Congratulations to the winners of the 2019 Outstanding Manuscript Awards, as determined by the Editorial Board and the Editors of the Journal of Athletic Training:
Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, these impairments limit sport participation and performance. A thorough evaluation and comprehensive treatment plan, centered on progressive tendon loading, is required to ensure full recovery of tendon health and to minimize the risk of reinjury. In this review, we will provide an update on the evidence-based evaluation, outcome assessment, treatment, and return-to-sport planning for Achilles tendinopathy. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.
A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. To describe the PCEP and its development and implementation. Program development consisting of a literature review, focus group, and pilot implementation. Athletics department at a college participating at the National Collegiate Athletic Association Division II-sanctioned competition level. Fifteen student-athletes from the women's soccer and men's lacrosse teams participated in the focus group. Four peer concussion educators (PCEs) were debriefed after the pilot implementation of the PCEP with the women's soccer and men's lacrosse teams. Focus-group data were analyzed qualitatively. The PCEs were debriefed, and responses were organized into recommendation types. The literature review contributed information that supported the development of the PCEP's conceptual model. Focus-group results provided information used to train the PCEs and refine the PCEP's education modules. The pilot implementation and PCE debriefing supplied information used to further revise the education modules, PCE training, and PCEP implementation procedure. The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior and uses a peer-mediated, cognitive-behavioral, and interdisciplinary model to enhance concussion knowledge of and reporting by collegiate student-athletes. After a focus-group discussion and pilot implementation, we revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.Context
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The National Collegiate Athletic Association and US Department of Defense have called for educational programs to change the culture of concussion reporting, increase reporting behavior, and enhance the safety of players and service members. To evaluate the effects of a novel peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among collegiate student-athletes and assess program implementation. Randomized controlled trial and qualitative analysis of interviews. National Collegiate Athletic Association athletic teams from randomly selected colleges or universities. A total of 1614 male and female student-athletes from 60 teams at 10 colleges and universities and 8 athletic trainers. The PCEP intervention trains 2 peer concussion educators to provide 2 education modules to their teammates. Knowledge, attitudes (oneself and teammates), and concussion occurrence or reporting were assessed at baseline, postintervention, and 1 month later. Eight athletic trainers were interviewed about program implementation. Compared with the control group, the intervention group showed greater increases occurred postintervention and at 1 month in concussion knowledge (F1,2648 = 51.3, P < .0001), intention to report (oneself, F2,2633 = 82.3, P < .0001; teammates, F2,2624 = 53.9, P < .0001), return-to-play protocol knowledge, (F2,2632 = 28.4, P < .0001), direct subjective norms (oneself, F2,2625 = 51.7, P < .0001; teammates, F2,2644 = 40.6, P < .0001), direct perceived behavioral control (oneself, F2,2628 = 53.7, P < .0001; teammates, F2,2615 = 68.2, P < .0001), and indirect attitudes (oneself, F2,2626 = 47.1, P < .001; teammates, F2,2623 = 40.9, P < .0001). Peer concussion-education program participants discussed concussion more often with a teammate (F1,1396 = 13.96, P < .0001) or athletic staff (F1,1396 = 6.62, P < .001). Qualitative program analysis revealed both positive aspects of the PCEP and areas for improvement. The PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate's concussion, and facilitating attitudinal changes that support reporting among student-athletes.Context
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Whereas much attention has been paid to identifying mechanisms for decreasing concussion rates in women's soccer players, which strategies are currently being used is unknown. In addition, athletic trainers' (ATs') knowledge and beliefs about the efficacy of concussion-prevention practices have not been studied. To evaluate the concussion-prevention strategies being used in National Collegiate Athletic Association Division I and Division II women's soccer and identify the beliefs of certified ATs regarding mechanisms for preventing concussion. Cross-sectional study. Online survey. A total of 223 women's soccer team ATs employed at Division I or II universities. A survey instrument of structured questions and open-ended, follow-up questions was developed to identify the use of cervical-strengthening programs, headgear, and other techniques for preventing concussion. Questions also addressed ATs' beliefs regarding the effectiveness of cervical strengthening, headgear, and mouthguards in concussion prevention. Data were collected via questionnaire in Qualtrics survey software. Descriptive statistics of frequencies and percentages were calculated for close-ended questions. Open-ended questions were evaluated for common themes, which were then reported by response frequency. Cervical strengthening or stability for concussion prevention was reported by 38 (17.12%) respondents; 153 (69.86%) ATs believed that cervical strengthening would aid in concussion prevention. Seventy-eight (35.49%) reported that their players wore headgear. Nineteen (8.76%) believed that soccer headgear prevented concussions; 45 (20.74%) believed that mouthguards prevented concussions. Education in proper soccer technique was reported by 151 (69.59%) respondents. Fourteen (0.06%) respondents cited nutritional strategies for concussion prevention. Although ATs believed that cervical strengthening could help prevent concussions, few had implemented this strategy. However, the ATs whose teams used headgear outnumbered those who believed that headgear was an effective prevention strategy. Based on our findings, we saw a disconnect among the current use of concussion-prevention strategies, ATs' beliefs, and the available evidence.Context
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Deficits in both balance and oculomotor function, including impairments in saccadic eye movements, are observed in approximately 30% of patients postconcussion. Whereas balance and saccadic eye movements are routinely assessed separately, growing evidence suggests that they should be assessed concurrently. To compare balance measures and saccades between adolescents 1 to 3 months postconcussion and healthy uninjured adolescents. Case-control study. Concussion clinic and 2 private schools. Twenty-five adolescents (10 boys, 15 girls; median [interquartile range (IQR)] age = 14 years [11.5–16 years]) between 1 and 3 months postconcussion (median [IQR] time since injury = 39.5 days [30–56.75 days]) and 33 uninjured adolescents (18 boys, 15 girls; median [IQR] age = 13 years [11.5–14 years]). The center-of-pressure 95% ellipse area and medial-lateral and anterior-posterior velocity and the number of saccades in the dual-task balance conditions including a high cognitive load (cognitive condition), a low cognitive load and a gaze-shifting component (visual condition) or both a high cognitive load and a gaze-shifting component (combined condition). Concussion-group participants swayed over larger center-of-pressure ellipse areas in the visual (P = .02; effect size = 0.73) and combined (P = .005; effect size = 0.86) conditions but not in the cognitive condition (P = .07; effect size = 0.50). No group differences were identified for anterior-posterior (F1,56 = 2.57, P = .12) or medial-lateral (F1,56 = 0.157, P = .69) velocity. Concussion-group participants also did not perform more saccades than the control-group participants (F1,56 = 2.04, P = .16). Performing dual-task balance conditions for which the secondary task involved a gaze-shifting component or both a gaze-shifting component and a high cognitive load resulted in greater sway amplitude in adolescents with concussion. However, these larger amounts of postural sway were not associated with increased saccadic eye movements.Context
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The King-Devick (KD) test is a rapid number-reading test that has emerging use in the assessment of sport-related concussion (SRC). Previous research suggested that healthy individuals and patients with acute concussions who had shorter recovery times (<3 weeks) demonstrated a learning effect on the KD test after mild to moderate exertion, whereas patients with longer recovery times did not. To assess if the absence of postexertional improvement on the KD test within 10 days of concussive head injury was associated with a longer duration of recovery. Prospective cohort study. University concussion-management clinics. Male and female adolescent athletes (n = 99, aged 13–18 years) presenting within 10 days of SRC. The KD test was administered before and after the Buffalo Concussion Treadmill Test (BCTT). Days from injury to recovery, with recovery defined as being asymptomatic, confirmed by the assessment of a physician who was blinded to the treatment group, and the return of normal exercise tolerance on the BCTT were recorded. Participants with postexertional slowing (PES group, n = 33) had a longer duration of recovery (17 days versus 13.5 days, P = .033) than participants without PES (no-PES group, n = 66). At any clinic visit, PES was also associated with a relative risk of 2.36 (95% confidence interval = 1.55, 3.61; P < .001) of not recovering within the following week. The current study validates our prior work showing that acutely concussed adolescents who did not display the typical learning effect on the KD test after the BCTT took longer to recover from SRC than those who exhibited the typical learning effect.Context
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Researchers have suggested that balance deficiencies may linger during functional activities after concussion recovery. To determine whether participants with a history of concussion demonstrated dynamic balance deficits as compared with control participants during single-legged hops and single-legged squats. Cross-sectional study. Laboratory. A total of 15 previously concussed participants (6 men, 9 women; age = 19.7 ± 0.9 years, height = 169.2 ± 9.4 cm, mass = 66.0 ± 12.8 kg, median time since concussion = 126 days [range = 28–432 days]) were matched with 15 control participants (6 men, 9 women; age = 19.7 ± 1.6 years, height = 172.3 ± 10.8 cm, mass = 71.0 ± 10.4 kg). During single-legged hops, participants jumped off a 30-cm box placed at 50% of their height behind a force plate, landed on a single limb, and attempted to achieve a stable position as quickly as possible. Participants performed single-legged squats while standing on a force plate. Time to stabilization (TTS; time for the normalized ground reaction force to stabilize after landing) was calculated during the single-legged hop, and center-of-pressure path and speed were calculated during single-legged squats. Groups were compared using analysis of covariance, controlling for average days since concussion. The concussion group demonstrated a longer TTS than the control group during the single-legged hop on the nondominant leg (mean difference = 0.35 seconds [95% confidence interval = 0.04, 0.64]; F2,27 = 5.69, P = .02). No TTS differences were observed for the dominant leg (F2,27 = 0.64, P = .43). No group differences were present for the single-legged squat on either leg (P ≥ .11). Dynamic balance-control deficits after concussion may contribute to an increased musculoskeletal injury risk. Given our findings, we suggest that neuromuscular deficits currently not assessed after concussion may linger. Time to stabilization is a clinically applicable measure that has been used to distinguish patients with various pathologic conditions, such as chronic ankle instability and anterior cruciate ligament reconstruction, from healthy control participants. Whereas the single-legged squat may not sufficiently challenge balance control, future study of the more dynamic single-legged hop is needed to determine its potential diagnostic and prognostic value after concussion.Context
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Many runners report “hitting The Wall” (HTW) during a marathon (42.2 km). However, the performance manifestation of this subjectively experienced phenomenon remains unclear. To identify a pace-based classification for HTW by integrating subjective reports of fatigue and runners' pacing profiles during a marathon. Cross-sectional study. Public race event (2018 Dublin Marathon). Eighty-three runners (28 [34%] women, 55 [66%] men, age = 41.5 ± 9.1 years, height = 1.73 ± 0.09 m, mass = 70.2 ± 10.1 kg). The pacing profiles for respondents to our postrace questionnaire that concerned the phenomenon of HTW were evaluated. Receiver operating characteristic analyses were performed on discretized outcomes of the time series of marathoners' paces during the race. Using the receiver operating characteristic analyses, we observed that runners could be classified as having experienced HTW if they ran any 1-km segment 11% slower than the average of the remaining segments of the race (accuracy = 84.6%, sensitivity = 1, specificity = 0.6) or if the standard deviation of the normalized 1-km split times exceeded 0.0532 (accuracy = 83%, sensitivity = 0.818, specificity = 0.8). Similarly, runners could be classified as having experienced HTW if they ran any 5-km segment 7.3% slower than the average of the remaining 5-km segments of the race (accuracy = 84.6%, sensitivity = 1, specificity = 0.644) or if the standard deviation of the normalized 5-km split times exceeded 0.0346 (accuracy = 82%, sensitivity = 0.909, specificity = 0.622). These pace-based criteria could be valuable to researchers evaluating HTW prevalence in cohorts for whom they lack subjective questionnaire data.Context
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To determine the effects of an eccentric hamstrings strength-training program, performed for at least 4 weeks by healthy adults, on muscle architecture and eccentric strength. A systematic search was performed up to October 2018 in the following electronic databases: PubMed, PEDro, CINAHL and SPORTDiscus. Combinations of the following search terms were used: eccentric strength training, eccentric loading, nordic hamstring, hamstring strength, fascicle length, pennation angle, muscle thickness, muscle architecture, biceps femoris long head, biceps femoris, and hamstring muscles. Included articles were randomized controlled trials that allowed comparisons between isolated eccentric strength training of the biceps femoris muscle and other programs. Data from the included studies were extracted by 2 independent reviewers. These data included the study design, participant characteristics, inclusion and exclusion criteria of clinical studies, exercise and intervention characteristics, outcome measures, and the main results of the study. When meta-analysis was possible, we performed quantitative analysis. Ten randomized controlled trials were included. Limited to moderate evidence indicated that eccentric strength training was associated with an increase in fascicle length (mean difference [MD] = 1.97; 95% confidence interval [CI] = 1.48, 2.46), an increase in muscle thickness (MD = 0.10; 95% CI = 0.06, 0.13), and a decrease in pennation angle (MD = 2.36; 95% CI = 1.61, 3.11). Conflicted to moderate evidence indicated that eccentric hamstrings strength was increased after eccentric strength training compared with concentric strength training (standardized mean difference [SMD] = 1.06; 95% CI = 0.26, 1.86), usual level of activity (SMD = 2.72; 95% CI = 1.68, 3.77), and static stretching (SMD = 0.39; 95% CI = −0.97, 1.75). In healthy adults, an eccentric strength-training program produced architectural adaptations on the long head of the biceps femoris muscle and increased eccentric hamstrings strength.Objective
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A variety of factors have been linked to the occurrence of anterior cruciate ligament injury (ACLI), including sex, familial factors, and genetic variations. To find the genetic loci associated with ACLI and explore the genetic mechanism of ACLI in order to provide a genetic basis for the diagnosis, prognosis, and treatment of patients with ACLI. Cross-sectional study. Hospital. Data from 101 Chinese Yunnan Han patients with ACLI and 110 Yunnan Han individuals without ACLI (control group) were collected. The single nucleotide polymorphisms of COL1A1 rs1800012, COL5A1 rs12722 and rs13946, COL12A1 rs970547 and rs240736 and the rs1800787, rs1800788, rs1800789, rs1800790, rs1800791, and rs2227389 in the β-fibrinogen (β-fib) promoter region were analyzed using restriction fragment length polymorphism and DNA sequencing detection, and their genetic associations with ACLI were assessed. Single nucleotide polymorphisms of COL1A1 rs1800012, COL5A1 rs12722 and rs13946, and the rs1800789 and rs1800791 in the β-fib promoter region showed no difference between patients with ACLI and control participants, but the changes of COL12A1 rs970547 and rs240736 and the rs1800787, rs1800788, rs1800790, and rs2227389 genotypes in the β-fib promoter region were associated with ACLI. Furthermore, the rs970547 allele and genotype frequencies in male ACLI patients were different from the control group (P < .05): the frequencies of the rs970547 A and G alleles in the patients were 71.9% and 28.1%, respectively, and in the control group were 58.8% and 41.2%, respectively. The frequencies of AA, AG, and GG genotypes in the patients were 49.3%, 45.2%, and 5.5%, respectively, and in the control group were 27.5%, 62.7%, and 9.8%, respectively, suggesting that male carriers of rs970547 A and rs970547 AA were at high risk of ACLI. Males with the rs970547 A allele and rs970547 AA genotype of COL12A1 may be at high risk for ACLI. Low rs1800787 TT and high rs1800788 CT, rs1800790 AG, and rs2227389 CT frequencies as well as high TGA* of rs1800790, rs1800791, and rs2227389 in the β-fib promoter region may be genetic risk factors related to ACLI.Context
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The skill sets of athletic trainers (ATs) provide a unique contribution to the US military's optimization of physical readiness, and these positions are becoming more prevalent. However, knowledge regarding the job characteristics of, and ATs' preparation for, employment in a military setting is limited. To assess the position and clinician characteristics of ATs working with military members and document their perceptions of working in the military setting. Cross-sectional study. Online survey. A total of 53 ATs who currently or formerly worked in the military setting. A Web-based survey with closed- and open-ended questions was distributed via e-mail and social media. Closed-ended data were analyzed via descriptive statistics, and open-ended questions were evaluated for common themes using thematic analysis. Respondents were primarily males (n = 31, 58.5%), had a master's degree (n = 42, 79.2%), and were not current or former service members (n = 46, 86.8%). Positions were primarily full time (n = 50, 94.3%), contracted with an independent company (n = 27, 50.9%), and within the Army (n = 24, 45.3%). The ATs were highly satisfied with their workload and ability to apply their skill set. Qualitative analysis revealed 3 themes: (1) the context of clinical practice in the military (eg, rewarding, job scope, military environment), (2) the importance of clinical and interpersonal skills, and (3) the existence of multiple barriers (eg, hiring, military culture, lack of recognition). Overall, ATs working in the military setting were well-qualified practitioners who were very satisfied with their current positions, yet they also reported barriers, such as working within the military culture and lack of recognition of their skill set. Although ATs indicated a neutral belief that professional degree preparation was sufficient for this clinical practice setting, the qualitative themes provided additional career-preparation advice for individuals interested in this setting.Context
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Although researchers have directed scholars toward investigating the effectiveness of the nonwork personal time of athletic trainers (ATs), no one has characterized the occupational recovery experiences of ATs. To examine the reliability and validity of the Recovery Experience Questionnaire (REQ) for use in AT populations. Cross-sectional study. Web-based survey. A total of 144 ATs (71 men, 73 women) working in a variety of National Collegiate Athletic Association sports across all levels of competition. The REQ was administered to assess the AT recovery experience. Preliminary evidence emerged for the reliability (ω = 0.80–0.90) and validity of the REQ for use in AT populations. Weak linear relationships were identified between stress and perceptions of psychological detachment (r = −0.314, P < .001), mastery (r = −0.179, P = .32), control (r = −0.284, P = .001), and relaxation (r = −0.157, P = .06). Our results support measuring and applying occupational recovery for AT stress and work-life balance. Given that occupational recovery as a construct was only weakly related to stress, it is clearly a unique and distinct variable worth considering within the work-life balance line of inquiry.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