Among sports-recovery methods, cold-water immersion (CWI), contrast-water therapy (CWT), and whole-body cryotherapy (WBC) have been applied widely to enhance recovery after strenuous exercise. However, the different timing effects in exercise-induced muscle damage (EIMD) after these recovery protocols remain unknown. To compare the effects of CWI, CWT, and WBC on the timing-sequence recovery of EIMD through different indicator responses. Crossover study. Laboratory. Twelve male middle- and long-distance runners from the Beijing Sport University (age = 21.00 ± 0.95 years). Participants were treated with different recovery methods (control [CON], CWI, CWT, WBC) immediately postexercise and at 24, 48, and 72 hours postexercise. We measured perceived sensation using a visual analog scale (VAS), plasma creatine kinase (CK) activity, plasma C-reactive protein (CRP) activity, and vertical-jump height (VJH) pre-exercise, immediately postexercise, and at 1, 24, 48, 72, and 96 hours postexercise. For the VAS score and CK activity, WBC exhibited better timing-sequence recovery effects than CON and CWI (P < .05), but the CWT demonstrated better effects than CON (P < .05). The CRP activity was lower after WBC than after the other interventions (P < .05). The VJH was lower after WBC than after CON and CWI (P < .05). The WBC positively affected VAS, CK, CRP, and VJH associated with EIMD. The CWT and CWI also showed positive effects. However, for the activity and timing-sequence effect, CWT had weaker effects than WBC.Context
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Long-term eccentric exercise is known to promote muscle growth better than concentric exercise, but its acute effect on muscle is not well understood because of misinterpreted modeling and in situ and in vitro stretch protocols. Knowing if the initial bout of eccentric exercise promotes muscle growth and limits damage is critical to understanding the effect of this mode of exercise. To directly evaluate the immediate effects of eccentric and concentric exercises on untrained muscle when fiber strains were physiological and exercise doses were comparable. Controlled laboratory study. Laboratory. A total of 40 skeletally mature male Long-Evans rats (age = 16 weeks, mass = 452.1 ± 35.2 g) were randomly assigned to an eccentric exercise (downhill walking, n = 16), concentric exercise (uphill walking, n = 16), or control (no exercise, n = 8) group. Rats were exposed to a single 15-minute bout of eccentric or concentric exercise on a motorized treadmill and then were euthanized at 6 or 24 hours postexercise. We harvested the vastus lateralis muscle bilaterally. The percentage increase or decrease in protein abundance in exercised animals relative to that in unexercised control animals was evaluated as elevated phosphorylated p70S6k relative to total p70S6k. Fiber damage was quantified using immunoglobulin G permeability staining. One-way analysis of variance and post hoc Tukey tests were performed. Rats exposed to eccentric exercise and euthanized at 24 hours had higher percentage response protein synthesis rates than rats exposed to eccentric exercise and euthanized at 6 hours (P = .02) or to concentric exercise and euthanized at 6 (P = .03) or 24 (P = .03) hours. We assessed 9446 fibers for damage and found only 1 fiber was infiltrated (in the concentric exercise group euthanized at 6 hours). Furthermore, no between-groups differences in immunoglobulin G fluorescent intensity were detected (P = .94). Incorporating eccentric exercise is a simple, universally available therapeutic intervention for promoting muscle recovery. A single 15-minute dose of eccentric exercise to a novice muscle can better exert an anabolic effect than a comparable dose of concentric exercise, with very limited evidence of fiber damage.Context
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Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 90° of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercises is advised and has been suggested to influence scapular muscle activity levels. To study the influence of kinetic chain incorporation during 5 variations of a shoulder-elevation exercise on scapular muscle activity. Cross-sectional study. University laboratory. Thirty-one asymptomatic participants (15 men, 16 women). The electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior was determined during 5 variations of bilateral elevation with external rotation: (1) open-hand position (reference exercise), (2) closed-hand position, (3) dynamic bipedal squat, (4) static unipedal squat, and (5) dynamic unipedal squat on the contralateral leg. All data were normalized as a percentage of maximal voluntary isometric contraction (MVIC). A closed-hand position (exercise 2) instead of an open-hand position (exercise 1) resulted in lower MT (mean difference = 3.44% MVIC) and LT (mean difference = 7.76% MVIC) activity. Incorporating the lower limb (exercises 3–5) increased UT activity when compared with exercise 1 (mean differences = 3.67, 2.68, 5.02% MVIC, respectively), which in general resulted in increased UT : MT ratios. Additionally, LT activity decreased when a dynamic unipedal squat was added (mean difference: 4.90% MVIC). For the serratus anterior, the greatest activity occurred during elevation in a static unipedal squat position (exercise 4, 22.90% MVIC). Incorporating the kinetic chain during shoulder-elevation exercises influenced scapular muscle activity and ratios. In particular, incorporating the lower limb resulted in more UT activity, whereas the open-hand position increased MT and LT activity.Context
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Rotator cuff weakness and rotation ratio imbalances are possible risk factors for shoulder injury among overhead athletes. In consensus statements, organizations have highlighted the importance of a screening examination to identify athletes at risk of injury. The screening should be portable and designed to be feasible in many different environments and contexts. To evaluate the reliability and validity of the Self-Assessment Corner (SAC) for self-assessing shoulder isometric rotational strength and examining whether performance on 2 physical performance tests was correlated with isometric shoulder rotational strength using the SAC in handball players. Cross-sectional study. Sport setting. A first sample of 42 participants (18 men, 24 women) was recruited to determine the reliability and validity of the SAC. In a second sample of 34 handball players (18 men, 16 women), we examined correlations between physical performance tests and the SAC. The SAC was used to measure isometric rotational strength with the upper extremity at 90° of abduction in the frontal plane and 90° of external rotation and the elbow flexed to 90° with neutral rotation of the forearm. The SAC findings were compared with those from manual testing. Results from the seated medicine ball throw (SMBT) and closed kinetic chain upper extremity stability test (CKCUEST) were used to establish relationships with the SAC. We calculated intraclass correlation coefficients to determine relative reliability and used standard error of measurement and minimal detectable change to quantify absolute reliability. Relationships among the different strength-testing procedures and with the physical performance tests were determined using the Pearson product moment correlation coefficient (r) or Spearman rank correlation coefficient (rs). We observed good to excellent reliability (intraclass correlation coefficient [2,k] range = 0.89 to 0.92). The standard error of measurement varied from 3.45 to 3.48 N. The minimal detectable change with 95% confidence intervals ranged from 8.06 to 8.13 N. Strong correlations were present among strength procedures (r = 0.824, rs range = 0.754–0.816). We observed moderate to strong correlations between the CKCUEST findings and rotational strength (r range = 0.570–0.767). Moderate correlations were found between rotational strength and SMBT (r range = 0.573–0.626). The SAC is a clinically applicable and standardized protocol for self-assessing rotational strength in young healthy adults without pathologic conditions. Performance on the SMBT and CKCUEST may be valuable as a screening tool to further assess shoulder strength.Context
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Neuromuscular training programs can reduce the rate of noncontact anterior cruciate ligament (ACL) injuries, particularly in female athletes. To assess the awareness of, experience with, and factors associated with participation in preventive training programs (PTPs) among female collegiate athletes and their knowledge of ACL injuries. Cross-sectional study. National Collegiate Athletic Association (NCAA) sports programs. A total of 440 female NCAA athletes (age = 20 ± 1 years) representing 20 sports during the 2017–2018 academic year. We used a 12-item survey to collect data on each participant's age, sport, position, college, NCAA division, and awareness of and experience with PTPs. We performed descriptive statistics and used odds ratios (ORs) to assess relationships between demographic data and awareness of or interest in PTPs. Of the 440 respondents, 85% (n = 373) knew that female athletes were at higher risk for sustaining ACL injuries than male athletes, and 89% (n = 391) knew that ACL injuries were preventable. Thirty-three percent (n = 143) were familiar with the concept of ACL PTPs. Only 15% (n = 64) had ever performed PTPs, but 89% (n = 391) reported they would perform a daily PTP if it could prevent ACL injuries. Fifty-two of the 64 respondents (81%) who had performed PTPs said athletic trainers or coaches oversaw the PTPs. Participants were more likely to be familiar with ACL PTPs if they (OR = 3.5; 95% confidence interval [CI] = 2.0, 5.8) or a teammate (OR = 4.6; 95% CI = 2.1, 9.8) had sustained an ACL injury. Respondents were more willing to perform PTPs if they (OR = 2.3; 95% CI = 0.80, 6.6) or a teammate (OR = 3.4; 95% CI = 1.8, 6.6) had sustained an ACL injury. Although 89% of respondents expressed interest in performing daily ACL PTPs, only 15% had performed such programs, and only 33% were familiar with the concept of ACL PTPs.Context
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Postconcussion, student-athletes should return to the classroom using a gradual, stepwise process to ensure that symptoms are not exacerbated by cognitive activities. The National Collegiate Athletic Association (NCAA) has mandated that its affiliated institutions develop return-to-learn (RTL) policies to support the return to the classroom. To investigate athletic trainers' (ATs') perceptions of their role in the RTL policy development and implementation at NCAA Division II and III institutions. Qualitative study. Individual phone interviews. Fifteen ATs (age = 40 ± 11 years, clinical practice experience = 16 ± 9 years, employment term = 9 ± 9 years) representing NCAA Division II (n = 6) or III (n = 9) institutions. Interviews were transcribed verbatim and checked for accuracy by the principal investigator. A 2-member data-analysis team independently coded a portion of the transcripts and then met to discuss the codebook. The codebook was applied to the remaining transcripts, confirmed, and externally reviewed. Five themes emerged: (1) approach, (2) collaborative practice, (3) patient advocacy, (4) institutional autonomy, and (5) barriers. Policies must allow for an individualized, evidence-based approach through facilitated, active communication among members of the RTL team and the student-athlete. Collaborative practice was described as key to successful policy implementation and should include interprofessional collaboration beyond health care providers (eg, educating academicians about the purpose of RTL). The RTL process was triggered by a specific member of the RTL team, usually a medical doctor or the head AT. Participants noted that the purpose of the RTL policy was to advocate for the student-athlete's successful postconcussion outcomes. For the development and implementation of a successful RTL policy, strong communication and interprofessional practice must extend beyond health care professionals. Members of the health care team must establish a network with academic partners to develop a policy that is appropriate for the institution's available resources and the needs of its student-athletes.Context
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Rugby union is a field-based collision sport with high injury rates. Associations between injury characteristics and global positioning system–derived movement demands in rugby union athletes are yet to be investigated. To investigate associations between match injuries and movement demands, anthropometrics, and physical performance in under-20-years university-level rugby union players. Descriptive epidemiology study. Competition season. Rugby union players (n = 34, age = 19.3 ± 0.6 years) from a university club were recruited. Acute medical attention non–time-loss (NTL), medical-attention time-loss (TL), and total medical-attention (MA) injuries sustained were recorded. Principal component (PC) analysis was performed on player-movement demand variables to identify independent-movement demand components. Pearson correlation and bivariate linear regression were used to test associations between match injuries and PCs. Anthropometric and physical performance measures were tested as predictors of match injuries using a forward stepwise multiple regression analysis. Backs had lower anthropometric and performance measures than forwards (P < .05), whereas forwards performed fewer weekly movement demands than backs (P < .05). Increases in body mass and skinfold thickness were associated with more injuries (P < .05). Principal component analysis revealed 3 PCs representing overall performance, high-intensity running (HIR) performance, and impacts. Increases in HIR were associated with decreases in NTL upper limb and trunk (r = −0.32, P = .03), NTL musculoskeletal (r = −0.36, P = .05), NTL total (r = −0.46, P < .01), TL musculoskeletal (r = −0.30, P = .05), MA musculoskeletal (r = −0.41, P < .01), and MA total (r = −0.48, P < .01) injuries. Increases in impacts were associated with increased TL (r = 0.32, P = .03) and MA (r = 0.33, P = .03) head or neck injuries. Backs experienced greater weekly movement demands than forwards. Increases in HIR demands were associated with decreased acute injuries in university rugby players. Increases in impacts were associated with more acute head or neck injuries. Positional differences in movement demands, anthropometrics, and physical performance highlight the need for position-specific training.Context
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Tactical athletes commonly experience high levels of physical stress, which may increase their risk of musculoskeletal injury. It is critical to understand psychological predictors of functional movement (FM), which may help prevent musculoskeletal injury in this population. To determine the associations of combat and trauma exposure with FM characteristics of male tactical athletes. Secondary objectives were to explore confounding influences of age and physical injury history as well as the mediating role of bodily pain. Cross-sectional study. Research laboratory. Eighty-two healthy, male, active-duty US Navy Explosive Ordnance Disposal personnel (age = 34.0 ± 6.7 years). Participants completed measures of combat exposure, trauma exposure, physical injury history, and bodily pain. We assessed FM characteristics (ie, Functional Movement Screen [FMS], Y-Balance Test), from which we derived a composite functional status (CFS) measure. Hypotheses were tested using correlational and multiple regression (causal-steps) models. In unadjusted models, trauma exposure was inversely associated with the FMS (P = .005) and CFS (P = .009) scores. In adjusted models, these relationships were robust to the confounding influences of age and physical injury history. Trauma exposure and bodily pain were substantive, independent predictors of FMS and CFS in causal-steps models (all P values < .05), implying additive rather than mediated effects (R2adj = 0.18–0.20). Combat exposure did not predict FM characteristics. To our knowledge, this is the first evidence of the influence of trauma exposure on the FM characteristics of male tactical athletes, independent of age, physical injury, and bodily pain. This program of research may help to advance the prevention and treatment of musculoskeletal injuries in the tactical environment.Context
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Despite the importance of assessing patient outcomes during patient care, current evidence suggests relatively limited use of patient-reported outcome measures (PROMs) by athletic trainers (ATs). Major barriers to PROM use include lack of knowledge, navigating the intricate process of assessing a wide variety of PROMs, and selecting the most appropriate PROM to use for care. A concise resource for ATs to consult when selecting and implementing PROMs may help facilitate the use of PROMs in athletic health care. To review the instrument essentials and clinical utility of PROMs used by ATs. We studied 11 lower extremity region–specific, 10 upper extremity region–specific, 6 generic, and 3 single-item PROMs based on the endorsement of at least 10% of ATs who use PROMs, as reported in a recent investigation of PROM use in athletic training. A literature search was conducted for each included PROM that focused on identifying and extracting components of the instrument essentials (ie, instrument development, reliability, validity, responsiveness and interpretability, and precision) and clinical utility (ie, acceptability, feasibility, and appropriateness). Through independent review and group consensus, we also classified each PROM question by International Classification of Functioning, Disability and Health domain and health-related quality-of-life dimensions. The PROMs contained in this report generally possessed appropriate instrument essentials and clinical utility. Moreover, the PROMs generally emphasized body structure and function as well as the physical functioning of the patient. Athletic trainers aiming to assess patients via a whole-person approach may benefit from combining different PROMs for use in patient care to ensure broader attention to disablement health domains and health-related quality-of-life dimensions.Background
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Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. Qualitative study. Semistructured one-on-one telephone interviews. Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24–48 years]; years certified = 9 ± 8). Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.Context
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To identify the causes, effects, and prevalence of burnout in athletic trainers (ATs) identified in the literature. EBSCO: SPORTDiscus and OneSearch were accessed, using the search terms athletic trainer AND burnout. Studies selected for inclusion were peer reviewed, published in a journal, and written in English and investigated prevalence, causes, effects, or alleviation of AT burnout. The initial search yielded 558 articles. Articles that did not specifically involve ATs were excluded from further inspection. The remaining 83 full-text articles were reviewed. Of these 83 articles, 48 examined prevalence, causes, effects, or alleviation of AT burnout. An evaluation of the bibliographies of those 48 articles revealed 3 additional articles that were not initially identified but met the inclusion criteria. In total, 51 articles were included in data collection. Articles were categorized based on investigation of prevalence, causes, effects, or alleviation of burnout. Articles were also categorized based on which subset of the athletic training population they observed (ie, athletic training students, certified graduate assistants, high school or collegiate staff members, academic faculty). Burnout was observed in all studied subsets of the population (ie, students, graduate assistants, staff, faculty), and multiple causes of burnout were reported. Suggested causes of burnout in ATs included work-life conflict and organizational factors such as poor salaries, long hours, and difficulties dealing with the “politics and bureaucracy” of athletics. Effects of burnout in ATs included physical, emotional, and behavioral concerns (eg, intention to leave the job or profession).Objective
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Conclusions
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