Abstract

Context:

Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment.

Objective:

To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment.

Design:

Crossover study.

Setting:

University sports medicine clinic.

Patients or Other Participants:

A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players.

Intervention(s):

Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained.

Main Outcome Measure(s):

The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale.

Results:

All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players.

Conclusions:

Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited.

Abstract

Context:

Valid and reliable measurements of ankle-complex motion have been reported using the Hollis Ankle Arthrometer. No published normative data of ankle-complex motion obtained from ankle arthrometry are available for use as a reference for clinical decision making.

Objective:

To describe the distribution variables of ankle-complex motion in uninjured ankles and to establish normative reference values for use in research and to assist in clinical decision making.

Design:

Descriptive laboratory study.

Setting:

University research laboratory.

Patients or Other Participants:

Both ankles of 50 men and 50 women (age = 21.78 ± 2.0 years [range, 19–25 years]) were tested.

Intervention(s):

Each ankle underwent anteroposterior (AP) and inversion-eversion (I-E) loading using an ankle arthrometer.

Main Outcome Measure(s):

Recorded anterior, posterior, and total AP displacement (millimeters) at 125 N and inversion, eversion, and total I-E rotation (degrees) at 4 Nm.

Results:

Women had greater ankle-complex motion for all variables except for posterior displacement. Total AP displacement of the ankle complex was 18.79 ± 4.1 mm for women and 16.70 ± 4.8 mm for men (U = 3742.5, P < .01). Total I-E rotation of the ankle complex was 42.10° ± 9.0° for women and 34.13° ± 10.1° for men (U = 2807, P < .001). All variables were normally distributed except for anterior displacement, inversion rotation, eversion rotation, and total I-E rotation in the women's ankles and eversion rotation in the men's ankles; these variables were skewed positively.

Conclusions:

Our study increases the available database on ankle-complex motion, and it forms the basis of norm-referenced clinical comparisons and the basis on which quantitative definitions of ankle pathologic conditions can be developed.

Abstract

Context:

The Hertel model of chronic ankle instability (CAI) is commonly used in research but may not be sufficiently comprehensive. Mechanical instability and functional instability are considered part of a continuum, and recurrent sprain occurs when both conditions are present. A modification of the Hertel model is proposed whereby these 3 components can exist independently or in combination.

Objective:

To examine the fit of data from people with CAI to 2 CAI models and to explore whether the different subgroups display impairments when compared with a control group.

Design:

Cross-sectional study.

Patients or Other Participants:

Community-dwelling adults and adolescent dancers were recruited: 137 ankles with ankle sprain for objective 1 and 81 with CAI and 43 controls for objective 2.

Intervention(s):

Two balance tasks and time to recover from an inversion perturbation were assessed to determine if the subgroups demonstrated impairments when compared with a control group (objective 2).

Main Outcome Measure(s):

For objective 1 (fit to the 2 models), outcomes were Cumberland Ankle Instability Tool score, anterior drawer test results, and number of sprains. For objective 2, outcomes were 2 balance tasks (number of foot lifts in 30 seconds, ability to balance on the ball of the foot) and time to recover from an inversion perturbation. The Cohen d was calculated to compare each subgroup with the control group.

Results:

A total of 56.5% of ankles (n = 61) fit the Hertel model, whereas all ankles (n = 108) fit the proposed model. In the proposed model, 42.6% of ankles were classified as perceived instability, 30.5% as recurrent sprain and perceived instability, and 26.9% as among the remaining groups. All CAI subgroups performed more poorly on the balance and inversion-perturbation tasks than the control group. Subgroups with perceived instability had greater impairment in single-leg stance, whereas participants with recurrent sprain performed more poorly than the other subgroups when balancing on the ball of the foot. Only individuals with hypomobility appeared unimpaired when recovering from an inversion perturbation.

Conclusions:

The new model of CAI is supported by the available data. Perceived instability alone and in combination characterized the majority of participants. Several impairments distinguished the sprain groups from the control group.

We thank our 2010 Manuscript Reviewers for their hard work and dedication. We also recognize retiring Editorial Board member A. Louise Fincher, EdD, ATC, for her years of service.

John P. Abt, PhD, ATC

Jon Almquist, ATC

Jatin P. Ambegaonkar, PhD, OT, ATC, CSCS

Naoko Aminaka, PhD, ATC

J. C. Andersen, PhD, PT, LAT, ATC, SCS

Scott Anderson, ATC

Philip Anloague, DHSc, PT, OCS, MTC

Kirk J. Armstrong, EdD, ATC

William J. Armstrong, PhD

Brent L. Arnold, PhD, ATC

Patricia A. Aronson, PhD, ATC

Tricia M. Austin, PhD, PT, ATC

Klaus Bak, MD

Robert J. Baker, MD, PhD, ATC

Kim

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