The Journal of Athletic Training is pleased to publish the International Olympic Committee's consensus statement on periodic health evaluation of elite athletes (along with the American Journal of Sports Medicine, the British Journal of Sports Medicine, the Clinical Journal of Sport Medicine, the International Sports Medicine Journal, the Journal of Science and Medicine in Sports, the Scandinavian Journal of Medicine and Science in Sports, and the South African Journal of Sports Medicine). The publication of a sports medicine–related consensus statement prepared for a worldwide
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PhD ATC CSCS,
PhD FACSM, and
PhD ATC FNATA FACSM
Health care professionals advocate that athletes who are susceptible to exercise-associated muscle cramps (EAMCs) should moderately increase their fluid and electrolyte intake by drinking sport drinks. Some clinicians have also claimed drinking small volumes of pickle juice effectively relieves acute EAMCs, often alleviating them within 35 seconds. Others fear ingesting pickle juice will enhance dehydration-induced hypertonicity, thereby prolonging dehydration. To determine if ingesting small quantities of pickle juice, a carbohydrate-electrolyte (CHO-e) drink, or water increases plasma electrolytes or other selected plasma variables. Crossover study. Exercise physiology laboratory. Nine euhydrated, healthy men (age = 25 ± 2 years, height = 179.4 ± 7.2 cm, mass = 86.3 ± 15.9 kg) completed the study. Resting blood samples were collected preingestion (−0.5 minutes); immediately postingestion (0 minutes); and at 1, 5, 10, 15, 20, 25, 30, 45, and 60 minutes postingestion of 1 mL/kg body mass of pickle juice, CHO-e drink, or tap water. Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume were analyzed. Urine specific gravity, osmolality, and volume were also measured to characterize hydration status. Mean fluid intake was 86.3 ± 16.7 mL. Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma osmolality, and plasma volume did not change during the 60 minutes after ingestion of each fluid (P ≥ .05). Water ingestion slightly decreased plasma potassium concentration at 60 minutes (0.21 ± 0.14 mg/dL [0.21 ± 0.14 mmol/L]; P ≤ .05). At these volumes, ingestion of pickle juice and CHO-e drink did not cause substantial changes in plasma electrolyte concentrations, plasma osmolality, or plasma volume in rested, euhydrated men. Concern that ingesting these volumes of pickle juice might exacerbate an athlete's risk of dehydration-induced hypertonicity may be unwarranted. If EAMCs are caused by large electrolyte loss due to sweating, these volumes of pickle juice or CHO-e drink are unlikely to restore any deficit incurred by exercise.Abstract
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MS LAT ATC,
PhD,
MS LAT ATC, and
PhD ATC FACSM
Rehabilitation protocols involving eccentric resistance exercise performed with loading more than 100% concentric 1-repetition maximum are effective in increasing muscle function in both healthy and injured populations. The mode of eccentric exercise (isokinetic versus isotonic) may be an important factor in limiting symptoms of delayed-onset muscle soreness and in improving muscle function after training. To compare functional and symptomatic responses after an eccentric-only (ECC) isotonic exercise protocol and after a combined concentric-eccentric (CON-ECC) isokinetic exercise protocol matched for total exercise volume. Observational study. Controlled research laboratory. Twenty-four healthy, untrained, college-aged men (n = 12) and women (n = 12). Participants were randomly assigned to the ECC isotonic or CON-ECC isokinetic exercise group and performed a single bout of resistance exercise involving the elbow flexors. Measurements of elbow flexion and extension, isometric strength, and muscle point tenderness were obtained before exercise (baseline) and during follow-up sessions (days 2, 4, 7, and 14). Separate 1-way analyses of variance and repeated-measures analyses of variance were used to determine outcome differences. Tukey post hoc testing was performed when indicated. At baseline, no differences were present between groups for any measure. The ECC isotonic exercise protocol resulted in a 30% to 36% deficit in muscle strength, a 5% to 7% reduction in elbow flexion, and a 6% to 8% reduction in elbow extension at follow-up days 2 and 4 (P < .01). The CON-ECC isokinetic exercise protocol did not alter muscle strength or range of motion at any time when compared with baseline. Muscle point tenderness increased from baseline on days 2 and 4 in both groups (P < .05) but was not different between groups throughout the recovery period. Our results indicated more pronounced functional deficits occurred after a single bout of ECC isotonic exercise than with a CON-ECC isokinetic exercise protocol matched for training volume.Abstract
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MS ATC,
PhD ATC, and
PhD ATC
Whole-body vibration machines are a relatively new technology being implemented in the athletic setting. Numerous authors have examined the proposed physiologic mechanisms of vibration therapy and performance outcomes. Changes have mainly been observed in the lower extremity after individual exercises, with minimal attention to the upper extremity and resistance training programs. To examine the effects of a novel vibration intervention directed at the upper extremity as a precursor to a supervised, multijoint dynamic resistance training program. Randomized controlled trial. National Collegiate Athletic Association Division IA institution. Thirteen female student-athletes were divided into the following 2 treatment groups: (1) whole-body vibration and resistance training or (2) resistance training only. Participants in the vibration and resistance training group used an experimental vibration protocol of 2 × 60 seconds at 4 mm and 50 Hz, in a modified push-up position, 3 times per week for 10 weeks, just before their supervised resistance training session. Isokinetic total work measurements of the rotator cuff were collected at baseline and at week 5 and week 10. No differences were found between the treatment groups (P > .05). However, rotator cuff output across time increased in both groups (P < .05). Although findings did not differ between the groups, the use of whole-body vibration as a precursor to multijoint exercises warrants further investigation because of the current lack of literature on the topic. Our results indicate that indirectly strengthening the rotator cuff using a multijoint dynamic resistance training program is possible.Abstract
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PhD ATC,
MD MS,
PhD PT ATC, and
PhD ATC FNATA FACSM
Isolated lumbar paraspinal muscle fatigue causes lower extremity and postural control deficits. To describe the change in body position during gait after fatiguing lumbar extension exercises in persons with recurrent episodes of low back pain compared with healthy controls. Case-control study. Motion analysis laboratory. Twenty-five recreationally active participants with a history of recurrent episodes of low back pain, matched by sex, height, and mass with 25 healthy controls. We measured 3-dimensional lower extremity and trunk kinematics before and after fatiguing isometric lumbar paraspinal exercise. Measurements were taken while participants jogged on a custom-built treadmill surrounded by a 10-camera motion analysis system. Group-by-time interactions were observed for lumbar lordosis and trunk angles (P < .05). A reduced lumbar spine extension angle was noted, reflecting a loss of lordosis and an increase in trunk flexion angle, indicating increased forward trunk lean, in healthy controls after fatiguing lumbar extension exercise. In contrast, persons with a history of recurrent low back pain exhibited a slight increase in spine extension, indicating a slightly more lordotic position of the lumbar spine, and a decrease in trunk flexion angles after fatiguing exercise. Regardless of group, participants experienced, on average, greater peak hip extension after lumbar paraspinal fatigue. Small differences in response may represent a necessary adaptation used by persons with recurrent low back pain to preserve gait function by stabilizing the spine and preventing inappropriate trunk and lumbar spine positioning.Abstract
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PhD ATC,
PhD, and
PhD ATC
”Psychosocial Intervention and Referral„ is 1 of the 12 content areas in athletic training education programs, but knowledge gained and skill usage after an educational intervention in this area have never been evaluated. To evaluate the effectiveness of an educational intervention in increasing psychology-of-injury knowledge and skill usage in athletic training students (ATSs). Observational study. An accredited athletic training education program at a large Midwestern university. Participants included 26 ATSs divided into 2 groups: intervention group (4 men, 7 women; age = 21.4 ± 0.67 years, grade point average = 3.37) and control group (7 men, 8 women; age = 21.5 ± 3.8 years, grade point average = 3.27). All participants completed the Applied Sport Psychology for Athletic Trainers educational intervention. Psychology-of-injury knowledge tests and skill usage surveys were administered to all participants at the following intervals: baseline, intervention week 3, and intervention week 6. Retention tests were administered to intervention-group participants at 7 and 14 weeks after intervention. Analysis techniques included mixed-model analysis of variance (ANOVA) and repeated-measures ANOVA. The Applied Sport Psychology for Athletic Trainers educational intervention effectively increased psychology-of-injury knowledge (29-point increase from baseline to intervention week 6; F2,23 = 29.358, P < .001, ηp2 = 0.719) and skill usage (50-point increase from baseline to intervention week 6; F2,23 = 5.999, P = .008, ηp2 = 0.343) in undergraduate ATSs. These increases were maintained at the 7-week and 14-week retention testing (P < .001 for both). This first attempt at evaluating an educational intervention designed to improve ATSs' knowledge and skill usage revealed that the intervention was effective. Although both knowledge and skill usage scores decreased by the end of the retention period, the scores were still higher than baseline scores, indicating that the intervention was effective.Abstract
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Observational Studies
PT,
PT,
PT,
PhD,
PhD, and
PhD
Patellofemoral pain syndrome (PFPS) is a common knee condition in athletes. Recently, researchers have indicated that factors proximal to the knee, including hip muscle weakness and motor control impairment, contribute to the development of PFPS. However, no investigators have evaluated eccentric hip muscle function in people with PFPS. To compare the eccentric hip muscle function between females with PFPS and a female control group. Cross-sectional study. Musculoskeletal laboratory. Two groups of females were studied: a group with PFPS (n = 10) and a group with no history of lower extremity injury or surgery (n = 10). Eccentric torque of the hip musculature was evaluated on an isokinetic dynamometer. Eccentric hip abduction, adduction, and external and internal rotation peak torque were measured and expressed as a percentage of body mass (Nm/kg × 100). We also evaluated eccentric hip adduction to abduction and internal to external rotation torque ratios. The peak torque value of 5 maximal eccentric contractions was used for calculation. Two-tailed, independent-samples t tests were used to compare torque results between groups. Participants with PFPS exhibited much lower eccentric hip abduction (t18 = −2.917, P = .008) and adduction (t18 = −2.764, P = .009) peak torque values than did their healthy counterparts. No differences in eccentric hip external (t18 = 0.45, P = .96) or internal (t18 = −0.742, P = .47) rotation peak torque values were detected between the groups. The eccentric hip adduction to abduction torque ratio was much higher in the PFPS group than in the control group (t18 = 2.113, P = .04), but we found no difference in the eccentric hip internal to external rotation torque ratios between the 2 groups (t18 = −0.932, P = .36). Participants with PFPS demonstrated lower eccentric hip abduction and adduction peak torque and higher eccentric adduction to abduction torque ratios when compared with control participants. Thus, clinicians should consider eccentric hip abduction strengthening exercises when developing rehabilitation programs for females with PFPS.Abstract
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Generalizability Theory Analysis of Balance Error Scoring System Reliability in Healthy Young Adults
PhD, ATC,
PhD,
, and
MS
An assessment of postural control is commonly included in the clinical concussion evaluation. Previous investigators have demonstrated learning effects that may mask concussion-induced balance decrements. To establish the test-retest reliability of the Balance Error Scoring System (BESS) and to provide recommendations that account for known learning effects. Test-retest generalizability study. Balance research laboratory. Young adults (n = 48) free from injuries and illnesses known to affect balance. Each participant completed 5 BESS trials on each of the assessment dates, which were separated by 50 days. Total score of the BESS was used in a generalizability theory analysis to estimate the overall reliability of the BESS and that of each facet. A decision study was completed to estimate the number of days and trials needed to establish clinical reliability. The overall reliability of the BESS was G = 0.64. The test-retest reliability was improved when male (0.92) and female (0.91) participants were examined independently. Clinically acceptable reliability (greater than 0.80) was established when 3 BESS trials were administered in a single day or 2 trials were administered at different time points. Learning effects have been noted in individuals with no previous exposure to the BESS. Our findings indicate that clinicians should consider interpreting the mean score from 3 BESS administrations on a given occasion for both normative data comparison and pretest and posttest design. The multiple assessment technique yields clinically reliable scores and provides the sports medicine practitioner with accurate data for clinical decision making.Abstract
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PhD ATC CSCS,
PhD, and
PhD ATC
Cutting maneuvers have been implicated as a mechanism of noncontact anterior cruciate ligament (ACL) injuries in collegiate female basketball players. To investigate knee kinematics and kinetics during running when the width of a single step, relative to the path of travel, was manipulated, a lateral false-step maneuver. Crossover design. University biomechanics laboratory. Thirteen female collegiate basketball athletes (age = 19.7 ± 1.1 years, height = 172.3 ± 8.3 cm, mass = 71.8 ± 8.7 kg). Three conditions: normal straight-ahead running, lateral false step of width 20% of body height, and lateral false step of width 35% of body height. Peak angles and internal moments for knee flexion, extension, abduction, adduction, internal rotation, and external rotation. Differences were noted among conditions in peak knee angles (flexion [P < .01], extension [P = .02], abduction [P < .01], and internal rotation [P < .01]) and peak internal knee moments (abduction [P < .01], adduction [P < .01], and internal rotation [P = .03]). The lateral false step of width 35% of body height was associated with larger peak flexion, abduction, and internal rotation angles and larger peak abduction, adduction, and internal rotation moments than normal running. Peak flexion and internal rotation angles were also larger for the lateral false step of width 20% of body height than for normal running, whereas peak extension angle was smaller. Peak internal rotation angle increased progressively with increasing step width. Performing a lateral false-step maneuver resulted in changes in knee kinematics and kinetics compared with normal running. The differences observed for lateral false steps were consistent with proposed mechanisms of ACL loading, suggesting that lateral false steps represent a hitherto neglected mechanism of noncontact ACL injury.Abstract
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PhD ATC and
PhD ATC CSCS
The relationship between lower extremity alignment and lower extremity injury risk remains poorly understood, perhaps because most authors have examined only individual or a select group of alignment variables. Examining the relationships among alignment variables may allow us to more accurately describe lower extremity posture and clarify the relationship between lower extremity alignment and injury risk in future studies. To measure lower extremity alignment variables and examine whether relationships could be identified among these variables. Observational study. Laboratory. Two hundred eighteen (102 males: age = 23.1 ± 3.2 years, height = 177.3 ± 8.4 cm, mass = 80.8 ± 13.0 kg; 116 females: age = 21.8 ± 2.7 years, height = 163.5 ± 7.4 cm, mass = 63.4 ± 12.4 kg) healthy, college-aged participants. We measured pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, and tibial torsion to the nearest degree and navicular drop to the nearest millimeter on the right and left lower extremities. Separate principal components factor analyses were performed for each sex and side (left, right). A distinct lower extremity factor was identified, with relationships observed among increased pelvic angle, increased quadriceps angle, and increased tibiofemoral angle. A second distinct lower extremity factor was identified, with relationships observed among increased supine genu recurvatum, decreased tibial torsion, and increased navicular drop. Femoral anteversion loaded as an independent third factor. These distinct lower extremity alignment factors were consistent across side and sex. Factor analysis identified 3 distinct lower extremity alignment factors that describe the potential interactions among lower extremity alignment variables. Future authors should examine how these collective alignment variables, both independently and in combination, influence dynamic knee function and risk for lower extremity injuries.Abstract
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PT,
PhD MSc,
PT,
PT,
PT, and
PhD
The reliability of the measurement of the distance between the posterior border of the acromion and the wall and the reliability of the modified lateral scapular slide test have not been studied. Overall, the reliability of the clinical tools used to assess scapular positioning has not been studied in musicians. To examine the intertester reliability of scapular observation and 2 clinical tests for the assessment of scapular positioning in musicians. Intertester reliability study. University research laboratory. Thirty healthy student musicians at a single university. Two assessors performed a standardized observation protocol, the measurement of the distance between the posterior border of the acromion and the wall, and the modified lateral scapular slide test. Each assessor was blinded to the other's findings. The intertester reliability coefficients (κ) for the observation in relaxed position, during unloaded movement, and during loaded movement were 0.41, 0.63, and 0.36, respectively. The κ values for the observation of tilting and winging at rest were 0.48 and 0.42, respectively; during unloaded movement, the κ values were 0.52 and 0.78, respectively; and with a 1-kg load, the κ values were 0.24 and 0.50, respectively. The intraclass correlation coefficient (ICC) of the measurement of the acromial distance was 0.72 in relaxed position and 0.75 with the participant actively retracting both shoulders. The ICCs for the modified lateral scapular slide test varied between 0.63 and 0.58. Our results demonstrated that the modified lateral scapular slide test was not a reliable tool to assess scapular positioning in these participants. Our data indicated that scapular observation in the relaxed position and during unloaded abduction in the frontal plane was a reliable assessment tool. The reliability of the measurement of the distance between the posterior border of the acromion and the wall in healthy musicians was moderate.Abstract
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MSc and
PhD
To establish the isokinetic strength profiles and work ratios of the shoulder internal and external rotators in sport climbers and to compare them with these profiles and ratios in nonclimbers. We hypothesized that the strength profiles of the shoulder rotators were different between sport climbers and nonclimbers. Cross-sectional study. Exercise science laboratory. Thirty-one experienced sport climbers and 27 nonclimbers. We tested all participants by measuring the isokinetic concentric and eccentric work output of their shoulder rotators in the middle 110° of shoulder rotation. We measured mean conventional work ratios of concentric external rotation (ER) to internal rotation (IR) (con ER:IR) and eccentric ER to IR (ecc ER:IR), and we measured mean functional work ratios of eccentric ER to concentric IR (ecc ER:con IR) and eccentric IR to concentric ER (ecc IR:con ER). All work ratios were different between the 2 groups (P < .001). In the climbers, the conventional work ratios were smaller than 1 for con ER:IR (0.79) and ecc ER:IR (0.88), whereas for the nonclimbers, the ratios were 1.03 and 1.13, respectively. The functional work ratio of ecc ER:con IR was smaller for the climbers (1.05) than for the nonclimbers (1.30), but the functional work ratio of ecc IR:con ER was larger for the climbers (1.58) than for the nonclimbers (1.17). The difference in work ratios of the shoulder rotators between participant groups might be due to training-induced changes in the shoulder rotation muscles of sport climbers. The clinical implication of this strength difference in shoulder IR and ER in climbers has yet to be examined.Abstract
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Evidence-Based Practice
EdD LAT ATC
Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT. Topical silver for treating infected wounds. Cochrane Database Syst Rev. 2007(1);CD005486. What is the clinical evidence base for silver dressings in the management of contaminated and infected acute and chronic wounds? Investigations were identified by Cochrane Wounds Group Specialized Register (2006), CENTRAL (2006), MEDLINE (2002–2006), EMBASE (2002–2006), CINAHL (2002–2006), and digital dissertations (2006) searches. Product manufacturers were contacted to identify additional eligible studies. The search terms included wound infection, surgical wound infection, ulcer, wound healing, and silver. Each study fulfilled the following criteria: (1) The study was a randomized controlled trial of human participants that compared dressings containing silver with any dressings without silver, dressings with other antiseptics, or dressings with different dosages of silver. (2) The participants were aged 18 years and older with contaminated and infected open wounds of any cause. (3) The study had to evaluate the effectiveness of the dressings using an objective measure of healing. No language or publication status restrictions were imposed, and participants could be recruited in any care setting. Studies were excluded if the wounds were ostomies (surgically formed passages). Study quality assessment was conducted independently by 3 authors using the Dutch Institute for Health Care Improvement and Dutch Cochrane Centre protocols. Characteristics of the study, participants, interventions, and outcome measures were extracted by one author and verified by a second using a standard form. The principal outcome measure was healing (time to complete healing, rate of change in wound area and volume, number and proportion of wounds healed within trial period). Secondary measures were adverse events (eg, pain, maceration, erythema), dressing leakage, and wound odor. Based on the unique comparisons in the studies, a meta-analysis was not conducted. As a result, summary estimates of treatment effect were calculated for each outcome comparison. RevMan software (version 4.2; Cochrane Centre, Oxford, United Kingdom) was used for statistical analysis. Specific search criteria identified 31 studies for review, of which 3 met the inclusion and exclusion criteria. Lack of randomization and absence of wound infections excluded the majority of studies from the review. In the 3 studies selected, silver-containing dressings were compared with nonsilver dressings and dressings with other antimicrobials. One group used a silver-containing foam dressing and a nonsilver foam dressing; another group used a silver-containing alginate and a nonsilver alginate; and a third group used a silver-containing foam and various dressings (nonsilver foams, alginates, hydrocolloids, and gauze and other antimicrobial dressings). Sample sizes ranged between 99 and 619 participants. Most of the wounds in the included studies were pressure, diabetic, and venous leg ulcers. Wound infection was subjectively defined by 1 group as the presence of 2 or more signs and symptoms (eg, continuous pain, erythema, heat, or moderate to high levels of exudate) and by the other 2 groups as signs of critical colonization (eg, delayed healing, increased pain and exudate levels, discoloration, and odor). The primary measure in the included studies was healing outcome. The 3 groups used various assessments of healing, including relative and absolute reduction in wound area and number of wounds healed during the trial period. The trial period in each study was 4 weeks. In the 3 trials, the authors randomized the participants to the treatment groups. Examining healing, one group (129 participants) compared Contreet silver foam (Coloplast A/S, Humlebaek, Denmark) with Allevyn foam (Smith & Nephew, St-Laurent, Quebec, Canada). The authors reported no differences for rates of complete healing (risk difference [RD] = 0.00, 95% confidence interval [CI] = −0.09, 0.09) and median wound area reduction (weighted mean difference [WMD] = −0.30 cm2, 95% CI = −2.92, 2.35). However, Contreet was favored over Allevyn (P = .034) for median relative reduction in wound area (WMD = −15.70 cm2, 95% CI = −29.5, −1.90). One group (99 participants) compared Silvercel silver alginate (Johnson & Johnson Wound Management, Somerville, NJ) with Algosteril alginate (Johnson & Johnson Wound Management). The authors found no differences in rates of complete healing (RD = 0.00, 95% CI = −0.06, 0.05), mean absolute (WMD = 4.50 cm2, 95% CI = −0.93, 9.93) and relative wound area reduction (WMD = −0.30 cm2, 95% CI = −17.08, 16.48), or healing rate per day (week 1 to 4) (WMD = 0.16 cm2, 95% CI = −0.03, 0.35). One group (619 participants) compared Contreet with various dressings (nonsilver foams, alginates, hydrocolloids, and gauze and other antimicrobial dressings). For median relative wound area reduction, the authors noted a superiority of Contreet over the various dressings (P = .0019). Examining secondary outcomes, 2 groups used subjective analysis to compare adverse reactions among the dressings. One group reported no difference between Contreet (in satellite ulcers, deterioration of periwound tissue) and Allevyn (in satellite ulcers, maceration, eczema) (RD = 0.02, 95% CI = −0.07, 0.12), and one group found no difference between Silvercel (in pain during dressing change, eczema, periwound erythema, maceration) and Algosteril (in pain during dressing change, eczema, erythema) (RD = −0.01, 95% CI = −0.12, 0.11). Two groups subjectively assessed leakage among silver and nonsilver dressings. The data from one group demonstrated superiority of Contreet over Allevyn (P = .002; RD = −0.30, 95% CI = −0.47, −0.13), and one group found Contreet better than various dressings (eg, nonsilver foams, alginates, hydrocolloids, and gauze, and other antimicrobial dressings) (P = .0005; RD = −0.11, 95% CI = −0.18, −0.05). Using a subjective 4-point scale, one group compared silver and nonsilver dressings and reported a difference favoring Contreet over Allevyn in terms of wound odor (P = .030; RD = −0.19, 95% CI = −0.36, −0.03). Overall, this review provides no clear evidence to support the use of silver-containing foam and alginate dressings in the management of infected chronic wounds for up to 4 weeks. However, the use of silver foam dressings resulted in a greater reduction in wound size and more effective control of leakage and odor than did use of nonsilver dressings. Randomized controlled trials using standardized outcome measures and longer follow-up periods are needed to determine the most appropriate dressing for contaminated and infected acute and chronic wounds.Abstract
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Case Report
DPT DSc ATC SCS and
MD
To introduce the case of a collegiate wrestler who suffered a traumatic unilateral hypoglossal nerve injury. This case presents the opportunity to discuss the diagnosis and treatment of a 20-year-old man with an injury to his right hypoglossal nerve. Injuries to the hypoglossal nerve (cranial nerve XII) are rare. Most reported cases are the result of malignancy, with traumatic causes less common. In this case, a collegiate wrestler struck his head on the wrestling mat during practice. No loss of consciousness occurred. The wrestler initially demonstrated signs and symptoms of a mild concussion, with dizziness and a headache. These concussion symptoms cleared quickly, but the athlete complained of difficulty swallowing (dysphagia) and demonstrated slurred speech (dysarthria). Also, his tongue deviated toward the right. No other neurologic deficits were observed. Occipital-cervical junction fracture, syringomyelia, malignancy, iatrogenic causes, cranial nerve injury. After initial injury recognition, the athletic trainer placed the patient in a cervical collar and transported him to the emergency department. The patient received prednisone, and the emergency medicine physician ordered cervical spine plain radiographs, brain computed tomography, and brain and internal auditory canal magnetic resonance imaging. The physician consulted a neurologist, who managed the patient conservatively, with rest and no contact activity. The neurologist allowed the patient to participate in wrestling 7 months after injury. To our knowledge, no other reports of unilateral hypoglossal nerve injury from relatively low-energy trauma (including athletics) exist. Hypoglossal nerve injury should be considered in individuals with head injury who experience dysphagia and dysarthria. Athletes with head injuries require cranial nerve assessments.Abstract
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The Olympic Games is the largest sport event in the world. In Beijing, 10500 athletes competed, selected from a large group of elite athletes in 204 countries. Sports participation on the elite level, aside from winning medals, fame and other rewards, is also important from a health perspective. There is no longer any doubt that regular physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, colon cancer, obesity, and diabetes mellitus in particular. The question is whether the health benefits of sports participation outweigh the risk of injury and long-term disability, especiallyIntroduction
Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Landon B. LempkePhD, ATC,
Benjamin L. BrettPhD, and
Douglas P. TerryPhD,ABPP
Driving After Concussion: Clinical Measures Associated with Post-concussion
Kumiko Hashida,
Julia Drattell,
Kim Love,
Robert C. Lynall,
Russell K. Gore,
Hannes Devos, and
Julianne D. Schmidt
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Yi-Hsuan WengPT, MS,
Tsun-Shun HuangPT, PhD, and
Jiu-Jenq LinPT, PhD
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
Joosung Kim,
Arlette C. Perry,
Kevin A. Jacobs,
Brian Arwari,
Soyeon Ahn, and
Kyung-Min Kim
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
Nikki RommersPT PhD,
Lieselot LongéPT MSc,
Winnie DebeckerPT MSc,
Nikie PeetersPT MSc,
Bruno TassignonPT PhD,
Eva HuysmansPT PhD,
Koen PutmanPT PhD,
Johan VanlauweMD PhD,
David BeckwéePT PhD,
Nicky Van MelickPT PhD, and
Christophe EechautePT PhD
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X
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