the mean torque output during eccentric trunk flexion and extension.

Original Research

21 August 2024

A comparison of individual force decline profiles during a fatiguing eccentric trunk flexion and extension protocol: a pilot study

Yasemin Paksoy

, 3 more and

Tilman Engel

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The plot differences were obtained by subtracting the Alex7 test value from the Witty test value. Thick black solid line – mean difference between the two tests; thick black dashed lines – 95% limits of agreement; thin black dashed line – zero value.

Original Research

25 July 2024

Reliability and validity of sprint performance using the Alex7 motorized device

Austra Skujytė

, 5 more and

Sigitas Kamandulis

1,172 views

0 citations

Classification tree depicting accuracy derived from binary predictors of core or lower extremity injury (CLEI) occurrence among female and male high school athletes.

Original Research

27 March 2024

Concussion history and virtual reality metrics predict core or lower extremity injury occurrence among high school athletes

Gary B. Wilkerson

, 4 more and

Jennifer Hogg

1,983 views

2 citations

Flow diagram of video verified contact events, direct head impacts and IMG captured head acceleration events.

Original Research

20 November 2023

Validation of an instrumented mouthguard in rugby union—a pilot study comparing impact sensor technology to video analysis

Byron Field

, 3 more and

Andrew J. Gardner

Background: To better understand the biomechanical profile of direct head impacts and the game scenarios in which they occur in Rugby Union, there is a need for an on-field validation of a new instrumented mouthguard (IMG) against the reference standard. This study considers the potential of a combined biomechanical (IMG) and video analysis approach to direct head impact recognition, both of which in isolation have limitations. The aim of this study is to assess the relationship between an instrumented mouthguard and video analysis in detection of direct head impacts in rugby union.

Design: Pilot Study - Observational Cohort design

Methods: The instrumented mouthguard was worn by ten (3 backs, 7 forwards) professional Rugby Union players during the 2020–21 Gallagher Premiership (UK) season. Game-day video was synchronized with timestamped head acceleration events captured from the instrumented mouthguard. Direct Head Impacts were recorded in a 2 × 2 contingency table to determine sensitivity. Impact characteristics were also collected for all verified head impacts to further the understanding of head biomechanics during the game.

Results: There were 2018 contact events that were reviewed using video analysis. Of those 655 were categorized as direct head impacts which also correlated with a head acceleration event captured by the IMG. Sensitivity analysis showed an overall sensitivity of 93.6% and a positive predictive value (PPV of 92.4%). When false positives were excluded due to ball out of play, mouthguard removal or handling after a scoring situation or stoppage, PPV was improved (98.3%). Most verified head impacts occurred in and around the ruck contest (31.2%) followed by impacts to the primary tackler (28.4%).

Conclusion: This pilot validation study demonstrates that this IMG provides a highly accurate measurement device that could be used to complement video verification in the recognition of on-field direct head impacts. The frequency and magnitude of direct head impacts derived from specific game scenarios has been described and allows for greater recognition of high-risk situations. Further studies with larger sample sizes and in different populations of Rugby Union players are required to develop our understanding of head impact and enable strategies for injury mitigation.

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