Most researchers investigating soccer injuries have studied elite athletes because they have greater athletic-exposure hours than other athletes, but most youth participate at the recreational level. If risk factors for injury vary by soccer level, then recommendations generated using research with elite youth soccer players might not generalize to recreational players. To examine injury risk factors of strength and jump biomechanics by soccer level in female youth athletes and to determine whether research recommendations based on elite youth athletes could be generalized to recreational players. Cross-sectional study. Seattle Youth Soccer Association. Female soccer players (N = 92) aged 11 to 14 years were recruited from 4 randomly selected elite (n = 50; age = 12.5 years, 95% confidence interval [95% CI]) = 12.3, 12.8 years; height = 157.8 cm, 95% CI = 155.2, 160.3 cm; mass = 49.9 kg, 95% CI = 47.3, 52.6 kg) and 4 randomly selected recreational (n = 42; age = 13.2 years, 95% CI = 13.0, 13.5 years; height = 161.1 cm, 95% CI = 159.2, 163.1 cm; mass = 50.6 kg, 95% CI = 48.3, 53.0 kg) soccer teams. Players completed a questionnaire about demographics, history of previous injury, and soccer experience. Physical therapists used dynamometry to measure hip strength (abduction, adduction, extension, flexion) and knee strength (flexion, extension) and Sportsmetrics to measure vertical jump height and jump biomechanics. We compared all measurements by soccer level using linear regression to adjust for age and mass. Elite players were similar to recreational players in all measures of hip and knee strength, vertical jump height, and normalized knee separation (a valgus estimate generated using Sportsmetrics). Female elite youth players and recreational players had similar lower extremity strength and jump biomechanics. This suggests that recommendations generated from research with elite youth soccer players could be generalized to recreational players.Context
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Balance ability has been associated with performance and injury prevention in athletes. Few published reports have investigated the differences in dynamic balance abilities among male high school, collegiate, and professional soccer players. To examine the differences on the Lower Quarter Y-Balance Test in male high school, collegiate, and professional soccer players. Descriptive laboratory study. Field testing. Dynamic balance data were collected for male high school (HS; n = 38), collegiate (n = 37), and professional (n = 44) soccer players during preparticipation physical examinations using the Lower Quarter Y Balance Test standardized protocol. For the Lower Quarter Y Balance Test, the participant reaches with 1 foot in the anterior, posteromedial, and posterolateral directions while standing on a centralized stance platform with the other foot. The test is performed for both left and right limbs. Differences in reach distances between competition levels were analyzed using a 1-way analysis of variance with significance set at P < .05. The HS group had a greater anterior reach distance than the other 2 groups. In contrast, the HS group had less reach distance in the posteromedial and posterolateral directions than the other groups. Also, HS players tended to exhibit a lower composite reach score than the other groups, but this difference was not significant (P = .08). No differences were observed among groups for bilateral symmetry in any of the reach directions. Dynamic balance performance varied with competition level. This may indicate that athletes' movement strategies may be different depending on the competition level and that normative values may need to be established for each competition level.Context
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Neuromuscular deficits are common in people with chronic ankle instability (CAI). Corticomotor pathways are very influential in the production of voluntary muscle function, yet these pathways have not been evaluated in people with CAI. To determine if corticomotor excitability of the fibularis longus (FL) differs between individuals with unilateral CAI and matched control participants without CAI. Case-control study. Laboratory. Ten people with CAI (4 men, 6 women; age = 21.2 ± 1.23 years, height = 175.13 ± 9.7 cm, mass = 77.1 ± 13.58 kg) and 10 people without CAI (4 men, 6 women; age = 21.2 ± 2.3 years; height = 172.34 ± 8.86 cm, mass = 73.4 ± 7.15 kg) volunteered for this study. Transcranial magnetic stimulation was performed over the motor cortex on neurons corresponding with the FL. All testing was performed with the participant in a seated position with a slightly flexed knee joint and the ankle secured in 10° of plantar flexion. The resting motor threshold (RMT), which was expressed as a percentage of 2 T, was considered the lowest amount of magnetic energy that would induce an FL motor evoked potential equal to or greater than 20 μV, as measured with surface electromyography, on 7 consecutive stimuli. In addition, the Functional Ankle Disability Index (FADI) and FADI Sport were used to assess self-reported function. Higher RMTs were found in the injured and uninjured FL of the CAI group (60.8% ± 8.4% and 59.1% ± 8.99%, respectively) than the healthy group (52.8% ± 8.56% and 52% ± 7.0%, respectively; F1,18 = 4.92, P = .04). No leg × group interactions (F1,18 = 0.1, P = .76) or between-legs differences (F1,18 = 0.74, P = .40) were found. A moderate negative correlation was found between RMT and FADI (r = −0.4, P = .04) and FADI Sport (r = −0.44, P = .03), suggesting that higher RMT is related to lower self-reported function. Higher bilateral RMTs may indicate deficits in FL corticomotor excitability in people with CAI. In addition, a moderate correlation between RMT and FADI suggests that cortical excitability deficits may be influential in altering function.Context
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Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. Descriptive laboratory study. University clinical laboratory. Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. Difference in scores between groups with stable and unstable ankles and between test repeats. Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.Context
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Kinesio Tex tape is a therapeutic tape that is applied with the Kinesio-taping (KT) method and is theorized to increase circulation and subsequently improve muscle function. However, little research has been conducted to determine how KT affects performance. To determine the effect of KT on muscular endurance ratio, blood flow, circumference, and volume of the gastrocnemius muscle. Randomized controlled clinical trial. Research laboratory. Sixty-one healthy, active people (23 men, 38 women; age = 19.99 ± 8.01 years, height = 169.42 ± 23.62 cm, mass = 71.53 ± 36.77 kg) volunteered to participate. They were assigned randomly to 1 of 3 groups: treatment KT, sham KT, and control. Tape was applied based on group assignment. The treatment KT group received the ankle-tape technique as described in the KT manual. The sham KT group received 1 strip of Kinesio Tex tape around the circumference of the proximal gastrocnemius muscle. The control group did not receive tape application. The dependent variables were blood flow in blood perfusion units, volume of water displacement in milliliters, circumference of the gastrocnemius muscle in centimeters, and endurance ratio in joules measured before, 24 hours after, and 72 hours after the intervention. Separate repeated-measures analyses of variance were conducted for each dependent variable. We found no group-by-test day interaction for endurance ratios (F4,116 = 1.99, P = .10). Blood flow, circumference, and volume measurements also yielded no differences among groups (F2,58 range, 0.02–0.51; P > .05) or test days (F2,116 range, 0.05–2.33; P > .05). We found KT does not enhance anaerobic muscle function measured by endurance ratio. The KT also did not affect circulation or volume of the gastrocnemius muscle in a healthy population.Context
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In the electrically induced cramp model, the tibial nerve is stimulated at an initial frequency of 4 Hz with increases in 2-Hz increments until the flexor hallucis brevis cramps. The frequency at which cramping occurs (ie, threshold frequency [TF]) can vary considerably. A potential limitation is that multiple subthreshold stimulations before TF might induce fatigue, which is operationally defined as a decrease in maximal voluntary isometric contraction (MVIC) force, thereby biasing TF. To determine if TF is similar when initially stimulated at 4 Hz or 14 Hz and if MVIC force is different among stimulation frequencies or over time (precramp, 1 minute postcramp, and 5 minutes postcramp). Crossover study. Laboratory. Twenty participants (13 males: age = 20.6 ± 2.9 years, height = 184.4 ± 5.7 cm, mass = 76.3 ± 7.1 kg; 7 females: age = 20.4 ± 3.5 years, height = 166.6 ± 6.0 cm, mass = 62.4 ± 10.0 kg) who were prone to cramps. Participants performed 20 practice MVICs. After a 5-minute rest, three 2-second MVICs were recorded and averaged for the precramp measurement. Participants were stimulated at either 4 Hz or 14 Hz, and the frequency was increased in 2-Hz increments from each initial frequency until cramp. The MVIC force was reevaluated at 1 minute and 5 minutes postcramp. The TF and MVIC force. Initial stimulation frequency did not affect TF (4 Hz = 16.2 ± 3.8 Hz, 14 Hz = 17.1 ± 5.0 Hz; t19=1.2, P = .24). Two participants had inaccurate TFs when initially stimulated at 14 Hz; they cramped at 10 and 12 Hz in the 4-Hz condition. The MVIC force did not differ between initial frequencies (F1,19 = 0.9, P = .36) but did differ over time (F2,38 = 5.1, P = .01). Force was lower at 1 minute postcramp (25.1 ± 10.1 N) than at precramp (28.7 ± 7.8 N; P < .05) but returned to baseline at 5 minutes postcramp (26.7 ± 8.9 N; P > .05). The preferred initial stimulation frequency might be 4 Hz because it did not alter or overestimate TF. The MVIC force was lower at 1 minute postcramp, suggesting the induced cramp rather than the varying electrical frequencies affected force. A 1- to 5-minute rest should be provided postcramp induction if multiple cramps are induced.Context
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Individuals prone to exercise-associated muscle cramps (EAMCs) are instructed to eat bananas because of their high potassium (K+) concentration and carbohydrate content and the perception that K+ imbalances and fatigue contribute to the genesis of EAMCs. No data exist about the effect of bananas on plasma K+ concentration ([K+]p) or plasma glucose concentration ([glucose]p) after exercise in the heat. To determine whether ingesting 0, 1, or 2 servings of bananas after 60 minutes of moderate to vigorous exercise in the heat alters [K+]p or [glucose]p and whether changes in [K+]p result from hypotonic fluid effluxes or K+ ion changes. Crossover study. Laboratory. Nine euhydrated men (age = 27 ± 4 years, height = 180.3 ± 8.4 cm, mass = 84.9 ± 26.1 kg, urine specific gravity ≤ 1.006) without EAMCs volunteered. On 3 separate days, participants completed 60 minutes of moderate to vigorous cycling (temperature = 36.4°C ± 1.1°C, relative humidity = 19.4% ± 2.5%) and then ate 0 g (0 servings), 150 g (1 serving), or 300 g (2 servings) of bananas. Blood samples were collected at −3, 5, 15, 30, and 60 minutes postingestion. The [K+]p, changes in plasma K+ content, plasma volume changes, and [glucose]p. The [K+]p differed between conditions at 60 minutes; 2 servings (4.6 ± 0.3 mmol/L [conventional unit = 4.6 ± 0.3 mEq/L]) was greater than 1 serving (4.5 ± 0.2 mmol/L [conventional unit = 4.5 ± 0.2 mEq/L]) and 0 servings (4.4 ± 0.3 mmol/L [conventional unit = 4.4 ± 0.3 mEq/L]) (P < .05). The [K+]p was greater at 60 minutes than at −3 and 5 minutes in the 1-serving condition and was greater at 30 and 60 minutes than at −3 and 5 minutes in the 2-servings condition (P < .05). Percentage change in K+ content was greater only at 30 and 60 minutes postingestion than at baseline in the 2-servings condition (4.4% ± 3.7% and 5.8% ± 2.3% increase, respectively) (P < .05). The plasma volume changes among conditions were unremarkable. The [glucose]p was greater in the 2-servings condition than in all other conditions at 15, 30, and 60 minutes (P < .05). The effect of banana ingestion on EAMCs is unknown; however, these data suggested bananas are unlikely to relieve EAMCs by increasing extracellular [K+] or [glucose]p. The increases in [K+]p were marginal and within normal clinical values. The changes in [K+]p, plasma K+ content, and [glucose]p do not occur quickly enough to treat acute EAMCs, especially if they develop near the end of competition.Context
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Cold-water immersion is the criterion standard for treatment of exertional heat illness. Cryotherapy and water immersion also have been explored as ergogenic or recovery aids. The kinetics of inflammatory markers, such as interleukin-6 (IL-6), during cold-water immersion have not been characterized. To characterize serum IL-6 responses to water immersion at 2 temperatures and, therefore, to initiate further research into the multidimensional benefits of immersion and the evidence-based selection of specific, optimal immersion conditions by athletic trainers. Controlled laboratory study. Human performance laboratory Eight college-aged men (age = 22 ± 3 years, height = 1.76 ± 0.08 m, mass = 77.14 ± 9.77 kg, body fat = 10% ± 3%, and maximal oxygen consumption = 50.48 ± 4.75 mL·kg−1·min−1). Participants were assigned randomly to receive either cold (11.70°C ± 2.02°C, n = 4) or warm (23.50°C ± 1.00°C, n = 4) water-bath conditions after exercise in the heat (temperature = 37°C, relative humidity = 52%) for 90 minutes or until volitional cessation. Whole-body cooling rates were greater in the cold water-bath condition for the first 6 minutes of water immersion, but during the 90-minute, postexercise recovery, participants in the warm and cold water-bath conditions experienced similar overall whole-body cooling. Heart rate responses were similar for both groups. Participants in the cold water-bath condition experienced an overall slight increase (30.54% ± 77.37%) in IL-6 concentration, and participants in the warm water-bath condition experienced an overall decrease (−69.76% ± 15.23%). We have provided seed evidence that cold-water immersion is related to subtle IL-6 increases from postexercise values and that warmer water-bath temperatures might dampen this increase. Further research will elucidate any anti-inflammatory benefit associated with water-immersion treatment and possible multidimensional uses of cooling therapies.Context
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Tournament season can provoke overreaching syndrome in professional tennis players, which may lead to deteriorated performance. Thus, appropriate recovery methods are crucial for athletes in order to sustain high-level performance and avoid injuries. We hypothesized that whole-body cryostimulation could be applied to support the recovery process. To assess the effects of 5 days of whole-body cryostimulation combined with moderate-intensity training on immunologic, hormonal, and hematologic responses; resting metabolic rate; and tennis performance in a posttournament season. Controlled laboratory study. National Olympic Sport Centre. Twelve high-ranking professional tennis players. Participants followed a moderate-intensity training program. A subgroup was treated with the 5-day whole-body cryostimulation (−120°C) applied twice a day. The control subgroup participated in the training only. Pretreatment and posttreatment blood samples were collected and analyzed for tumor necrosis factor α, interleukin 6, testosterone, cortisol, and creatine kinase. Resting metabolic rate and performance of a tennis drill were also assessed. Proinflammatory cytokine (tumor necrosis factor α) decreased and pleiotropic cytokine (interleukin 6) and cortisol increased in the group exposed to cryostimulation. In the same group, greater stroke effectiveness during the tennis drill and faster recovery were observed. Neither the training program nor cryostimulation affected resting metabolic rate. Professional tennis players experienced an intensified inflammatory response after the completed tournament season, which may lead to overreaching. Applying whole-body cryostimulation in conjunction with moderate-intensity training was more effective for the recovery process than the training itself. The 5-day exposure to cryostimulation twice a day ameliorated the cytokine profile, resulting in a decrease in tumor necrosis factor α and an increase in interleukin 6.Context
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Good sleep is an important recovery method for prevention and treatment of overtraining in sport practice. Whether sleep is regulated by melatonin after red-light irradiation in athletes is unknown. To determine the effect of red light on sleep quality and endurance performance of Chinese female basketball players. Cohort study. Athletic training facility of the Chinese People's Liberation Army and research laboratory of the China Institute of Sport Science. Twenty athletes of the Chinese People's Liberation Army team (age = 18.60 ± 3.60 years) took part in the study. Participants were divided into red-light treatment (n = 10) and placebo (n = 10) groups. The red-light treatment participants received 30 minutes of irradiation from a red-light therapy instrument every night for 14 days. The placebo group did not receive light illumination. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was completed, serum melatonin was assessed, and 12-minute run was performed at preintervention (baseline) and postintervention (14 days). The 14-day whole-body irradiation with red-light treatment improved the sleep, serum melatonin level, and endurance performance of the elite female basketball players (P < .05). We found a correlation between changes in global Pittsburgh Sleep Quality Index and serum melatonin levels (r = −0.695, P = .006). Our study confirmed the effectiveness of body irradiation with red light in improving the quality of sleep of elite female basketball players and offered a nonpharmacologic and noninvasive therapy to prevent sleep disorders after training.Context
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Career opportunities for athletic training students (ATSs) have increased substantially over the past few years. However, ATSs commonly appear to be opting for a more diversified professional experience after graduation. With the diversity in available options, an understanding of career decision is imperative. To use the theoretical framework of socialization to investigate the influential factors behind the postgraduation decisions of senior ATSs. Qualitative study. Web-based management system and telephone interviews. Twenty-two ATSs (16 females, 6 males; age = 22 ± 2 years) who graduated in May 2010 from 13 different programs accredited by the Commission on Accreditation of Athletic Training Education. All interviews were transcribed verbatim, and the data were analyzed inductively. Data analysis required independent coding by 2 athletic trainers for specific themes. Credibility of the results was confirmed via peer review, methodologic triangulation, and multiple analyst triangulation. Two higher-order themes emerged from the data analysis: persistence in athletic training (AT) and decision to leave AT. Faculty and clinical instructor support, marketability, and professional growth were supporting themes describing persistence in AT. Shift of interest away from AT, lack of respect for the AT profession, compensation, time commitment, and AT as a stepping stone were themes sustaining the reasons that ATSs leave AT. The aforementioned reasons to leave often were discussed collectively, generating a collective undesirable outlook on the AT profession. Our results highlight the importance of faculty support, professional growth, and early socialization into AT. Socialization of pre–AT students could alter retention rates by providing in-depth information about the profession before students commit in their undergraduate education and by helping reduce attrition before entrance into the workforce.Context
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Female athletic trainers (ATs) experience gender discrimination in the workplace due to stereotypical gender roles, but limited information is available regarding the topic. To understand the challenges and obstacles faced by young female ATs working in National Collegiate Athletic Association Division I athletics. Exploratory study using semistructured interviews. Division I clinical setting. A total of 14 female ATs were included in the study, using both criterion and snowball- sampling techniques. Their mean age was 27 ± 2 years, with 5 ± 2 years of overall clinical experience. Criteria included employment at the Division I clinical setting, being a full-time assistant AT, and at least 3 years of working experience but no more than 9 years to avoid role continuance. Analysis of the interview data followed inductive procedures as outlined by a grounded theory approach. Credibility was established by member checks, multiple-analyst triangulation, and peer review. Clear communication with both coaches and players about expectations and philosophies regarding medical care, a supportive head AT in terms of clinical competence, and having and serving as a role model were cited as critical tools to alleviate gender bias in the workplace. The female ATs in this study stressed the importance of being assertive with coaches early in the season with regard to the AT's role on the team. They reasoned that these actions brought forth a greater perception of congruity between their roles as ATs and their gender and age. We suggest that female athletic training students seek mentors in their field while they complete their coursework and practicums. The ATs in the current study indicated that a mentor, regardless of sex, helped them feel empowered to navigate the male-centric terrain of athletic departments by encouraging them to be assertive and not second-guess their decisions.Context
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The extent to which individuals are prepared completely for work in a particular athletic training setting (eg, professional sports, college, high school) is unknown. This issue is critical today, and findings in this area have implications for athletic training education policy and employers. To determine the perceptions of preparation for work-specific tasks by professional baseball athletic trainers (PBATs). We also wanted to determine whether various preparation experiences interact with perceived skills. Cross-sectional study. Online survey administered via SurveyMonkey. Two hundred seventy-five PBATs. The PBATs reported their levels of preparation before employment in their positions and their current skills in each of the 8 work task domains: evaluation of elbow injuries; evaluation of shoulder injuries; evaluation of general injuries; acute care; injury prevention; treatment, rehabilitation, and reconditioning; organization and administration; and non–athletic-training tasks. Nine repeated-measures analyses of covariance were performed with each perception of preparation (retrospective, current) as a within-subject factor. Preparation experiences were included as between-subjects factors, and number of years working in baseball was the covariate. Subscale reliabilities were calculated and found to be between 0.79 and 0.97. A total of 180 PBATs (65%) completed the survey. The backgrounds and routes by which PBATs gained employment in the professional baseball setting varied. Individuals who completed professional baseball internships, had previous work experience, and immediately entered the professional baseball setting after graduation had noted differences in their perceptions of preparation for work tasks. The PBATs indicated they were substantially underprepared for tasks in the organization and administration and non–athletic-training task domains. The organizational socialization process is complex, and no 1 experience appears to completely prepare an individual for work in the professional baseball setting.Context
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No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury. To systematically review and synthesize the published literature to determine if compliance with neuromuscular training is associated with reduced incidence of ACL injury in young female athletes. We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective knee prevention, neuromuscular training, and neuromuscular intervention. Criteria for inclusion required that (1) the number of ACL injuries was reported, (2) a neuromuscular training program was used, (3) females were included as participants, (4) the study design was prospective and controlled, and (5) compliance data for the neuromuscular training program were provided. Extracted data included the number of ACL injuries, total number of participants per group, observation time period, number of participants who completed each session, number of sessions completed by an entire team, and number of total sessions. Attendance was calculated as the number of participants who completed each session converted into a percentage of the total number of participants. Intervention completion was calculated as the number of sessions completed by an entire team converted into a percentage of the total number of training sessions. These data were used to calculate an overall rate of compliance. Six of 205 identified studies were included. Incidence rates of ACL injury were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance rates (incidence rate ratio = 0.27 [95% confidence interval = 0.07, 0.80]). Tertile analysis indicated rates of ACL injury incidence were lower in studies with high compliance rates than in studies with moderate and low compliance rates (incidence rate ratio = 0.18 [95% confidence interval = 0.02, 0.77]). A potential inverse dose-response relationship exists between compliance with neuromuscular training and incidence of ACL injury. Attending and completing recommended neuromuscular sessions appears to be an important factor for preventing ACL injuries.Context
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To present a case of bilateral subtalar joint coalition in a National Collegiate Athletic Association Division I basketball player and the treatment plan that was used to manage the coalition from the beginning of conference play through the postseason. A 20-year-old male basketball athlete (height = 182.8 cm, mass = 83.4 kg) presented with bilateral subtalar joint tarsal coalition that became symptomatic in 2006 and resulted in constant pain with any form of activity. Traumatic injury of the talocalcaneal joint. Nonsurgical intervention of conservative therapy was elected. Less than 13% of the overall population is affected with tarsal coalition, so it is safe to assume that very few athletes competing at the collegiate or elite level suffer from this condition. This is the first report in the literature to document conservative manual therapies used to manage the symptoms of subtalar joint tarsal coalition in a Division I basketball player. After the intensive treatment program for tarsal coalition was implemented, the patient experienced pain relief and was able to continue to compete at a competitive level. This case represents the need to further explore and document a conservative treatment protocol for tarsal coalition.Objective
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Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Driving After Concussion: Clinical Measures Associated with Post-concussion
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X