Physical therapy, not a knee brace, aids in ACL recovery

Wearing a knee brace following anterior cruciate ligament (ACL) surgery has no effect on a person’s recovery. However, strength, range-of- motion, and functionality exercises provide significant benefits, and other new therapies may show promise.

In a new literature review recently published in the Journal of Bone and Joint Surgery (JBJS), a team of orthopaedic surgeons reviewed 29 studies regarding treatment following reconstructive ACL surgery. They found that physical therapy, begun shortly after surgery, can bring about very good outcomes for patients. Bracing, though, did not seem to improve results.

The ACL runs through the middle of the knee joint and helps to stabilize it. While the ACL can be injured through impact, it is most commonly strained or torn during non-contact injuries when a person:
- Suddenly changes direction
- Stops abruptly
- Lands incorrectly after a jump

These injuries often require reconstructive surgery, with post-surgical rehabilitative therapy. These therapies usually focus on improving the patient’s strength, range of motion, and function, and also may include some balance exercises.

Other findings include:
Physical therapy should begin early, ideally within a few days after surgery.
Therapies focusing on proprioception (awareness of movement of one’s body) may have benefits; however, the extent of their efficacy requires further research.
Balance therapies also may be promising.
Neuromuscular therapies are not harmful, but their benefits are in doubt and require more study. Neuromuscular therapies should be used to support other physical therapies, not in place of them.
Accelerated rehabilitation also does not appear to be harmful, but should be studied further.
No vitamins or other supplements have been proven to have any effect on ACL healing.

“The most important thing for ACL surgery patients is to start physical therapy early and rigorously,” says Rick W. Wright, MD, professor and co-chief of the sports medicine department at the Washington University Department of Orthopaedic Surgery, St, Louis, Mo. "It can be difficult at first, but it’s worth it in terms of returning to sports and other activities.”

Simple routine could help athletes avoid choking under pressure

Squeezing a ball before competition may improve performance, study finds

Some athletes may improve their performance under pressure simply by squeezing a ball or clenching their left hand before competition to activate certain parts of the brain, according to new research published by the American Psychological Association.

In three experiments with experienced soccer players, judo experts and badminton players, researchers in Germany tested the athletes' skills during practice and then in stressful competitions before a large crowd or video camera. Right-handed athletes who squeezed a ball in their left hand before competing were less likely to choke under pressure than right-handed players who squeezed a ball in their right hand. The study was published online in the Journal of Experimental Psychology: General.

For skilled athletes, many movements, such as kicking a soccer ball or completing a judo kick, become automatic with little conscious thought. When athletes under pressure don't perform well, they may be focusing too much on their own movements rather than relying on their motor skills developed through years of practice, said lead researcher Juergen Beckmann, PhD, chair of sport psychology at the Technical University of Munich in Germany.

"Rumination can interfere with concentration and performance of motor tasks. Athletes usually perform better when they trust their bodies rather than thinking too much about their own actions or what their coaches told them during practice," Beckmann said. "While it may seem counterintuitive, consciously trying to keep one's balance is likely to produce imbalance, as was seen in some sub-par performances by gymnasts during the Olympics in London."

Previous research has shown that rumination is associated with the brain's left hemisphere, while the right hemisphere is associated with superior performance in automated behaviors, such as those used by some athletes, the study notes. The right hemisphere controls movements of the left side of the body, and the left hemisphere controls the right side. The researchers theorized that squeezing a ball or clenching the left hand would activate the right hemisphere of the brain and reduce the likelihood of the athlete's choking under pressure. The study focused exclusively on right-handed athletes because some relationships between different parts of the brain aren't as well understood for left-handed people, according to the authors.

The research could have important implications outside athletics. Elderly people who are afraid of falling often focus too much on their movements, so right-handed elderly people may be able to improve their balance by clenching their left hand before walking or climbing stairs, Beckmann said.

"Many movements of the body can be impaired by attempts at consciously controlling them," he said. "This technique can be helpful for many situations and tasks."

In the first experiment, 30 semi-professional male soccer players took six penalty shots during a practice session. The next day, they attempted to make the same penalty shots in an auditorium packed with more than 300 university students waiting to see a televised soccer match between Germany and Austria. The players who squeezed a ball with their left hand performed as well under pressure as during practice, while players who squeezed a ball in their right hand missed more shots in the crowded auditorium.

Twenty judo experts (14 men and six women) took part in the second experiment. First, they performed a series of judo kicks into a sandbag during practice. During a second session, they were told that their kicks would be videotaped and evaluated by their coaches. The judo athletes who squeezed a ball with their left hand not only didn't choke under pressure, they performed better overall during the stressful competition than during practice, while those in the control group choked under pressure, the study found.

The final experiment featured 18 experienced badminton players (12 men and six women) who completed a series of practice serves. Then, they were divided into teams and competed against each other while being videotaped for evaluation by their coaches. Athletes who squeezed a ball in their left hand didn't choke under pressure, unlike the control group players who squeezed a ball in their right hand. A final phase of the experiment had the athletes just clench their left or right hand without a ball before competition, and players who clenched their left hand performed better than players who squeezed their right hand.

The ball-squeezing technique probably wouldn't help athletes whose performance is based on strength or stamina, such as weightlifters or marathon runners, the authors noted. The effects apply to athletes whose performance is based on accuracy and complex body movements, such as soccer players or golfers, they said.

Runners can improve health and performance with less training

The new 10-20-30 training concept can improve both a person's running performance and health, despite a significant reduction in the total amount of training. This is the conclusion of a study from University of Copenhagen researchers just published in the renowned scientific Journal of Applied of Physiology.

Over the course of seven weeks, runners were able to improve performance on a 1500-metre run by 23 seconds and almost by a minute on a 5-km run – and this despite a 50 per cent reduction in their total amount of training. These are just some of the results from a research project involving 18 moderately trained runners following the 10-20-30 training concept developed by researchers from the Department of Exercise and Sport Sciences at the University of Copenhagen.

In addition to enhancing running performance, the runners from the project also had a significant decrease in blood pressure and a reduction in cholesterol in the blood.

"We were very surprised to see such an improvement in the health profile considering that the participants have been running for several years," says Professor Jens Bangsbo, Department of Exercise and Sport Sciences, who heads the project.

"The results show that the very intense training has a great potential for improving health status of already trained individuals," says Professor Bangsbo.

PhD student Thomas Gunnarsson adds that the emotional well-being of the participants also improved over the span of the project.

"We found a reduction in emotional stress when compared to control subjects continuing their normal training based on a recovery-stress questionnaire administered before and after the 7-week training period," explains Gunnarsson.

The 10-20-30 training concept

The 10-20-30 training concept consists of a 1-km warm-up at a low intensity followed by 3-4 blocks of 5 minutes running interspersed by 2 minutes of rest. Each block consists of 5 consecutive 1-minute intervals divided into 30, 20 and 10 seconds of running at a low, moderate and near maximal intensity, respectively.

30 minutes is all you need

According to Professor Bangsbo, the 10-20-30 training concept is easily adapted in a busy daily schedule as the time needed for training is low. A total of 20-30 minutes including warm-up is all that is needed. Since the 10-20-30 concept deals with relative speeds and includes low speed running and 2-minute rest periods, individuals with different fitness levels and training backgrounds can perform the 10-20-30 training together.

"The training was very inspiring. I could not wait to get out and run together with the others. Today, I am running much faster than I ever thought possible," says Katrine Dahl, one of the participants in the study.

Psychological Testing May Predict Success in Soccer

I have always maintained that good decision making, especially with the ball, is a key to being a good soccer player. Now research supports this:

Measuring what are known as 'executive functions', which reflect the cognitive ability to deal with sudden problems, may make it possible to predict how good an elite soccer player will become in the future. This has been shown by a new study from Karolinska Institutet. Scientists believe for the first time that they have found the scientific key to what has previously been described as 'game intelligence' in successful soccer players.

It has long been known that physical ability and ball sense are not enough to become really good at soccer. A third vital component has often been mentioned: game intelligence, which is the ability to 'read' the play, to be always in the right place at the right time, and steal goals. Many people have regarded game intelligence to be almost a magical ability, something that is impossible to measure.

The scientists at Karolinska Institutet, however, claim that game intelligence is hardly mystical, and that it can be understood from a scientific perspective. It is, rather, an example of something that cognitive scientists call executive functions, which encompass the ability to be immediately creative, to be able to see new solutions to problems, to change tactics rapidly and to revise previous behaviour that has proved not to work.

"Our brains have specific systems that process information in just this manner, and we have validated methods within cognitive research to measure how well the executive functions work in an individual," says Dr Predrag Petrovic at the Department of Clinical Neuroscience.

Predrag Petrovic and his colleagues report in one study, to be published in the on-line scientific journal PLoS ONE, tests of certain executive functions in soccer players in Allsvenskan (the highest Swedish league) and in Division 1 (the league under Allsvenskan), a total of 57 elite soccer players. The scientists found that soccer players in both groups performed much better in tests of executive functions than the general population. And they found that players in Allsvenskan achieved much better results in these tests than players in Division 1.

The study then compared the test results with the performance of the players on the field. The scientists followed several of the soccer players for some years and recorded the number of goals and the number of assists each player made. In this way, each player was awarded points related to his or hers performance on the field. A clear correlation appeared between the results of the tests of executive functions and the number of points obtained on the soccer field (when corrected for such factors as a player's position and age).

It was thus shown that the best players had also performed best on the tests of executive functions. These results are unique, since they are based on scientifically standardised tests. Previously, researchers have used either specific tests from which it has not been possible to generalise the results, or studied specifically how heading the ball can cause cognitive abilities to deteriorate.

"We can imagine a situation in which cognitive tests of this type become a tool to develop new, successful soccer players. We need to study whether it is also possible to improve the executive functions through training, such that the improvement is expressed on the field. But there is probably a hereditary component, and a component that can be developed by training," says Torbjörn Vestberg, psychologist and a member of the research group that carried out the study.

Psychological testing may predict success in football

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I agree with this, a lot of success in soccer depends on good decision making , particularly when one has possession of the ball.

Measuring what are known as 'executive functions', which reflect the cognitive ability to deal with sudden problems, may make it possible to predict how good an elite football player will become in the future. This has been shown by a new study from Karolinska Institutet. Scientists believe for the first time that they have found the scientific key to what has previously been described as 'game intelligence' in successful football players.

It has long been known that physical ability and ball sense are not enough to become really good at football. A third vital component has often been mentioned: game intelligence, which is the ability to 'read' the play, to be always in the right place at the right time, and steal goals. Many people have regarded game intelligence to be almost a magical ability, something that is impossible to measure.

The scientists at Karolinska Institutet, however, claim that game intelligence is hardly mystical, and that it can be understood from a scientific perspective. It is, rather, an example of something that cognitive scientists call executive functions, which encompass the ability to be immediately creative, to be able to see new solutions to problems, to change tactics rapidly and to revise previous behaviour that has proved not to work.

"Our brains have specific systems that process information in just this manner, and we have validated methods within cognitive research to measure how well the executive functions work in an individual," says Dr Predrag Petrovic at the Department of Clinical Neuroscience.

Predrag Petrovic and his colleagues report in one study, to be published in the on-line scientific journal PLoS ONE, tests of certain executive functions in football players in Allsvenskan (the highest Swedish league) and in Division 1 (the league under Allsvenskan), a total of 57 elite footballers. The scientists found that football players in both groups performed much better in tests of executive functions than the general population. And they found that players in Allsvenskan achieved much better results in these tests than players in Division 1.

The study then compared the test results with the performance of the players on the pitch. The scientists followed several of the football players for some years and recorded the number of goals and the number of assists each player made. In this way, each player was awarded points related to his or hers performance on the pitch. A clear correlation appeared between the results of the tests of executive functions and the number of points obtained on the football pitch (when corrected for such factors as a player's position and age).

It was thus shown that the best players had also performed best on the tests of executive functions. These results are unique, since they are based on scientifically standardised tests. Previously, researchers have used either specific tests from which it has not been possible to generalise the results, or studied specifically how heading the ball can cause cognitive abilities to deteriorate.

"We can imagine a situation in which cognitive tests of this type become a tool to develop new, successful football players. We need to study whether it is also possible to improve the executive functions through training, such that the improvement is expressed on the pitch. But there is probably a hereditary component, and a component that can be developed by training," says Torbjörn Vestberg, psychologist and a member of the research group that carried out the study.

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Beanballs and the psychology of revenge

This week, as tens of millions of Americans awaited the baseball season’s first pitches, Brown University psychologist Fiery Cushman was watching more warily for the first beanballs. As someone who studies moral judgment, Cushman recognizes that the intentional targeting of an innocent player to avenge a hit batsman could be a telling exception within American culture, even if the rest of the game is a national institution.

Cushman and collaborators A.J. Durwin of Hofstra University and Chaz Lively of Boston University put the question to scores of baseball fans mingling outside Yankee Stadium and Fenway Park last season: A pitcher on the Chicago Cubs intentionally throws at and hits a batter on the St. Louis Cardinals. An inning later, the Cardinals’ pitcher retaliates by throwing at and hitting a previously uninvolved batter for the Cubs.

In their new study published in the Journal of Experimental Social Psychology, the researchers report that 44 percent of the fans they surveyed granted moral approval for the Cardinal pitcher’s beanball.

The researchers call this system of exacting revenge by targeting a teammate “vicarious punishment,” and note that it has emerged in many cultures throughout human history. In such “honor cultures” it has been acceptable to kill someone’s brother to avenge one’s own brother — as in, for example, the American blood feud between the Hatfields and McCoys.

“No one should conclude from this that ... vicarious punishment is considered acceptable widely in American culture,” Cushman said. “Quite to the contrary, what makes this striking is that it’s an exception. We’re trying to explain this exception.”

The new study examines what the revenge culture of baseball may reveal about the cultural practice of “blood feud” more broadly.

The beanball exception

In their survey questions, Cushman, Durwin, and Lively peeled back the layers of the fans’ thinking and found data that suggest vicarious punishment is more of a social norm than a product of different moral reasoning.

In the first survey of 145 fans at both ballparks, they asked half about the revenge scenario between the Cubs and Cardinals (of which 44 percent approved), and asked the other half to judge a situation where the Cardinals exacted their revenge not on the Cubs, but an entirely different team the next night. Far fewer fans (although still 19 percent) approved of that.

In a second experiment they asked 78 fans outside Yankee Stadium to judge either the original situation or the beaning of the pitcher who himself threw the malicious pitch the inning before. In that case 39 percent of fans still approved of the original vicarious method, but 70 percent approved of beaning the offending pitcher himself.

The third experiment, played out among 79 fans at Fenway Park, put the question in the context of the hometown favorite Red Sox. In one case a Red Sox pitcher was described avenging a previously beaned teammate. In the other case, a Sox batter was described as bearing the brunt of his teammates’ pitching transgression. In these cases, 43 percent of Red Sox fans acknowledged the morality of their own player being beaned out of revenge, but 67 percent approved of their pitcher exacting revenge against the other team.

In a final experiment, conducted among 131 baseball fans in an online discussion group, Cushman, Durwin, and Lively sought to assess fans’ understanding of moral responsibility, as well as their opinions about the overall morality of vengeful beaning. In this sample, 61 percent approved of beaning, such as in the Cubs and Cardinals case (the more highly they rated their affinity for baseball, the more likely they were to approve). Despite the high approval for vicarious punishment, only 18 percent of the surveyed fans held the recipient of the retaliatory beaning to be morally responsible for the original beaning. Meanwhile, 92 percent of fans held the pitcher who threw the first beanball morally responsible.

“Deserve’s got nothing to do with it”

If the vast majority of fans recognize the individual responsibility of the situation as accruing to the first pitcher who beans and not the last batter to be beaned, why do as many as two-thirds (in the hometown experiment) approve of that second batter being hit? It’s a similar question to ask why such systems of justice emerged in Iceland around the 10th century A.D. or in Montenegro more than a century ago, Cushman said. Vicarious punishment also characterizes some cases of gang- and mob-related violence. Previous researchers have seen a correlation between such systems and weak state oversight.

The cultural exception that Americans make for baseball, even as they acknowledge who is and is not really at fault, the researchers suggest, may indicate cultures that practice vicarious retribution can be understood more as driven by either contextual necessity or tradition, rather than by a fundamentally different way of assigning moral responsibility. Motivations might instead be honor or deterrence.

“It’s really beautifully captured by this quote from the Clint Eastwood movie Unforgiven: ‘Deserve’s got nothing to do with it,’” Cushman said. “The idea is we have to protect ourselves, we have to do something to respond to this act. The person we’re targeting isn’t morally responsible but the practical demands of the situation are such that we’ve got to do something and this is it.”

In that sense baseball is a game of athleticism, strategy, community, and collective punishment without an underlying theory of moral responsibility.

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Fewer Injuries for Winning Soccer Teams

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All soccer players and fans know that it is better to win than to lose. Yet the fact that victory also means less risk of injury is not as obvious. New findings from researchers in sports medicine at Linköping University have aroused great interest among Europe's elite soccer teams.

Håkan Bengtsson, a master's student in physiotherapy, has analysed data from 6272 games played by 26 of the top European clubs. The material comprises 2739 injuries and constitutes the world's largest database of its kind. The results was tabled at a regional conference on physiotherapy in Linköping March 22.

Based on information the clubs sent to the Swedish researchers once a month, Håkan Bengtsson then examined how the injury rate is influenced by three factors:

* the result
* home or away match
* type of competition

It turned out that the outcome of the match had the clearest correlation with the proportion of injuries. For teams that lost, the risk of injury was 21 percent greater than for the winning teams; in drawn games the risk was 15 percent higher.

"We have not established which is the chicken or the egg. The most likely scenario is that a player was injured during the match, which subsequently lead to a loss. The bottom line is that the clubs' medical work is vital to the results," says Håkan Bengtsson.

Bengtsson was somewhat surprised that a higher injury risk ensued for the home team than the away team. One conceivable explanation is that home teams play more aggressively coupled with longer and faster running sorties. With regard to the type of competition, Champions League matches appeared somewhat more dangerous than for the rhythm of the domestic leagues.

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