The COVID-19 pandemic has affected almost every aspect of life, including youth sports. Few data exist on COVID-19 incidences and risk-mitigation strategies in youth club sports. To determine the incidence of reported COVID-19 cases among youth club sport athletes, describe the reported sources of infection for reported cases, and identify the information sources used to develop COVID-19 risk-mitigation procedures. Cross-sectional study. Online surveys. Soccer and volleyball youth club directors. Surveys were completed by directors of youth soccer and volleyball clubs across the country in October 2020. Surveys addressed the self-reported date of re-initiation, number of players, player COVID-19 cases, sources of infection, COVID-19 mitigation strategies, and information sources for the development of COVID-19 mitigation strategies. The total number of cases reported, number of players, and days since club re-initiation were used to calculate an incidence rate of cases per 100 000 player-days. To compare reported incidence rates between soccer and volleyball, a negative binomial model was developed to predict player cases with sport and state incidence as covariates and log (player-days) as an offset. Estimates were exponentiated to yield a reported incidence rate ratio with Wald CIs. A total of 205 136 athletes (soccer = 165 580; volleyball = 39 556) were represented by 437 clubs (soccer = 159; volleyball = 278). Club organizers reported 673 COVID-19 cases (soccer = 322; volleyball = 351), for a reported incidence rate of 2.8 cases per 100 000 player-days (soccer = 1.7, volleyball = 7.9). Volleyball had a higher reported COVID-19 incidence rate than soccer (reported incidence rate ratio = 3.06 [95% CI = 2.0, 4.6], P < .001). Out of 11 possible mitigation strategies, the median number of strategies used by all clubs was 7, with an interquartile range of 2. The incidence of self-reported cases of COVID-19 was lower in soccer clubs than in volleyball clubs. Most clubs reported using many COVID-19 mitigation strategies to reduce the risk of infection.Context
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Sport specialization during adolescence may affect future injury risk. This association has been demonstrated in some professional sport athletes. To determine the association between adolescent sport specialization levels in high school and injuries sustained during collegiate club sports. Cross-sectional study. Paper and online surveys. Collegiate club-sport athletes. An anonymous survey was administered from September 2019 to May 2020. The survey included sport specialization classification via a commonly used 3-point scale (low, moderate, high) for each high school year (9th–12th), high school sports participation, and collegiate club-sport injury history. The number of years (0–4) an individual was highly specialized in high school was calculated. Individuals who participated in the same sport in high school and college were compared with individuals who played a different sport in college than in high school. An injury related to sport club activities was classified as arising from a contact, noncontact, or overuse mechanism required and the individual to seek medical treatment or diagnosis. Injuries were classified into overuse and acute mechanisms for the upper extremity, lower extremity (LE), and head/neck. Single-sport participation and the number of years highly specialized in high school sport were not associated with college club-sport injuries (P > .1). Individuals who played a different collegiate club sport than their high school sport were more likely to report an LE or head/neck acute injury compared with athletes who played the same collegiate and high school sport (LE = 20% versus 8%, χ2 = 7.4, P = .006; head/neck = 16% versus 3%, χ2 = 19.4, P < .001). Adolescent sport specialization was not associated with reported injuries in collegiate club-sport athletes. Collegiate club-sport athletic trainers should be aware that incoming students exploring a new sport may be at risk for LE and head/neck acute injuries.Context
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Stress fractures (SFs) are injuries that can result from beginning new or higher-volume physical training regimens. The pattern of clinical presentation of SFs over time after individuals start a new or more demanding physical training regimen is not well defined in the medical literature. To report trends in the clinical presentation of SFs over the first 6 months of soldiers' time in the service. Retrospective cohort study. This study was conducted using medical encounter and personnel data from US Army soldiers during the first 6 months of their career. United States Army soldiers beginning their careers from 2005 to 2014 (N = 701 027). Weekly SF numbers and incidence were calculated overall, as well as by sex, over the first 6 months of military service. Stress fracture diagnoses (n = 14 155) increased steeply in weeks 3 and 4, with a peak in the overall incidence during weeks 5 to 8. Although the clinical incidence of SFs generally decreased after 8 weeks, incident lower extremity SFs continued to present for more than 20 weeks. The hazard ratio for SFs among women compared with men was 4.14 (95% CI = 4.01, 4.27). Across the 6-month study period, women showed a more than 4 times greater hazard for SFs than men. The results also suggest that health care providers should be particularly vigilant for SFs within 3 weeks of beginning of a new or higher-intensity exercise regimen. The incidence of SFs may continue to climb for several weeks. Even as the SF incidence declines, these injuries may continue to appear clinically several months after a change in activity or training.Context
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Vestibular and ocular motor assessment is an emerging clinical assessment for patients with sport-related concussion (SRC). The increased use of these assessments by clinicians calls for the examination of outcomes that may affect clinical practice. To compare vestibular and ocular motor impairments in high school and collegiate athletes within 72 hours of SRC and examine the distribution of impairments in these populations based on pre-established clinical cutoff scores. Cross-sectional study. High school and collegiate athletics. Data were collected from 110 athletes (high school: n = 47, age = 15.40 ± 1.35 years; college: n = 63, age = 19.46 ± 1.28 years) within 72 hours of sustaining an SRC. Total and change scores were calculated for the Vestibular/Ocular Motor Screening (VOMS) tool, along with average near point of convergence (NPC) distance. Separate Mann-Whitney U tests were used to compare group differences, and χ2 analyses were used to examine the proportion of athletes with scores greater than clinical cutoff scores for all VOMS outputs. The α level was set a priori at .05. No differences were found between high school and collegiate athletes for VOMS total and change scores and NPC distance. A larger proportion of the sample had scores greater than the cutoff for all total scores (P < .001) and change scores in horizontal vestibulo-ocular reflex (59.01%; P < .001), vertical vestibulo-ocular reflex (60.91%; P < .001), and visual motion sensitivity (60.91%; P < .001). However, a larger proportion demonstrated smooth pursuit change scores (85.45%; P < .001) and NPC distances (73.64%; P = .01) that were less than the cutoff scores. During the acute phase of SRC, high school and collegiate athletes presented with similar vestibular and ocular motor impairments as measured using the VOMS, but vestibular tasks appeared to cause greater symptom provocation. Lastly, VOMS change scores may offer more clinical utility compared with total scores in assessing specific impairments after SRC.Context
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After concussion, a multifaceted assessment is recommended, including tests of physical exertion. The current criterion standard for exercise testing after concussion is the Buffalo Concussion Treadmill Test (BCTT); however, validated tests that use alternative exercise modalities are lacking. To evaluate the feasibility and concurrent validity of a universal cycling test of exertion compared with the BCTT in adults who sustained a sport-related concussion. Crossover study. University sports medicine clinic. Twenty adults (age = 18–60 years) diagnosed with a sport-related concussion. Participants completed the BCTT and a cycling test of exertion in random order, approximately 48 hours apart. The primary outcome of interest was maximum heart rate (HRmax; beats per minute [bpm]). Secondary outcomes of interest were the total number of symptoms endorsed on the Post-Concussion Symptom Scale, whether the participant reached volitional fatigue (yes or no), the symptom responsible for test cessation (Post-Concussion Symptom Scale), maximum rating of perceived exertion, symptom severity on a visual scale (0–10), and the time to test cessation. Of the 20 participants, 19 (10 males, 9 females) completed both tests. One participant did not return for the second test and was excluded from the analysis. No adverse events were reported. The median HRmax for the BCTT (171 bpm; interquartile range = 139–184 bpm) was not different from the median HRmax for the cycle (173 bpm; interquartile range = 160–182 bpm; z = −0.63; P = .53). For both tests, the 3 most frequently reported symptoms responsible for test cessation were headache, dizziness, and pressure in the head. Of interest, most participants (64%) reported a different symptom responsible for cessation of each test. On the novel cycling test of exertion, participants achieved similar HRmax and test durations and, therefore, this test may be a suitable alternative to the BCTT. Future research to understand the physiological reason for the heterogeneity in symptoms responsible for test cessation is warranted.Context
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Current guidelines for recovery after sport-related concussion (SRC) recommend 24 to 48 hours of rest, followed by a gradual return to activity with heart rate (HR) maintained below the symptom threshold. In addition, monitoring physical activity (PA) after SRC using ActiGraph accelerometers can provide further objective insight into the amounts of activity associated with recovery trajectories. Cutpoint algorithms for these devices allow minute-by-minute PA to be classified into intensity domains; however, researchers have shown that different algorithms used to evaluate the same healthy participant dataset can produce various classifications. To identify the more physiologically appropriate cutpoint algorithm (Evenson or Romanzini) to analyze ActiGraph data among concussed adolescents in comparison with their HR responses on the Buffalo Concussion Treadmill Test (BCTT). Prospective cohort study. University sport concussion clinic. Eleven high school students (5 boys, 6 girls; median [range] age = 16 years [15–17 years], height = 177.8 cm [157.5–198.1 cm], mass = 67 kg [52–98 kg], body mass index = 22 [17–31]) involved in high-risk sports who sustained a physician-diagnosed SRC. Evenson and Romanzini algorithm PA intensity domains via ActiGraph data and HR during the BCTT. We observed differences in PA time classified as moderate (P = .003) and vigorous (P = .004) intensities between algorithms but no difference in PA time classified as light intensity (P = .48). The Evenson algorithm classified most of the time as moderate-intensity PA (mean = 57.03%, range = 0.00%–94.12%), whereas the Romanzini algorithm classified virtually all PA as vigorous intensity (mean = 88.25%, range = 2.94%–97.06%]). Physical activity based on HR (stages 1–7 = 20%–39% HR reserve [HRR], stages 8–13 = 40%–59% HRR, stages ≥14 = 60%–85% HRR) indicated the BCTT primarily involved light to moderate intensity and, therefore, was better represented by the Evenson algorithm. The Evenson algorithm better characterized the HR response during a standardized exercise test in concussed individuals and, thus, should be used to analyze ActiGraph PA data in pediatric populations with concussion.Context
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A relationship between a history of sport-related concussion (SRC) and lower extremity injury has been well established in the literature. To determine if biomechanical differences existed during a double-limb jump landing between athletes who had been released to return to play after SRC and healthy matched control individuals. Cross-sectional study. Health system–based outpatient sports medicine center. A total of 21 participants with SRC (age = 15.38 ± 1.77 years, height = 169.23 ± 8.59 cm, mass = 63.43 ± 7.39 kg, time since release to return to sport after SRC = 16.33 ± 12.7 days) were compared with 21 age-, sex-, and activity-matched healthy participants serving as controls (age = 15.36 ± 1.73 years, height = 169.92 ± 11.1 cm, mass = 65.62 ± 12.08 kg). Biomechanical performance during the double-limb jump landing was assessed using a motion-capture system and force plates. The average of 3 consecutive trials was used to calculate lower extremity joint kinetics and kinematics. The variables of interest were internal knee-extension moment, internal varus moment, and total sagittal-plane knee displacement for the dominant and nondominant limbs. Independent t tests were performed to examine the differences between SRC and control groups for the variables of interest. No differences existed between groups for the descriptive data. The SRC group demonstrated greater internal knee-extension moments in the dominant (−0.028 ± 0.009 Nm/kg, P = .003) and nondominant (−0.018 ± 0.007, P = .02) limbs. The SRC group also exhibited greater internal varus moments in the dominant (0.012 ± 0.004 Nm/kg, P = .005) and nondominant (0.010 ± 0.003, P = .005) limbs. For sagittal-plane knee displacement, the SRC group displayed less knee-flexion displacement in the dominant (−12.56 ± 4.67°, P = .01) but not the nondominant (−8.30 ± 4.91°, P = .10) limb. Athletes who had been released for return to sport after SRC landed with greater knee valgus than healthy matched control participants.Context
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Supraspinatus tendinopathy and shoulder pain are common in competitive youth swimmers. However, no researchers have investigated clinical and structural factors contributing to shoulder pain and disability in masters-level swimmers. To (1) determine the prevalence of shoulder pain and disability in masters-level swimmers; (2) identify the most provocative special tests for shoulder pain; and (3) determine if shoulder clinical and tissue-specific measures, training variables, and volume varied between those with and those without shoulder pain, dissatisfaction, and disability. Cross-sectional study. Collegiate swimming facilities. Thirty-nine adult masters-level swimmers. Demographics, training, and pain and disability ratings using the Penn Shoulder Score and Disability of Arm, Shoulder, and Hand sports module were surveyed. Swimmers underwent a clinical examination that consisted of passive range of shoulder motion, posterior shoulder endurance test, and supraspinatus tendon structure and posterior capsule thickness. One-way analyses of variance were used to compare demographic, clinical, and structural findings between those with significant (positive) pain, dissatisfaction, and disability (+PDD) and those without (negative) pain, dissatisfaction, and disability (−PDD). Pain was reported by 15% of participants at rest, 28% with normal activities (eating, dressing), and 69% with strenuous activities (sports); 50% reported disability. The +PDD group had less shoulder internal rotation (10°) and less external rotation (8°) and completed less yardage per day and per year. Differences were noted in supraspinatus tendon structure between the +PDD and −PDD groups. Masters swimmers with pain and disability were able to self-limit yardage, which was likely the reason they recorded less yardage. The reduced shoulder motion (internal and external rotation) without posterior capsule differences may be due to rotator cuff muscle and tendon restrictions; the supraspinatus tendon structure may reflect degeneration caused by previous overuse that resulted in pain.Context
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Overhead-throwing athletes consistently display substantial bilateral differences in humeral retroversion (HRV). However, evidence is limited regarding HRV asymmetries in tennis players despite similarities between the overhead throw and tennis serve. To determine whether (1) junior and collegiate tennis players demonstrated bilateral differences in HRV and (2) the magnitude of the HRV side-to-side difference (HRVΔ) was similar across age groups. Cross-sectional study. Field-based setting. Thirty-nine healthy tennis players were stratified into 3 age groups: younger juniors (n = 11, age = 14.5 ± 0.5 years), older juniors (n = 12, age = 17.1 ± 0.9 years), and collegiate (n = 16, age = 19.6 ± 1.2 years). Three-trial HRV means were calculated for the dominant and nondominant limbs, and HRVΔ was obtained by subtracting the mean of the nondominant side from that of the dominant side. A paired-samples t test was used to determine bilateral differences in HRV, and a 1-way analysis of variance was used to compare HRVΔ among groups. For all 3 groups, HRV angle was greater in the dominant versus nondominant upper limb (younger juniors = 62.9° ± 9.1° versus 56.3° ± 6.8°, P = .039; older juniors = 75.5° ± 11.2° versus 68.6° ± 14.2°, P = .043; collegiate = 71.7° ± 8.5° versus 61.2° ± 6.9°, P = .001). However, no differences were detected in HRVΔ across age groups (P = .511). Consistent with the findings of previous studies of overhead-throwing athletes, we demonstrated greater measures of HRV in the dominant limb of tennis players. Furthermore, HRV asymmetries appeared to have developed before the teenage years, as no changes were observed in HRVΔ among age groups.Context
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Scapular-retraction exercises are often prescribed to enhance scapular stabilization. To investigate upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) activities and UT/MT and UT/LT ratios during scapular-retraction exercises with elastic resistance at different shoulder-abduction angles. Descriptive laboratory study. Biomechanical analysis laboratory. Thirty-five asymptomatic individuals. Surface electromyography was used to evaluate UT, MT, and LT activities during the scapular-retraction exercise at 0°, 45°, 90°, and 120° of shoulder abduction. The mean muscle activity ranged from 15.8% to 54.7% maximal voluntary isometric contraction (MVIC) for UT, 30.5% to 51.6% MVIC for MT, and 21.4% to 25.5% MVIC for LT. A significant muscle × angle interaction was found (P < .001). Post hoc analysis revealed that the MT was more activated than the UT and LT during both retraction at 0° (P < .001 and P = .01, respectively) and 120° (P = .03 and P = .002, respectively). During retraction at 45° and 90°, the LT generated less activity than the UT (P = .02 and P = .03, respectively) and MT (P < .001 and P = .002, respectively). Further, UT/MT and UT/LT ratios during retraction at 0° were lower than at 45° (P = .03 and P = .001, respectively) and 90° (P < .001 and P < .001, respectively). Retraction at 90° resulted in a higher UT/LT ratio than at 45° (P = .004) and 120° (P = .004). Due to less UT relative to MT activity, retraction at 0°, 45°, and 120° can be preferable in early shoulder training or rehabilitation. Additionally, retraction at 90° was the most effective exercise in activating all parts of the trapezius muscle.Context
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How specific coping strategies are associated with short-term outcomes among athletes after knee surgery is unknown. To determine whether (1) specific coping strategies were associated with return to sport, satisfaction, self-reported knee function, or kinesiophobia after sport-related knee surgery and (2) these associations varied by age, sex, or surgical procedure. Case series. Athletes (N = 184; men: n = 104, women: n = 80; aged <20 years: n = 38; aged 20–25 years: n = 35; aged 26–31 years: n = 36; aged 32–40 years: n = 36; aged >40 years: n = 39) who underwent outpatient knee surgery at a single center were enrolled. Use of specific coping strategies (self-distraction, venting, acceptance, positive reframing, emotional support, and instrumental support) was assessed preoperatively with the Brief-Coping Orientation to Problems Experienced inventory. Relationships among coping strategies and postoperative satisfaction, return to sport, International Knee Documentation Committee–Subjective and Tampa Scale for Kinesiophobia scores at a median 10.7 months follow-up were determined with consideration for age, sex, and surgical procedure. Return to the prior level of sport was 72%, and satisfaction was 86%. Most coping strategies had age-specific utilization rates; positive reframing was used least frequently in individuals aged <20 years. Satisfaction increased with greater positive reframing among those aged <20 years and decreased with greater self-distraction among men. Return to sport was higher with greater positive reframing in people aged <32 years. No coping strategies predicted International Knee Documentation Committee–Subjective scores. Greater positive reframing correlated with less kinesiophobia in individuals aged <20 years and greater instrumental support with less kinesiophobia in those aged >40 years. No other coping strategies were associated with outcomes. The surgical procedure was not related to an association between coping strategies and outcomes. Coping strategies had age-specific associations with outcomes after knee surgery in athletes. Positive reframing was infrequently used in younger athletes. Greater use of positive reframing in this group may improve return to sport and satisfaction and reduce fear of reinjury.Context
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The International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) is the most frequently used patient-reported measure of subjective knee function among individuals with anterior cruciate ligament reconstruction (ACLR). Yet, due to the limitations of traditional validation approaches, whether the IKDC measures knee function as intended is unclear. Rasch analysis offers a robust validation approach, which may enhance the clinical interpretation of the IKDC. To assess the psychometric properties, ability to classify health status, and relationships between the IKDC and objective measures of strength and functional performance relative to a newly proposed reduced-item instrument. Cross-sectional study. Laboratory. A total of 77 individuals with primary unilateral ACLR (age = 21.9 ± 7.8 years, time postsurgery = 6.2 ± 1.0 months) and 76 age-matched control individuals (age = 22.0 ± 4.2 years). Rasch analysis was used to assess the psychometric properties of the IKDC. Receiver operator characteristic curves and logistic regression were calculated to assess the accuracy of classifying participants with ACLR versus control participants. Pearson product moment and Spearman rank order correlation analyses were conducted to evaluate relationships among subjective knee function, quadriceps torque, and single-limb hop performance. Rasch analysis aided the development of a reduced 8-item instrument (IKDC-8), which yielded improved psychometric properties in the rating scale performance (IKDC-8 = 0, IKDC = 3 nonmonotonic “misbehaving” items), percentage of variance accounted for by 1 dimension (IKDC-8 = 71.5%, IKDC = 56.7%), and precision in item separation (IKDC-8 = 9.79, IKDC = 5.02). The IKDC was an outstanding diagnostic tool, and the IKDC-8 was excellent, correctly classifying 87.2% and 82.7% of cases, respectively. Using the Hanley-McNeil formula, we found no difference in the areas under the respective receiver operator characteristic curves. Equivalent associations between subjective and objective knee function were observed regardless of the instrument used. We demonstrated evidence of enhanced reliability and validity for a parsimonious measure of subjective knee function. The proposed instrument reduces the number of items, increases the score interpretability as measuring a single construct, and improves the rating scale functioning while not diminishing its ability to classify participants with ACLR versus control participants or changing existing relationships with objective measures of recovery. We suggest the IKDC-8 may enhance clinical use by reducing administration time, improving the interpretation of the subjective knee function score, and clarifying functional ability.Context
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A National Collegiate Athletic Association Division I female basketball athlete (age = 20 years, height = 190.5 cm, mass = 87 kg) had chronic patellar tendinopathy. After undergoing unsuccessful conservative treatments, the athlete underwent bilateral open patellar debridement surgery. Pain and dysfunction were assessed via the Victorian Institute of Sport-P (VISA-P) score with concurrently collected B-mode ultrasound images of the patellar tendon throughout a 12-month rehabilitation. Peak spatial frequency radius (PSFR), a quantitative ultrasound measure previously shown to be correlated with collagen organization, was compared with changes in VISA-P scores. Overall increases in PSFR values across 0°, 30°, 60°, and 90° of knee flexion were observed throughout recovery. Despite increased PSFR values and returning to sport, the athlete reported substantial pain. In this level 3 exploration case report, we provide novel insight into ultrasonically measured structural changes of the patellar tendon after surgery and during rehabilitation of an athlete with chronic tendinopathy. Perceived pain measurements were not necessarily related to structural adaptations.Context
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Lateral-flexion range of movement (LF ROM) is used to assess and monitor recovery of side strain injury in athletes. To establish a reliable and pragmatic measure of LF ROM and investigate the stability of the measure over time in athletes. (1) Cross-sectional reliability study and (2) cohort longitudinal study. Elite cricket teams in Australia and England. Ten healthy first-class cricket players recruited from Australia and England domestic and international competitions. (1) The intrarater and interrater reliability of 2 methods of measuring LF ROM toward and away from the bowling arm was assessed (distance to the floor or distance to the fibular head). Three experienced physiotherapists obtained the measures. Intraclass correlations [2,1] were calculated for absolute agreement for all 3 testers. (2) Lateral-flexion ROM was measured monthly during the preseason and competitive season. A 1-way repeated-measures analysis of variance was performed to identify differences within the preseason, within the competitive season, and between competitive seasons. Both methods had good intratest and intertest reliability (intraclass correlations > 0.84). As LF ROM measurement to the floor was easier for clinicians, it was used for the longitudinal study. Lateral-flexion ROM did not alter throughout the preseason and competitive season or between seasons (P values > .05). This new method of measuring LF ROM demonstrated good intrarater and interrater reliability and stability over time and can be used as an outcome measure in side strain injury.Context
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Three foot-strike techniques are common in runners. If these techniques generate different sounds at the point of impact with the ground, lower limb kinetics may be influenced. No previous authors have determined whether such relationships exist. To determine foot-ground impact sound characteristics and compare the impact-sound characteristics across foot-strike techniques and the relationships between impact-sound characteristics and vertical loading rates. Cross-sectional study. Gait analysis laboratory. A total of 30 runners (15 women, 15 men; age = 23.5 ± 4.0 years, height = 1.67 ± 0.1 m, mass = 58.1 ± 8.2 kg) completed overground running trials with rearfoot-strike, midfoot-strike (MFS), and forefoot-strike (FFS) techniques in a gait analysis laboratory. Impact sound was measured using a shotgun microphone, and the peak sound amplitude, median frequency, and sound duration were analyzed. Separate linear regressions, clustering participants due to repeated measures, were used to compare the sound characteristics across foot-strike techniques. Kinetic data were collected from a force plate, and the vertical loading rates were calculated. Pearson correlation was used to determine the relationship between sound characteristics and kinetics. Landing with an MFS or FFS resulted in greater peak sound amplitude (P < .001) and shorter sound duration (P < .001) than a rearfoot strike. The MFS exhibited the highest median frequency among the 3 foot-strike patterns, followed by the FFS (P < .001). We did not find a significant relationship between vertical loading rates and any impact sound characteristics (P > .115). The results suggest that impact-sound characteristics may be used to differentiate foot-strike patterns in runners. However, these did not relate to lower limb kinetics. Therefore, clinicians should not solely rely on impact sound to infer impact loading.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