Journal of Orthopaedic & Sports Physical Therapy最新文献

{"title":"Comment on: Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial.","authors":"Wei-Chun He, Jing Luo","doi":"10.2519/jospt.2025.0203-R","DOIUrl":"10.2519/jospt.2025.0203-R","url":null,"abstract":"<p><p>Author response to the <i>JOSPT</i> Letter to the Editor-in-Chief \"Neuromuscular Control and Resistance Training for Chronic Low Back Pain: Discussing a Randomized Controlled Trial\" <i>J Orthop Sports Phys Ther 2025;55(4):305-306. doi:10.2519/jospt.2025.0203-R</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 4","pages":"305-306"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Findings Associated With Osteoarthritis Are Common in Dancers, and Are Rarely Symptomatic: A Systematic Review With Meta-Analysis.","authors":"Melanie Fuller, Joshua Hanel, Susan Mayes, Tracy Bruce, Ebonie Rio","doi":"10.2519/jospt.2025.12918","DOIUrl":"10.2519/jospt.2025.12918","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To estimate the prevalence of imaging findings that may be associated with osteoarthritis (OA), and their relationship with symptoms in dancers. <b>DESIGN:</b> Etiology systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> Four electronic databases were searched (PubMed, Scopus, CINAHL, SPORTDiscus) from inception to September 2023. <b>STUDY SELECTION CRITERIA:</b> Included studies reported joint imaging findings in dancers. We considered all study designs that investigated populations with regular participation in any form of dance, at any stage of career. <b>DATA SYNTHESIS:</b> Data were pooled for meta-analysis if at least 3 studies reported on the same intra-articular imaging findings, at the same joint, in a similar dance genre. <b>RESULTS:</b> Thirty-two studies were included. Meta-analysis was performed for the prevalence of hip, ankle, and first metatarsophalangeal joint OA, and ankle effusion. The first metatarsophalangeal joint had the highest prevalence of radiographic OA (59%). The prevalence of symptomatic OA was low (3%). The ankle (radiographic OA 41%) and then the hip (radiographic OA 19%) joint were the next most common regions to report imaging findings, with a lower prevalence of symptomatic OA seen at the ankle (2%) to pool 2 studies and hip (8%) to pool 4 studies. <b>CONCLUSION:</b> There was very low certainty evidence of the first metatarsophalangeal joint having the highest prevalence of imaging findings in dancers, followed by the ankle and hip joints. A lower prevalence of symptomatic OA was seen at all 3 joints. <i>J Orthop Sports Phys Ther 2024;55(4):1-9. Epub 3 March 2025. doi:10.2519/jospt.2025.12918</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 4","pages":"275-283"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myofascial Pain Syndromes: Controversies and Suggestions for Improving Diagnosis and Treatment.","authors":"Chad E Cook, Brian Degenhardt, Sasha Aspinall, Casper Nim, Shaista Malik, Damian Keter","doi":"10.2519/jospt.2025.13072","DOIUrl":"10.2519/jospt.2025.13072","url":null,"abstract":"<p><p><b>SYNOPSIS:</b> Myofascial pain syndromes (MPSs) affect a significant portion of the population. However, they remain controversial because their etiology, diagnostics, and effect mechanisms rely on theoretical frameworks with limited scientific rigor. This Viewpoint highlights 3 main challenges and proposes solutions: First, diagnosis lacks consistent criteria and is at risk of verification and incorporation biases. Tightened diagnostic criteria and differentiating myofascial pain syndrome from competing conditions will improve accuracy in research and clinical practice. Second, the etiology/pain mechanisms are poorly understood, with symptoms overlapping other conditions. We recommend recording of standardized assessments in national registries including psychological stress and systemic factors to identify distinct phenotypes. Third, the mechanisms behind treatments such as myofascial release and acupuncture are unclear. We advocate for mechanistic clinical trials to uncover how these treatments exert effects. Addressing these challenges will enhance understanding, diagnosis, and treatment of MPS and guide policymakers to fund appropriate research. <i>J Orthop Sports Phys Ther 2025;55(4):1-4. Epub 10 February 2025. doi:10.2519/jospt.2025.13072</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 4","pages":"231-234"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Group-Based Physiotherapy a Cost-Effective Intervention Compared to Usual One-on-One Physiotherapy Care in the Management of Musculoskeletal Disorders in Active Military Personnel? An Economic Evaluation Alongside a Pragmatic Randomized Clinical Trial.","authors":"Frédérique Dupuis, Jason Robert Guertin, Rose Gagnon, Simon Larue, Maj Anny Fredette, Luc J Hébert, François Desmeules, Kadija Perreault, Jean-Sébastien Roy","doi":"10.2519/jospt.2025.12888","DOIUrl":"10.2519/jospt.2025.12888","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To conduct a cost-utility analysis of a group physiotherapy intervention, compared to usual care, for musculoskeletal disorders in Canadian military personnel. <b>DESIGN:</b> Economic evaluation alongside a pragmatic randomized clinical trial. <b>METHODS:</b> One hundred and twenty military members presenting with shoulder, knee, ankle, or low back pain were randomized to receive either usual one-on-one physiotherapy care or a group intervention. Cumulative health care costs were prospectively collected over 26 weeks from the perspective of the Canadian Armed Forces. The clinical outcome of the cost-utility analysis was the quality-adjusted life-year (QALY) estimated by the ED-5Q-5L (European Quality of Life 5 Dimensions 5 Level Version) at baseline, 6, 12, and 26 weeks. The incremental cost-effectiveness ratio (ICER) was estimated by the cost difference between interventions (in 2023 Canadian dollars [CAD$]) divided by the effect difference. <b>RESULTS:</b> The mean QALY gain was 0.011 in the group intervention, and 0.010 in the usual care. The average cost for a patient was CAD $532 in the group intervention and CAD $599 in the usual care. The ICER (-$67 000/QALY) indicated that the group intervention was cost-effective, as it costs less than usual care while providing comparable effectiveness. <b>CONCLUSION:</b> Group interventions were cost-effective compared to usual care for treating musculoskeletal disorders in military personnel. <i>J Orthop Sports Phys Ther 2025;55(4):1-10. Epub 26 Feb 2025. doi: 10.2519/jospt.2025.12888</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 4","pages":"295-304"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Baseline MRI Findings Identify Who Responds Better to Early Surgery Versus Exercise and Education in Young Patients With Meniscal Tears? A Subgroup Analysis From the DREAM Trial.","authors":"Stine Haugaard Clausen, Mikael Boesen, Jonas B Thorlund, Werner Vach, Martin Lind, Per Hölmich, Mogens Strange Hansen, Afsaneh Mohammadnejad, Søren T Skou","doi":"10.2519/jospt.2025.12994","DOIUrl":"10.2519/jospt.2025.12994","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To investigate whether magnetic resonance imaging (MRI) findings modified the outcomes of early surgery compared to exercise and education in young patients with meniscal tears. <b>DESIGN:</b> A secondary effect modifier analysis of a randomized controlled trial. <b>METHODS:</b> The primary outcome was change from baseline to 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄). Three potential MRI-defined effect modifiers were predefined: (1) the type of meniscal tear (simple vs bucket handle or complex), (2) the meniscus affected (medial vs lateral), and (3) the presence of knee effusion/synovitis (yes/no). We used a linear mixed model to investigate the difference in mean change between the treatment groups, stratified by each of the 3 potential effect modifiers, and estimated the interactions. An adjusted effect difference ≥ 10 points (0-100 scale) was considered clinically relevant. <b>RESULTS:</b> Data from all participants (60 in the surgery group and 61 in the exercise group) were analyzed. The mean (SD) age was 29.7 (6.6) years, and 28% were female. A potential effect modification was observed for knee effusion/synovitis, with its presence implying an increase of the effect of early surgery by 11 points on the KOOS₄ (<i>P</i> = .07). <b>CONCLUSION:</b> Knee effusion/synovitis on MRI potentially modified the treatment effect with a clinically relevant difference in change of the KOOS₄ in patients with effusion/synovitis, favoring early surgery. We found no indication that patients with bucket handle or complex versus simple tears or medial versus lateral tears benefited more from early surgery. <i>J Orthop Sports Phys Ther 2025;55(3):1-11. Epub 30 January 2025. doi:10.2519/jospt.2025.12994</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 3","pages":"1-11"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Women Less Likely to Return to Sport Compared to Men Following Hip Arthroscopy. A Systematic Review and Meta-analysis.","authors":"Matthew G King, Pim Van Klij, Fan Hoak, Signe Kierkegaard-Brøchner, Thomas J West, Mark J Scholes, Joshua J Heerey, Adam I Semciw, Charlotte Ganderton, Rachael M McMillan, Andrea M Bruder","doi":"10.2519/jospt.2025.12813","DOIUrl":"10.2519/jospt.2025.12813","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To compare return-to-sport outcomes between females/women/girls and males/men/boys undergoing hip arthroscopy and explore social and structural determinants of health that may influence return to sport. <b>DESIGN:</b> Systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, SPORTDiscus, and Web of Science from inception to February 2024. <b>STUDY SELECTION CRITERIA:</b> Studies were included if they assessed return to sport after hip arthroscopy and analyzed the influence of sex/gender on return-to-sport outcomes, or reported sex- or gender-stratified return-to-sport rates. <b>DATA SYNTHESIS:</b> We used a random effects model to calculate pooled odds ratios and conducted meta-regressions to compare return-to-sport outcomes between females/women/girls and males/men/boys. <b>RESULTS:</b> Forty-five studies were included, with all pooled results deemed as very low-certainty evidence. Compared to males/men/boys, females/women/girls had inferior return to sport at the same or higher level between 1 and 3 years postoperatively (pooled OR = 0.53; 95% CI: 0.34, 0.81; <i>P</i> = .004), and at any level of sport at >3 years postoperatively (pooled OR = 0.46; 95% CI: 0.25, 0.86; <i>P</i> = .014). Sports participation decreased over time, with ~5.5% to 10% lower proportions observed in females/women/girls compared to males/men/boys. The reporting of determinants of returning to sport was minimal, precluding further exploration of their effects. <b>CONCLUSION</b>: Females/women/girls had lower odds of return to sport, especially during longer follow-up periods, than males/men/boys. The lack of reporting of social and structural determinants of health influencing return-to-sport outcomes makes the reasons for this disparity unclear. <i>J Orthop Sports Phys Ther 2025;55(3):1-13. Epub 10 February 2025. doi:10.2519/jospt.2025.12813</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 3","pages":"1-13"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving the Control-Chaos Continuum: Part 2-Shifting \"Attention\" to Progress On-Pitch Rehabilitation.","authors":"Matt Taberner, Tom Allen, Jason O'keefe, Meredith Chaput, Dustin Grooms, Daniel Dylan Cohen","doi":"10.2519/jospt.2025.13159","DOIUrl":"10.2519/jospt.2025.13159","url":null,"abstract":"<p><p><b>BACKGROUND:</b> On-pitch rehabilitation is key to supporting return to sport in elite soccer (football). The <i>control-chaos continuum</i> (<i>CCC</i>) guides practitioners through the sport-specific components of return to sport. There is a need to update the framework with recent research in injury neurophysiology, soccer performance, and coaching science. <b>CLINICAL QUESTION:</b> How do practitioners integrate the insights from injury neurophysiology, soccer performance, and coaching science discussed in part 1 of this 2-part series into an updated version of the <i>CCC</i>, to enhance the planning and execution of on-pitch rehabilitation for elite soccer players? <b>KEY RESULTS:</b> The revised <i>CCC</i> framework emphasizes the design and delivery of progressive training in increasingly <i>chaotic</i> conditions. The updated framework supports practitioners to incorporate elements of visual-cognitive challenges, attentional challenges, decision making, and progression representation of the game model when players are preparing to return to sport. <b>CLINICAL APPLICATION:</b> The updated <i>CCC</i> outlines training progression from <i>High Control</i>, which involves returning to on-pitch linear running, to <i>High Chaos</i>, which simulates the team environment at game speed. The <i>High Chaos</i> phase can be tailored to support players during their reintegration into team training. The model is adaptable for both short- and long-term injuries, integrating physical-cognitive load monitoring and strength and power diagnostics to enhance decision making throughout return to sport. <i>J Orthop Sports Phys Ther 2025;55(3):1-11. Epub 17 January 2025. doi:10.2519/jospt.2025.13159</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 3","pages":"162-172"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Manual Joint Mobilization Techniques in the Treatment of Nonspecific Neck Pain: Systematic Review With Meta-Analysis and Meta-Regression of Randomized Controlled Trials.","authors":"Alessia Benetton, Simone Battista, Gianluca Bertoni, Giacomo Rossettini, Luca Falsiroli Maistrello","doi":"10.2519/jospt.2025.12836","DOIUrl":"10.2519/jospt.2025.12836","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> The purpose of this study was to investigate the effects of cervical joint mobilization techniques (JMTs) on pain and disability in adults with nonspecific neck pain. <b>DESIGN:</b> This study is an intervention systematic review with meta-analysis and meta-regression of randomized controlled trials (RCTs). <b>LITERATURE SEARCH:</b> We searched MEDLINE, Cochrane CENTRAL, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Web of Science databases, including references from other reviews or clinical practice guidelines up to October 16, 2024. <b>STUDY SELECTION CRITERIA:</b> Eligible RCTs evaluated JMTs compared to routine physiotherapy, minimally active interventions, or no treatment. The primary outcome was pain; secondary outcomes were disability, Global Perceived Effect (GPE), quality of life, psychosocial status, and adverse events. <b>DATA SYNTHESIS:</b> Meta-analyses and meta-regression were conducted for pain, disability, and GPE. The risk of bias was assessed with Cochrane RoB 2.0 Tool; the certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluations approach. We used The Template for the Intervention Description and Replication checklist to evaluate the quality of reporting of interventions delivered. <b>RESULTS:</b> Results from 16 RCTs were pooled (<i>n</i> = 1,157 participants), reporting nonclinically positive results on pain reduction (mean difference [MD] = -0.86 (95% confidence interval [-1.35, -0.36])), disability (MD=-2.11 [-3.31, -0.91]), and GPE (standardized mean difference = 0.11 ([-0.15, 0.37]) and high heterogeneity. The meta-regressions did not identify any covariates associated with the treatment effects. Minor side effects (increased neck pain and headache) were reported. <b>CONCLUSION:</b> There was very low certainty evidence supporting the efficacy of JTMs for reducing pain and improving disability in people with NSNP. <i>J Orthop Sports Phys Ther 2025;55(3):1-20. Epub 12 February 2025. doi:10.2519/jospt.2025.12836</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 3","pages":"1-20"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shouldering Our Way Into a More Meaningful Research Agenda for Atraumatic Shoulder Pain: <i>A Priority Setting Study</i>.","authors":"Kristian Damgaard Lyng, Torben Krejberg Børsting, Mikkel Bek Clausen, Annelene Houen Larsen, Behnam Liaghat, Kim Gordon Ingwersen, Marcus Bateman, Amar Rangan, Karen Toftdahl Bjørnholdt, David Høyrup Christiansen, Steen Lund Jensen, Janus Laust Thomsen, Kristian Thorborg, Connie Ziegler, Jens Lykkegaard Olesen, Michael Skovdal Rathleff","doi":"10.2519/jospt.2025.13059","DOIUrl":"10.2519/jospt.2025.13059","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To amplify the voices of people living with atraumatic shoulder pain, their relatives, and health care practitioners, and to establish research questions. <b>DESIGN:</b> A priority-setting study using a modified approach originally formulated by the James Lind Alliance (JLA). <b>METHODS:</b> The process consisted of 6 phases (initiation, consultation, collation, prioritization, validation, and reporting), and included 2 e-surveys and 2 separate virtual workshops. We included people with atraumatic shoulder pain, relatives, health care practitioners managing shoulder pain, and researchers conducting research within the field. <b>RESULTS:</b> Six hundred and eight people participated (n = 383 [63%] patients, n = 213 [35%] health care practitioners, and n = 12 [2%] carers). In the first survey, 297 participants submitted 1080 potential research questions, which were collated into 16 main themes and 94 subthemes and transformed into research questions. These research questions were featured in the second survey, where 290 participants prioritized the questions, resulting in a compilation of the top 25 questions. Based on discussions from 2 separate online workshops with a total of 21 participants, a top-10 list was created. <b>CONCLUSION:</b> In the final priority list, the 3 research questions with the highest ranking were, first, \"how can we improve the translation of research into clinical practice?\"; second, \"how can we prevent atraumatic shoulder pain?\"; and third, \"who benefits from surgery, and who does not?\" <i>J Orthop Sports Phys Ther 2025;55(3):1-12. Epub 12 February 2025. doi:10.2519/jospt.2025.13059</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 3","pages":"1-12"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving the Control-Chaos Continuum: Part 1 - Translating Knowledge to Enhance On-Pitch Rehabilitation.","authors":"Matt Taberner, Tom Allen, Jason O'keefe, Meredith Chaput, Dustin Grooms, Daniel Dylan Cohen","doi":"10.2519/jospt.2025.13158","DOIUrl":"10.2519/jospt.2025.13158","url":null,"abstract":"<p><p><b>BACKGROUND:</b> On-pitch rehabilitation is a crucial part of returning to sport after injury in elite soccer. The <i>control-chaos continuum</i> (<i>CCC</i>) initially offered a framework for practitioners to plan on-pitch rehabilitation, focusing on physical preparation and sport specificity. However, our experiences with the <i>CCC</i>, combined with recent research in injury neurophysiology, point to a need for an updated model that integrates practice design and physical-cognitive interactions. <b>CLINICAL QUESTION:</b> What are the insights from injury neurophysiology, soccer performance, and coaching science needed to update the <i>CCC</i> and improve the planning, delivery, and progression of on-pitch rehabilitation in elite soccer? <b>KEY RESULTS:</b> Drawing on extensive experience in elite sport, we explain how recent research on neurophysiological recovery from injury, game models, and practice design has been applied to update the <i>CCC</i> and evolve the existing framework. <b>CLINICAL APPLICATION:</b> The evolution of the <i>CCC</i> expands on the original model to enhance planning, delivery, and progression of on-pitch rehabilitation. The updated framework incorporates elements of visual cognition, attentional challenges, decision-making, and progressive representation of the game model to enhance sport-specific preparation for returning to sport. <i>J Orthop Sports Phys Ther 2025;55(2):1-11. Epub 3 January 2025. doi:10.2519/jospt.2025.13158</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":"55 2","pages":"78-88"},"PeriodicalIF":6.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}