Balance Regularity Among Former High School Football Players With or Without a History of Concussion
Subclinical postural-control changes may persist beyond the point when athletes are considered clinically recovered postconcussion. To compare postural-control performance between former high school football players with or without a history of concussion using linear and nonlinear metrics. Case-control study. Clinical research laboratory. A total of 11 former high school football players (age range, 45–60 years) with 2 or more concussions and 11 age- and height-matched former high school football players without a history of concussion. No participant had college or professional football experience. Participants completed the Sensory Organization Test. We compared postural control (linear: equilibrium scores; nonlinear: sample and multiscale entropy) between groups using a 2 × 3 analysis of variance across conditions 4 to 6 (4: eyes open, sway-referenced platform; 5: eyes closed, sway-referenced platform; 6: eyes open, sway-referenced surround and platform). We observed a group-by-condition interaction effect for medial-lateral sample entropy (F2,40 = 3.26, P = .049, ηp2 = 0.140). Participants with a history of concussion presented with more regular medial-lateral sample entropy values (0.90 ± 0.41) for condition 5 than participants without a history of concussion (1.30 ± 0.35; mean difference = −0.40; 95% confidence interval [CI] = −0.74, −0.06; t20 = −2.48, P = .02), but conditions 4 (mean difference = −0.11; 95% CI: −0.37, 0.15; t20 = −0.86, P = .40) and 6 (mean difference = −0.25; 95% CI: −0.55, 0.06; t20 = −1.66, P = .11) did not differ between groups. Postconcussion deficits, detected using nonlinear metrics, may persist long after injury resolution. Subclinical concussion deficits may persist for years beyond clinical concussion recovery.Context:
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Heading, an integral component of soccer, exposes athletes to a large number of head impacts over a career. The literature has begun to indicate that cumulative exposure may lead to long-term functional and psychological deficits. Quantifying an athlete's exposure over a season is a first step in understanding cumulative exposure. To measure the frequency and magnitude of direct head impacts in collegiate women's soccer players across impact type, player position, and game or practice scenario. Cross-sectional study. National Collegiate Athletic Association Division I institution. Twenty-three collegiate women's soccer athletes. Athletes wore Smart Impact Monitor accelerometers during all games and practices. Impacts were classified during visual, on-field monitoring of athletic events. All direct head impacts that exceeded the 10g threshold were included in the final data analysis. The dependent variable was linear acceleration, and the fixed effects were (1) type of impact: clear, pass, shot, unintentional deflection, or head-to-head contact; (2) field position: goalkeeper, defense, forward, or midfielder; (3) playing scenario: game or practice. Shots (32.94g ± 12.91g, n = 38; P = .02) and clears (31.09g ± 13.43g, n = 101; P = .008) resulted in higher mean linear accelerations than passes (26.11g ± 15.48g, n = 451). Head-to-head impacts (51.26g ± 36.61g, n = 13; P < .001) and unintentional deflections (37.40g ± 34.41g, n = 24; P = .002) resulted in higher mean linear accelerations than purposeful headers (ie, shots, clears, and passes). No differences were seen in linear acceleration across player position or playing scenario. Nonheader impacts, including head-to-head impacts and unintentional deflections, resulted in higher mean linear accelerations than purposeful headers, including shots, clears, and passes, but occurred infrequently on the field. Therefore, these unanticipated impacts may not add substantially to an athlete's cumulative exposure, which is a function of both frequency and magnitude of impact.Context:
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Performance of quality cardiopulmonary resuscitation is essential for improving patient outcomes. Performing compressions over football equipment inhibits compression depth and rate, but lacrosse equipment has not yet been studied. To assess the effect of lacrosse shoulder pads on the ability to provide quality chest compressions on simulation manikins. Crossover study. Simulation laboratory. Thirty-six athletic trainers (12 men: age = 33.3 ± 9.7 years; 24 women: age = 33.4 ± 9.8 years). No shoulder pads (NSP), Warrior Burn Hitman shoulder pads (WSP), and STX Cell II shoulder pads (SSP) were investigated. Outcomes were chest-compression depth (millimeters), rate (compressions per minute), rating of perceived exertion (0−10), hand-placement accuracy (%), and chest recoil (%). We observed a difference in mean compression depth among shoulder-pad conditions (F2,213 = 3.73, P = .03, ω2 = 0.03), with a shallower depth during the WSP (54.1 ± 5.8 mm) than the NSP (56.8 ± 5.7 mm; P = .02) trials. However, no differences were found in mean compression rate (F2,213 = 0.87, P = .42, ω2 = 0.001, 1–β = .20). We noted a difference in rating of perceived exertion scores (F2,213 = 16.41, P < .001, ω2 = 0.12). Compressions were more difficult during the SSP condition (4.1 ± 1.3) than during the NSP (2.9 ± 1.2; P < .001) and WSP (3.3 ± 1.1; P = .002) conditions. A difference was present in hand-placement accuracy among the 3 shoulder-pad conditions (χ22 = 11.14, P = .004). Hand-placement accuracy was better in the NSP than the SSP condition (P = .002) and the SSP than the WSP condition (P = .001). Lacrosse shoulder pads did not inhibit the ability to administer chest compressions with adequate rate and depth. With appropriate training to improve hand placement, the pads may be left in place while cardiopulmonary resuscitation is initiated during sudden cardiac arrest.Context:
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Although the risk of osteoarthritis development after acute knee injury has been widely studied, the long-term consequences of knee overuse injury are not well understood. To identify the relationship between gait-related risk factors associated with osteoarthritis and the development of iliotibial band syndrome (ITBS) in members of a single University Army Reserve Officers' Training Corps unit. Prospective cohort study. Biomechanics laboratory. Sixty-eight cadets undergoing standardized physical fitness training. Three-dimensional lower extremity kinematics (240 Hz) and kinetics (960 Hz) were collected for 3 bilateral trials during shod running at 4.0 m/s ± 10%. Injury tracking was conducted for 7 months of training. Biomechanical variables, including varus thrust and knee-adduction moment, were compared between the injured and control groups. Twenty-six cadets with no history of overuse injury served as the control group, whereas 6 cadets (7 limbs) who developed ITBS that required them to modify their training program or seek medical care (or both) served as the injured group. Maximum varus velocity was higher (P = .006) and occurred sooner during stance (P = .04) in the injured group than in the control group, indicating greater varus thrust. Maximum knee-varus angle and maximum knee-adduction moment were higher (P = .02 and P = .002, respectively) and vertical stiffness was lower (P = .03) in the injured group. Measures of dynamic varus stability appeared to be altered in individuals who developed ITBS. Biomechanical knee variables previously identified as increasing the risk for knee osteoarthritis were also associated with the development of ITBS in healthy adults.Context:
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Aberrant biomechanics may affect force attenuation at the knee during dynamic activities, potentially increasing the risk of sustaining a knee injury or hastening the development of osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps neuromuscular function has been hypothesized to influence the development of aberrant biomechanics. To determine the association between quadriceps neuromuscular function (strength, voluntary activation, and spinal-reflex and corticomotor excitability) and sagittal-plane knee biomechanics during jump landings in individuals with ACLR. Cross-sectional study. Research laboratory. Twenty-eight individuals with unilateral ACLR (7 men, 21 women; age = 22.4 ± 3.7 years, height = 1.69 ± 0.10 m, mass = 69.4 ± 10.1 kg, time postsurgery = 52 ± 42 months). We quantified quadriceps spinal-reflex excitability via the Hoffmann reflex normalized to maximal muscle response (H : M ratio), corticomotor excitability via active motor threshold, strength as knee-extension maximal voluntary isometric contraction (MVIC), and voluntary activation using the central activation ratio (CAR). In a separate session, sagittal-plane kinetics (peak vertical ground reaction force [vGRF] and peak internal knee-extension moment) and kinematics (knee-flexion angle at initial contact, peak knee-flexion angle, and knee-flexion excursion) were collected during the loading phase of a jump-landing task. Separate bivariate associations were performed between the neuromuscular and biomechanical variables. In the ACLR limb, greater MVIC was associated with greater peak knee-flexion angle (r = 0.38, P = .045) and less peak vGRF (r = −0.41, P = .03). Greater CAR was associated with greater peak internal knee-extension moment (ρ = −0.38, P = .045), and greater H : M ratios were associated with greater peak vGRF (r = 0.45, P = .02). Greater quadriceps MVIC and CAR may provide better energy attenuation during a jump-landing task. Individuals with greater peak vGRF in the ACLR limb possibly require greater spinal-reflex excitability to attenuate greater loading during dynamic movements.Context:
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To evaluate the current evidence concerning kinematic and kinetic strategies adopted during dynamic landing tasks by patients with anterior cruciate ligament reconstruction (ACLR). PubMed, Web of Science. Original research articles that evaluated kinematics or kinetics (or both) during a landing task in those with a history of ACLR were included. Methodologic quality was assessed using the modified Downs and Black checklist. Means and standard deviations for knee or hip (or both) kinematics and kinetics were used to calculate Cohen d effect sizes and corresponding 95% confidence intervals between the injured limb of ACLR participants and contralateral or healthy matched limbs. Data were further stratified by landing tasks, either double- or single-limb landing. A random-effects–model meta-analysis was used to calculate pooled effect sizes and 95% confidence intervals. The involved limbs of ACLR patients demonstrated clinically and significantly lower knee-extension moments during double-legged landing compared with healthy contralateral limbs and healthy control limbs (Cohen d range = −0.81 to −1.23) and decreased vertical ground reaction forces when compared with healthy controls, regardless of task (Cohen d range = −0.39 to −1.75). During single- and double-legged landing tasks, individuals with ACLR demonstrated meaningful reductions in injured-limb knee-extension moments and vertical ground reaction forces. These findings indicate potential unloading of the injured limb after ACLR, which may have significant implications for secondary ACL injury and long-term joint health.Objective:
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Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited. To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM. Randomized controlled trial. Laboratory. Participants were 44 physically active people (53 limbs) with less than 30° of DF. Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken. Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted. A difference between groups was found in the standing (F2,52 = 13.78, P = .001) and kneeling (F2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group (P = .005). Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.Context:
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To describe the conservative management of a young athlete with extension-based (EB) low back pain (LBP). We present the case of a 15-year-old female high school gymnast with a 4-year history of EB LBP. Magnetic resonance imaging revealed a healed spondylolysis and significant atrophy with fatty infiltrate of the lumbar multifidi muscles (LMM). She had several courses of outpatient orthopaedic rehabilitation that focused on core muscle strengthening (improving activation and strength of the LMM and transversus abdominus muscle in a neutral pelvic position) without long-lasting improvement. She was unable to tolerate higher levels of training or compete. The LMM are rich in muscle spindles and provide continuous feedback to the central nervous system about body position. Atrophy and fatty infiltrate of the LMM can compromise neuromuscular function and contribute to dysfunctional movement patterns that place a greater demand on lumbar spine structures. Ongoing motor-control impairments perpetuate nociceptive input, leading to central sensitization. The athlete had difficulty controlling trunk extension during sport-specific activities; she moved early and to a greater extent in the lumbar spine. The aim of the treatment was to teach the athlete how to control her tendency to overload her lumbar spine when bending backward, thus reducing nociceptive input from lumbar spine structures and desensitizing the nervous system. Treating EB LBP by addressing motor-control impairments and cognitive-affective factors as opposed to core strengthening. Activity modification, bracing, and traditional core-strengthening exercises may not be the most appropriate treatment for athletes experiencing EB LBP. Addressing cognitive-affective factors in addition to correcting maladaptive motor behavior and moving in a pain-free range reduces nociceptive input, desensitizes the nervous system, and allows athletes to gain control over their pain.Objective:
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Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. Cross-sectional study. Male team handball senior divisions (the highest level) in France and Belgium. A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury. These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.Context:
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An VV, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg. 2016;25(5):853−863. Are clinical and patient-reported outcomes different between the Latarjet and Bankart repair stabilization procedures when performed for recurrent traumatic anterior shoulder instability? Ovid MEDLINE, PubMed, Cochrane databases, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness were searched up to June 2015. The search terms used were Bankart AND Latarjet OR Bristow. Criteria used to include studies that (1) were written in English; (2) compared the outcomes of any Latarjet procedure (Bristow-Latarjet, coracoid transfer, or modified Bristow) with Bankart repair (anatomic); (3) reported a minimum of 1 outcome of recurrence, redislocation, revision, or patient-reported outcome measure; and (4) reported original data. Data presented in any format (text, table, figure) were extracted from all included studies. The quality of each study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Summary statistics were reported as relative risks and weighted mean differences. Fixed-effects (the assumed treatment effect was the same across studies) and random-effects (variations in treatment effect were assumed among studies) models were tested. Heterogeneity between trials was assessed using the χ2 statistic, and the amount (percentage) of variation across studies due to heterogeneity was calculated using the I2 statistic. Forest plots were used to present pooled results. After the initial search, 245 articles were identified. After we applied the inclusion criteria, a total of 8 studies reporting on 795 patients (Latarjet = 379, Bankart = 416) were included in this review. Using the National Health and Medical Research Council's level of evidence, the authors scored 7 of the studies at level III and 1 study at level II. All Latarjet procedures were performed using an open technique, whereas the Bankart procedure was performed open in 6 studies and arthroscopically in 2 studies. The demographics of the patients (age, proportion of males to females, proportion with surgery on the dominant side, and proportion of revisions) were similar between the 2 surgical procedures. Four groups reported that patients who underwent the Latarjet procedure had fewer recurrences than patients in the Bankart repair group (11.6% versus 21.1%, respectively), irrespective of whether the Bankart was performed open or arthroscopically. Similarly, 4 groups observed that the Latarjet procedure resulted in fewer postsurgical redislocations (5.0%) than the Bankart (9.5%) procedure, irrespective of whether the repair was open or arthroscopic. The authors of 7 studies noted no differences between the 2 procedures in revision rates (Latarjet: 3.4%, Bankart: 4.5%), and 8 studies demonstrated no differences in complications requiring reoperation (Latarjet: 5.0%, Bankart: 3.1%). Investigators in 7 studies used the Rowe score to measure patient-reported satisfaction and function; patients who underwent the Latarjet procedure reported better Rowe scores postsurgically than patients who underwent the Bankart repair (scores: 79.0 and 85.4, respectively). Researchers in 4 studies reported a loss of external-rotation range of motion, which was less in the Latarjet (11.5°) compared with the Bankart (20.9°) procedure. Of the 5 groups that reported return to function, a trend suggested that a greater proportion of patients who underwent the Latarjet procedure returned to work, sport, and throwing activities compared with those who underwent the Bankart repair. The Latarjet procedure produced fewer recurrences, better patient-reported outcomes, and less restricted external-rotation motion than the Bankart repair.Reference/Citation:
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The demands and expectations of athletic trainers employed in professional sports settings (ATPSSs) have increased over the years. Meeting these demands and expectations may predispose the athletic trainer to workplace stress and ultimately role strain. To investigate the concept of role strain among ATPSSs. Sequential, explanatory mixed-methods study consisting of 2 phases: (1) population role-strain survey and (2) personal interviews. From a purposeful sampling of 389 athletic trainers employed in the 5 major sports leagues (Major League Baseball, Major League Soccer, National Basketball Association, National Football League, and National Hockey League), 152 individuals provided usable data (39% response rate). A previously validated and reliable role-strain survey using a 5-point Likert scale (1 = never, 5 = nearly all the time) was administered. Measures of central tendency were used to identify the presence and degree of role strain; inferential statistics were calculated using analysis of variance to determine group differences in overall role strain and its subcomponents. More than half of the participants (53.9%) experienced a moderate to high degree of role strain. Interrole conflict (2.99 ± 0.77) and role overload (2.91 ± 0.75) represented the most prominent components of role strain. Differences existed by sport leagues and employment. Role strain existed at moderate to high levels (mean Role Strain Score > 2.70) among ATPSSs. Interrole conflict and role overload contributed the most to overall role strain. The ATPSSs experienced role strain to a higher degree than reported in other settings.Context:
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Athletic trainers (ATs) employed in the professional sport setting (ATPSSs) demonstrate moderate to high degrees of role strain. The experiences and perceptions of these ATs provide insight regarding the sources of role strain as well as ways to reduce it. To investigate the perceptions of ATPSSs regarding role strain. Qualitative study. From a purposeful sampling of 389 ATs employed in the 5 major sport leagues (Major League Baseball, Major League Soccer, National Basketball Association, National Football League, and National Hockey League), we identified 34 participants willing to participate in phone interviews. Semistructured phone interviews. Inductive data analysis was based on a grounded theory approach. Credibility was addressed with member checks and a peer debriefing. Three first-order emergent themes materialized from the data: (1) sources of role strain, (2) consequences of role strain, and (3) strategies to alleviate role strain in ATPSSs. Participants described the antecedents of role strain as emerging from the competing expectations of the professional athlete, the organization, and the sport league. Consequences of role strain included effects on direct patient care and work-life imbalance. Improving organizational factors such as inadequate staffing and poor communication within the organization were strategies described by participants for decreasing role strain in the professional sports setting. Our participants discussed experiencing role strain, which was facilitated by trying to meet the competing demands placed on them with limited time and often with an inadequate support staff. Participant role strain affected health care and contributed to work-life imbalance. Participants described changing the organizational factors that contributed to role strain as a strategy to alleviate the perceived stress.Context:
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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