To test a helmetless-tackling behavioral intervention for reducing head impacts in National Collegiate Athletic Association Division I football players. Randomized controlled clinical trial. Football field. Fifty collegiate football players (intervention = 25, control = 25). The intervention group participated in a 5-minute tackling drill without their helmets and shoulder pads twice per week in the preseason and once per week through the season. During this time, the control group performed noncontact football skills. Frequency of head impacts was recorded by an impact sensor for each athlete-exposure (AE). Data were tested with a 2 × 3 (group and time) repeated-measures analysis of variance. Significant interactions and main effects (P < .05) were followed with t tests. Head impacts/AE decreased for the intervention group compared with the control group by the end of the season (9.99 ± 6.10 versus 13.84 ± 7.27, respectively). The intervention group had 30% fewer impacts/AE than the control group by season's end (9.99 ± 6.10 versus 14.32 ± 8.45, respectively). A helmetless-tackling training intervention reduced head impacts in collegiate football players within 1 season.Objective
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To explain statistical significance and clinical meaningfulness and to provide guidance in evaluating the clinical meaningfulness of a study. Understanding the results and statistics reported in original research remains a large challenge for many certified athletic trainers, which in turn, may be among the biggest barriers to integrating research into athletic training practice. Statistical significance reflects the influence of chance on the outcome, whereas clinical meaningfulness reflects the degree to which the differences and relationships reported in a study are relevant to athletic training practice. As consumers of original research, athletic trainers must understand the core factors, most notably sample size, that influence statistical significance. To assist clinicians in evaluating the clinical meaningfulness of a research study, authors should provide the core elements necessary for interpreting statistical significance and discuss the clinical meaningfulness of statistically significant findings.Objective
Background
Description
Recommendations
A variety of ankle self-stretching exercises have been recommended to improve ankle-dorsiflexion range of motion (DFROM) in individuals with limited ankle dorsiflexion. A strap can be applied to stabilize the talus and facilitate anterior glide of the distal tibia at the talocrural joint during ankle self-stretching exercises. Novel ankle self-stretching using a strap (SSS) may be a useful method of improving ankle DFROM. To compare the effects of 2 ankle-stretching techniques (static stretching versus SSS) on ankle DFROM. Randomized controlled clinical trial. University research laboratory. Thirty-two participants with limited active dorsiflexion (<20°) while sitting (14 women and 18 men) were recruited. The participants performed 2 ankle self-stretching techniques (static stretching and SSS) for 3 weeks. Active DFROM (ADFROM), passive DFROM (PDFROM), and the lunge angle were measured. An independent t test was used to compare the improvements in these values before and after the 2 stretching interventions. The level of statistical significance was set at α = .05. Active DFROM and PDFROM were greater in both stretching groups after the 3-week interventions. However, ADFROM, PDFROM, and the lunge angle were greater in the SSS group than in the static-stretching group (P < .05). Ankle SSS is recommended to improve ADFROM, PDFROM, and the lunge angle in individuals with limited DFROM.Context
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Research into alleviating muscle pain and symptoms in individuals after delayed-onset muscle soreness (DOMS) has been inconsistent and unsuccessful in demonstrating a useful recovery modality. To investigate the effects of short-term whole-body vibration (WBV) on DOMS over a 72-hour period after a high-intensity exercise protocol. Randomized controlled clinical trial. University laboratory. Thirty women volunteered to participate in 4 testing sessions and were assigned randomly to a WBV group (n = 16; age = 21.0 ± 1.9 years, height = 164.86 ± 6.73 cm, mass = 58.58 ± 9.32 kg) or a control group (n = 14; age = 22.00 ± 1.97 years, height = 166.65 ± 8.04 cm, mass = 58.69 ± 12.92 kg). Participants performed 4 sets to failure of single-legged split squats with 40% of their body weight to induce muscle soreness in the quadriceps. The WBV or control treatment was administered each day after DOMS. Unilateral pressure-pain threshold (PPT), range of motion (ROM), thigh circumference, and muscle-pain ratings of the quadriceps were collected before and for 3 days after high-intensity exercise. Each day, we collected 3 sets of measures, consisting of 1 measure before the WBV or control treatment protocol (pretreatment) and 2 sets of posttreatment measures. We observed no interactions for PPT, thigh circumference, and muscle pain (P > .05). An interaction was found for active ROM (P = .01), with the baseline pretreatment measure greater than the measures at baseline posttreatment 1 through 48 hours posttreatment 2 in the WBV group. For PPT, a main effect for time was revealed (P < .05), with the measure at baseline pretreatment greater than at 24 hours pretreatment and all other time points for the vastus medialis, greater than 24 hours pretreatment through 48 hours posttreatment 2 for the vastus lateralis, and greater than 24 hours pretreatment and 48 hours pretreatment for the rectus femoris. For dynamic muscle pain, we observed a main effect for time (P < .001), with the baseline pretreatment measure less than the measures at all other time points. No main effect for time was noted for thigh circumference (P = .24). No main effect for group was found for any variable (P > .05). The WBV treatment approach studied did not aid in alleviating DOMS after high-intensity exercise. Further research is needed in various populations.Context
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The National Athletic Trainers' Association and the American College of Sports Medicine have recommended removing American football uniforms from athletes with exertional heat stroke before cold-water immersion (CWI) based on the assumption that the uniform impedes rectal temperature (Trec) cooling. Few experimental data exist to verify or disprove this assumption and the recommendations. To compare CWI durations, Trec cooling rates, thermal sensation, intensity of environmental symptoms, and onset of shivering when hyperthermic participants wore football uniforms during CWI or removed the uniforms immediately before CWI. Crossover study. Laboratory. Eighteen hydrated, physically active men (age = 22 ± 2 years, height = 182.5 ± 6.1 cm, mass = 85.4 ± 13.4 kg, body fat = 11% ± 5%, body surface area = 2.1 ± 0.2 m2) volunteered. On 2 days, participants exercised in the heat (approximately 40°C, approximately 40% relative humidity) while wearing a full American football uniform (shoes; crew socks; undergarments; shorts; game pants; undershirt; shoulder pads; jersey; helmet; and padding over the thighs, knees, hips, and tailbone [PADS]) until Trec reached 39.5°C. Next, participants immersed themselves in water that was approximately 10°C while wearing either undergarments, shorts, and crew socks (NOpads) or PADS without shoes until Trec reached 38°C. The CWI duration (minutes) and Trec cooling rates (°C/min). Participants had similar exercise times (NOpads = 40.8 ± 4.9 minutes, PADS = 43.2 ± 4.1 minutes; t17 = 2.0, P = .10), hypohydration levels (NOpads = 1.5% ± 0.3%, PADS = 1.6% ± 0.4%; t17 = 1.3, P = .22), and thermal-sensation ratings (NOpads = 7.2 ± 0.3, PADS = 7.1 ± 0.5; P > .05) before CWI. The CWI duration (median [interquartile range]; NOpads = 6.0 [5.4] minutes, PADS = 7.3 [9.8] minutes; z = 2.3, P = .01) and Trec cooling rates (NOpads = 0.28°C/min ± 0.14°C/min, PADS = 0.21°C/min ± 0.11°C/min; t17 = 2.2, P = .02) differed between uniform conditions. Whereas participants cooled faster in NOpads, we still considered the PADS cooling rate to be acceptable (ie, >0.16°C/min). Therefore, if clinicians experience difficulty removing PADS or CWI treatment is delayed, they may immerse fully equipped hyperthermic football players in CWI and maintain acceptable Trec cooling rates. Otherwise, PADS should be removed preimmersion to ensure faster body core temperature cooling.Context
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The degree to which an individual likes his or her job is known as job satisfaction. A person with higher job satisfaction is less likely to depart from a profession than a person with lower job satisfaction. Researchers studying job satisfaction among other allied health professionals suggest a personality component could explain why the reasons for departure can be so individual. Collegiate institutions. To determine the relationship between job satisfaction and personality among collegiate athletic trainers (ATs). A total of 202 ATs (68 [33.7%] men and 134 [66.3%] women), were recruited using the National Athletic Trainers' Association e-mail database. We excluded any AT from this study who worked outside of the collegiate setting. The response rate was 20.2%. Data were collected using a Web-based survey instrument consisting of 3 sections: (1) demographics, (2) job satisfaction survey, and (3) Big Five Personality Inventory. Independent t tests were run to determine sex differences, and correlations were run to evaluate relationships between demographics and job satisfaction and between job satisfaction and personality. Women reported higher levels of neuroticism than men. Extroversion and conscientiousness showed a weak positive relationship with job satisfaction. A moderate positive relationship was found between agreeableness and job satisfaction. A moderate negative relationship was noted between neuroticism and job satisfaction. Based on our findings, head ATs or other organizational leaders may consider using personality assessments during interview processes, or athletic training program directors may be able to better guide students interested in athletic training based on knowledge of their personalities.Context
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The graduate-assistant position can be a highly influential experience because it is often the first time novice athletic trainers (ATs) are practicing autonomously. To gain an understanding of how graduate-assistant ATs (GAATs) perceive professional socialization and mentorship during their assistantships. Semistructured phone interviews. Graduate-assistant ATs in various clinical settings. Twenty-five GAATs (20 women, 5 men) studying in 1 of 3 academic tracks (postprofessional athletic training = 8, athletic training-based curriculum = 11, non–athletic training-based curriculum = 6). Median age was 24 years. Phone interviews were digitally recorded and transcribed verbatim. Data analysis used principles of the general inductive approach. Credibility was maintained using peer review, field notes, and intercoder reliability. Participants identified peer support throughout their experiences, in both academic and clinical settings. The GAATs frequently relied on other GAATs for support due to shared experiences and understanding of workloads. Participants described difficulty receiving supervisor support from full-time staff ATs due to the supervisors' workload and time constraints, limiting their availability for mentoring. Guidance from academic support personnel occurred only in athletic training-centered academic programs. Communication emerged as helpful for incoming GAATs; the previous GAATs provided formal mentorship via job descriptions highlighting role responsibilities and expectations. Differences between assistantship types were noted only in terms of receiving balanced mentorship between the academic and clinical staffs, such that students studying in postprofessional athletic training programs perceived more balanced support. Our results confirm the literature regarding the GAAT's pursuit of continued formal mentoring. The GAATs perceived less support from full-time AT staff members due to limited availability. Therefore, GAATs leaned on their peers for support during the graduate experience.Context
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Athletic trainers (ATs) commonly use psychological skills during sport rehabilitation. However, little is known about their ability to accurately implement these skills. To assess ATs' skills in identifying psychological symptoms, selecting appropriate strategies, and making referral decisions for athletes experiencing various degrees of psychological distress. Cross-sectional study. Participants were recruited using the National Athletic Trainers' Association professional member database. Of the 2998 ATs who were selected randomly, 494 (16.5%) partially completed the questionnaire and 326 (10.9%) completed the entire survey (mean age = 34.7 ± 10.8 years, mean years of experience = 11.3 ± 9.9). Using the Web-based questionnaire created for this study, we collected ATs' demographic information and assessed their perceptions about responsibilities as ATs, psychosocial competencies, training in sport psychology, and referral behaviors. Additionally, respondents were asked to identify symptoms, match psychological strategies (eg, goal setting, imagery, progressive muscle relaxation), and make referral decisions for athletes in 3 case vignettes. The ATs demonstrated high accuracy in identifying symptoms and making referral decisions but struggled in selecting appropriate psychosocial strategies for athletes. Stepwise regression analyses revealed that ATs who had had specific coursework in sport psychology were able to more accurately identify symptoms (t = 3.01, P < .01), and those ATs with more experience reported lower accuracy scores for their intended course of action (t = −2.25, P < .05). Our analogue research design provided new insights into ATs' knowledge and use of sport psychology in practice. The results highlighted the importance of coursework focusing on applied areas of sport psychology in the training of ATs.Context
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The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Cross-sectional study. Web-based survey. Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads.Context
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Parents play a crucial role in determining medical services for their children, and it is important they understand the scope of practice and skills of the athletic trainer (AT). To understand parents' perceptions and knowledge of the skills and job requirements of the secondary school AT. Cross-sectional study. Sport meetings and banquets at 5 high schools in southwest Michigan during the fall, winter, and spring seasons. A total of 539 parents whose children competed in at least 1 high school sport participated. A Parents' Perceptions and Knowledge of Certified Athletic Trainers Survey consisting of 32 questions, divided into 3 sections (demographics, perceptions, and knowledge), was developed and given to parents of high school athletes. One-way analyses of variance were used to determine significance among 3 categories of experience and perception and knowledge of ATs. Of the 539 parents who responded, 28% responded yes, and 72% responded no to having experience with an AT for their own injuries. When asked if they had experience with an AT due to their child's injuries, 60% responded yes. We found a difference among the 3 categories of experience for perception scores (P = .002) and knowledge scores (P < .001). In the absence of past experience with an AT, parents' perceptions and knowledge of the skills and job requirements of the secondary school AT are limited. Athletic trainers should educate parents on their professional roles, which may enhance their ability to provide better health care.Context
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Symptom presentation and recovery after sport concussion (SC) are variable. Empirically based models documenting typical symptom duration would assist health care providers in managing return to play after SC. To develop a prediction model for SC symptom duration. Cross-sectional study. Two National Collegiate Athletic Association Division I university laboratories. Seventy-six (51 male and 25 female) concussed athletes with an average age of 19.5 ± 1.65 years who were evaluated within 24 hours of diagnosis. Participants completed the Revised Head Injury Scale (HIS-r), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), and Sensory Organization Test within 24 hours of SC diagnosis. A stepwise multivariate regression incorporating ImPACT and Sensory Organization Test composites and HIS-r symptom severity-duration was used to predict the number of days athletes reported symptoms after SC. The resulting regression formula was cross-validated using the Stine cross-validation coefficient. The final formula consisted of the HIS-r's self-reported neck pain, drowsiness, tingling, and nervousness duration and ImPACT total symptom severity (R = 0.62, R2 = 39%, R2adj = 34.2%, P < .001). Approximately 29% (R2cv = 29%) of the variance associated with total days symptomatic after SC was explained by our preliminary formula when cross-validated. The current formula correctly identified 76% of participants who recovered within 10 days of injury. Our results suggest that self-reported duration of 4 symptoms during the initial 24 hours after injury along with total symptom severity as measured by ImPACT accounted for a considerable amount of variance associated with days symptomatic after SC in collegiate athletes. Until the formula is cross-validated in a college-aged sample, caution is warranted in using it clinically.Context
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Tennis is an asymmetric overhead sport with specific muscle-activation patterns, especially eccentrically in the rotator cuff. Magnetic resonance imaging (MRI) findings in asymptomatic adolescent elite tennis players have not previously been reported. The first aim of the study was to describe MRI findings regarding adaptations or abnormalities, as well as muscle cross-sectional area (CSA), of the rotator cuff. The second aim of the study was to investigate the rotator cuff based on the interpretation of the MRI scans as normal versus abnormal, with the subdivision based on the grade of tendinosis, and its association with eccentric rotator cuff strength in the dominant arm (DA) of the asymptomatic elite adolescent tennis player. Testing environment at the radiology department of Medicinsk Röntgen AB. Thirty-five asymptomatic elite tennis players (age = 17.4 ± 2.7 years) were selected based on ranking and exposure time. We assessed MRI scans and measured the CSA of the rotator cuff muscle. The non-DA (NDA) was used as a control. In addition, eccentric testing of the external rotators of the DA was performed with a handheld dynamometer. The DA and NDA displayed different frequencies of infraspinatus tendinosis (grade 1 changes) (P < .05). Rotator cuff measurements revealed larger infraspinatus and teres minor CSA (P < .05) in the DA than in the NDA. Mean eccentric external-rotation strength in the DA stratified by normal tendon and tendinosis was not different between groups (P = .723). Asymptomatic adolescent elite tennis players demonstrated infraspinatus tendinosis more frequently in the DA than in the NDA. Clinicians must recognize these tendon changes in order to modify conditioning and performance programs appropriately.Context
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Clinicians and athletes can benefit from field-expedient measurement tools, such as urine color, to assess hydration state; however, the diagnostic efficacy of this tool has not been established. To determine the diagnostic accuracy of urine color assessment to distinguish a hypohydrated state (≥2% body mass loss [BML]) from a euhydrated state (<2% BML) after exercise in a hot environment. Controlled laboratory study. Environmental chamber in a laboratory. Twenty-two healthy men (age = 22 ± 3 years, height = 180.4 ± 8.7 cm, mass = 77.9 ± 12.8 kg, body fat = 10.6% ± 4.6%). Participants cycled at 68% ± 6% of their maximal heart rates in a hot environment (36°C ± 1°C) for 5 hours or until 5% BML was achieved. At the point of each 1% BML, we assessed urine color. Diagnostic efficacy of urine color was assessed using receiver operating characteristic curve analysis, sensitivity, specificity, and likelihood ratios. Urine color was useful as a diagnostic tool to identify hypohydration after exercise in the heat (area under the curve = 0.951, standard error = 0.022; P < .001). A urine color of 5 or greater identified BML ≥2% with 88.9% sensitivity and 84.8% specificity (positive likelihood ratio = 5.87, negative likelihood ratio = 0.13). Under the conditions of acute dehydration due to exercise in a hot environment, urine color assessment can be a valid, practical, inexpensive tool for assessing hydration status. Researchers should examine the utility of urine color to identify a hypohydrated state under different BML conditions.Context
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Research is limited on the extent and nature of the care provided by athletic trainers (ATs) to student-athletes in the high school setting. To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) project and provide the descriptive epidemiology of AT services for injury care in 27 high school sports. Descriptive epidemiology study. Athletic training room (ATR) visits and AT services data collected in 147 high schools from 26 states. High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011−2012 through 2013−2014 academic years. The number of ATR visits and individual AT services, as well as the mean number of ATR visits (per injury) and AT services (per injury and ATR visit) were calculated by sport and for time-loss (TL) and non–time-loss (NTL) injuries. Over the 3-year period, 210 773 ATR visits and 557 381 AT services were reported for 50 604 injuries. Most ATR visits (70%) were for NTL injuries. Common AT services were therapeutic activities or exercise (45.4%), modalities (18.6%), and AT evaluation and reevaluation (15.9%), with an average of 4.17 ± 6.52 ATR visits and 11.01 ± 22.86 AT services per injury. Compared with NTL injuries, patients with TL injuries accrued more ATR visits (7.76 versus 3.47; P < .001) and AT services (18.60 versus 9.56; P < .001) per injury. An average of 2.24 ± 1.33 AT services were reported per ATR visit. Compared with TL injuries, NTL injuries had a larger average number of AT services per ATR visit (2.28 versus 2.05; P < .001). These findings highlight the broad spectrum of care provided by ATs to high school student-athletes and demonstrate that patients with NTL injuries require substantial amounts of AT services.Context
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Neurocognitive testing is widely performed for the assessment of concussion. Athletic trainers can use preseason baselines with reliable change indices (RCIs) to ascertain whether concussed athletes' cognitive abilities are below preinjury levels. Although the percentage of healthy individuals who show decline on any individual test is determined by its RCI's confidence level (eg, 10% false-positive rate using an RCI with an 80% confidence interval), the expected rate of 1 or more significant RCIs across multiple indices is unclear. To use a Monte Carlo simulation procedure to estimate the normal rate (ie, base rate) of significant decline on 1 or more RCIs in multitest batteries. For batteries producing 7 or more uncorrelated RCIs (80% confidence intervals), the majority of normal individuals would show significant declines on at least 1 RCI. Expected rates are lower for tests with fewer indices, higher inter-RCI correlations, and more stringent impairment criteria. These reference points can help testers interpret RCI output for multitest batteries.Background
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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