Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Athletes with femoroacetabular impingement syndrome (FAIS) managed arthroscopically do not always return to sport. Inability to control back/pelvis, hip and lower limb movements may contribute to the onset and recurrence of symptoms. Our hypothesis is that results from a battery of cognitive movement control tests can inform a cognitive movement control (neuromuscular) retraining programme for improving the clinical presentation and quality of life in an athlete with FAIS. This case report presents a female elite rower with persistent left-sided anterior hip pain, four years post-arthroscopic surgery for FAIS, whose symptoms failed to respond to conventional physical therapy. Hip and groin outcome score (HAGOS), passive and active hip flexion range of motion (ROM) workload (time training on water), hip and pelvic kinematics (3-D motion analysis) and electromyography during a seated hip flexion movement control test, and a movement control test battery to identify movement control impairments (The Foundation Matrix), were assessed pre-intervention (week 0) and immediately post-intervention (week 16). Impaired movement control was targeted in a tailored 16-week cognitive movement control retraining exercise program. All measures improved: HAGOS (all 6 sub-scales); symptoms (61/100 pre-training to 96/100 post-training); physical activities participation (13/100 to 75/100); and active hip flexion ROM increased (78 to 116 and 98 to 118 degrees, respectively); workload increased from 4 to 18 h/week; and movement control impairment reduced (25/50 to 9/50). Pelvic motion on kinematic analysis were altered, and delayed activation onset of tensor fascia latae and rectus femoris muscles reduced. This proof-of-concept case report supports the hypothesis that cognitive movement control tests can inform a targeted cognitive movement control retraining program to improve symptoms, function and quality of life, in an elite rower with persistent hip pain. This training offers an alternative approach to conventional physical therapy, which has failed to restore function in FAIS, and the present study illustrates how specific cognitive movement control assessment can direct individual training programmes.

Rowing Over the Edge: Nonfunctional Overreaching and Overtraining Syndrome as Maladjustment—Diagnosis and Treatment From a Psychological Perspective

A rigorous training schedule with insufficient recovery can lead to nonfunctional overreaching (NFOR) or overtraining syndrome (OTS). Research has suggested the multifactorial etiology of these phenomena. Stressors that contribute to and are symptoms and consequences of NFOR and OTS and adjustment disorder are almost identical. In this case study of an elite rower, the author illustrates an intervention approach that can be taken when overtraining is viewed as a sport-specific form of adjustment disorder. The intervention involved treatment that improved the athlete’s awareness of his basic biopsychosocial processes, developed sources of self-worth beyond athletic performance, and challenged his 1-dimensional athletic identity. The intervention included cognitive-behavioral therapy methods (e.g., autogenic training) and mindfulness- and acceptance-based interventions to enhance the athlete’s psychological flexibility. Mood monitoring was used as a diagnostic and evaluative instrument. Intervention effectiveness was evaluated through an in-depth interview with the athlete. The consulting sport psychologist also engaged in reflection about treatment effectiveness and predominant challenges. Challenging the athlete and clarifying his personal values were judged to be very important. Evaluation suggested that viewing NFOR and OTS as forms of adjustment disorder may help us recognize the multifaceted nature of an athlete’s maladjusted state and widen treatment options.

Adaptive smartphone-based sensor fusion for estimating competitive rowing kinematic metrics

Competitive rowing highly values boat position and velocity data for real-time feedback during training, racing and post-training analysis. The ubiquity of smartphones with embedded position (GPS) and motion (accelerometer) sensors motivates their possible use in these tasks. In this paper, we investigate the use of two real-time digital filters to achieve highly accurate yet reasonably priced measurements of boat speed and distance traveled. Both filters combine acceleration and location data to estimate boat distance and speed; the first using a complementary frequency response-based filter technique, the second with a Kalman filter formalism that includes adaptive, real-time estimates of effective accelerometer bias. The estimates of distance and speed from both filters werevalidated and compared with accurate reference data from a differential GPS system with better than 1 cm precision and a 5 Hz update rate, in experiments using two subjects (an experienced club-level rower and an elite rower) in two different boats on a 300 m course. Compared with single channel (smartphone GPS only) measures of distance and speed, the complementary filter improved the accuracy and precision of boat speed, boat distance traveled, and distance per stroke by 44%, 42%, and 73%, respectively, while the Kalman filter improved the accuracy and precision of boat speed, boat distance traveled, and distance per stroke by 48%, 22%, and 82%, respectively. Both filters demonstrate promise as general purpose methods to substantially improve estimates of important rowing performance metrics.

Chronic Exertional Compartment Syndrome of the Forearm in an Elite Rower

We report a case of chronic exertional compartment syndrome (CECS) affecting the volar forearm compartment of an elite rower. CECS of the forearm is a less well recognised entity than lower limb CECS. We describe a typical history and detail a potential treatment.