Keen interest has arisen in developing data-driven strategies to mitigate head injury and reduce repetitive head impacts in sports owing to concerns about the potential short-term and long-term neurologic consequences of these loads on the brain. Interventions can include advancements in equipment design, modifications to the rules of the game and training regimens, and enhancements to clinical assessments after an athlete sustains a concussive impact. One key to driving these improvements in athlete safety is the quantitative biomechanical measurement of head impact kinematics. Over the past 2 decades, technological advances in head kinematic measurement devices have made implementation more feasible,
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EDITORIAL
PhD,
PhD,
PhD, and
PhD
CONCUSSION
PhD, LAT, ATC,
PhD, ATC,
PhD, ATC,
PhD,
PhD, ATC, and
PhD, ATC
With growing concerns surrounding exposure to head impacts in youth tackle football, players and parents must understand the exposure level when assenting and consenting to participate. To determine whether youth football players and parents could estimate on-field head-impact frequency, severity, and location. Prospective cohort study. Football field. We administered a 10-question head-impact estimation tool to parents (n = 23; mean age = 36.5 years [95% CI = 31.7, 37.3 years]) and players (n = 16 boys; mean age = 11.1 years [95% CI = 10.3, 11.8 years]). Player on-field head-impact exposure was captured using the Triax SIM-G system. We determined the accuracy between player and parent estimates relative to on-field head-impact exposures using κ and weighted κ values. Youth tackle football players and parents did not accurately estimate on-field head-impact frequency (κ range = −0.09 to 0.40), severity (κ range = −0.05 to 0.34), or location (κ range = −0.30 to 0.13). Players and parents overestimated head-impact frequency in practices but underestimated the frequency in games. Both groups overestimated head-impact severity, particularly in games. Most players and parents underestimated the number of head impacts to the top of the head, particularly during practices. Underestimations of head-impact frequency in games and to the top of the head suggest that informed consent processes aimed at educating players and parents should be improved. Overestimations of head-impact frequency in practices and severity may explain declining rates of youth tackle football participation.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
PhD, ATC,
PhD, CAT(C),
PhD, CAT,
PhD, ATC,
PhD, ATC, and
PhD, ATC
Certified athletic therapists in Ireland and Canada serve essential concussion assessment and management roles, but their health care practices and concussion knowledge have not been established. To examine Irish and Canadian athletic therapist cohorts' (1) concussion knowledge, (2) current concussion assessment and management techniques across all job settings, and (3) the association of concussion assessment and management practices with years of clinical experience and highest degree attained. Cross-sectional cohort study. Online survey. Licensed Irish (49.7%, n = 91/183) and Canadian (10.1%, n = 211/2090) athletic therapists. Athletic therapists completed an online survey assessing their demographics, concussion knowledge (symptom recognition, patient–clinician scenarios), frequency of concussions assessed annually, and assessment and return-to-play (RTP) measures using a modified, previously validated survey. Symptom recognition consisted of 20 (8 true, 12 false) items on recognition of signs and symptoms that were scored as total correct. Descriptive statistics and odds ratios were used to examine survey responses where appropriate. Irish (86.8%, n = 46/53) and Canadian (93.4%, n = 155/166) athletic therapists indicated RTP guidelines were the most common method for determining RTP. Symptom recognition scores were 72.8% ± 17.0% among Irish and 76.6% ± 17.0% among Canadian athletic therapists. Irish (91.2%, n = 52/57) and Canadian (90.4%, n = 161/178) athletic therapists reported standardized sideline assessments as the most used concussion assessment method. Irish and Canadian athletic therapists' use of 2-domain (Irish: 38.6% [n = 22/57]; Canadian: 73.6% [n = 131/178]) and 3-domain (Irish: 3.5% [n = 2/57]; Canadian: 19.7% [n = 35/178]) minimum assessments (ie, symptoms, balance, or neurocognitive) was not associated with education or clinical experience (P ≥ .07), except for Canadian athletic therapists with master's degrees having greater odds of completing 2-domain assessments at initial evaluation than those with bachelor's degrees (odds ratio = 1.80; 95% CI = 1.41, 1.95). Irish and Canadian athletic therapists demonstrated similar concussion knowledge; however, most did not fully adhere to international consensus guidelines for concussion assessment as evidenced by low 2- and 3-domain assessment use. Athletic therapists should aim to implement multidimensional concussion assessments to ensure optimal health care practices and patient safety.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
CURRENT CLINICAL CONCEPTS
DPT, OCS, SCS, CSCS,
PT, PhD,
PhD,
PT, PhD,
PhD, ATC, and
PT, PhD
DOI: 10.4085/616.21
Myotonometry is a relatively novel method used to quantify the biomechanical and viscoelastic properties (stiffness, compliance, tone, elasticity, creep, and mechanical relaxation) of palpable musculotendinous structures with portable mechanical devices called myotonometers. Myotonometers obtain these measures by recording the magnitude of radial tissue deformation that occurs in response to the amount of force that is perpendicularly applied to the tissue through a device’s probe. Myotonometric parameters such as stiffness and compliance have repeatedly demonstrated strong correlations with force production and muscle activation. Paradoxically, individual muscle stiffness measures have been associated with both superior athletic performance and a higher incidence of injury. This indicates optimal stiffness levels may promote athletic performance, whereas too much or too little may lead to an increased risk of injury. Authors of numerous studies suggested that myotonometry may assist practitioners in the development of performance and rehabilitation programs that improve athletic performance, mitigate injury risk, guide therapeutic interventions, and optimize return-to-activity decision-making. Thus, the purpose of our narrative review was to summarize the potential utility of myotonometry as a clinical tool that assists musculoskeletal clinicians with the diagnosis, rehabilitation, and prevention of athletic injuries.
KNEE
PhD, ATC,
MPO,
PhD, ATC,
PhD, DPT,
PhD, ATC, CSCS, and
PhD, ATC
The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = −3.73, P = .002; second hop: t18 = −2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = −2.33, P = .03) and 27.3% (t18 = −4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = −0.44, P = .67; second hop: t18 = −0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post–ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
HAMSTRING MUSCLE EXERCISE
PhD,
MSc,
MSc,
,
PhD, and
PhD
The Nordic hamstring exercise (NHE) is commonly implemented to selectively improve eccentric knee-flexor strength. However, the standard version of the exercise (leveled shanks, extended hip joint) is too strenuous for most individuals, whose muscle activity rapidly decreases at extended knee angles. Hitherto, a gradual approach to the exercise has been missing. In this exploratory case study, we investigated elite performance to introduce a stepwise progression to the NHE. To determine the extent to which exercise modifications (shank inclination, additional load, hip flexion) altered NHE mechanics. One male long jumper (age = 33 years, height = 171 cm, mass = 69 kg) with high-level expertise in the NHE performed 20 exercise variations. The corresponding kinematics, kinetics, and electromyographic activity of the biceps femoris long head (BFlh) and semitendinosus (ST) muscles were evaluated. Exercise variations demonstrated gradually increased peak moments from 69% (zigzag pose) to 154% (inclined bent single-legged version) versus a standard NHE. Shank inclination and additional load elicited small to moderate effects on peak moments, BFlh, and ST (0.24 ≤ d ≤ 0.72), whereas hip flexion largely affected all tested variables (2.80 ≤ d ≤ 6.66), especially muscle activity (BFlh = −63%; ST = −55% of maximal voluntary isometric contraction). These insights will help practitioners and scientists design multifaceted stepwise NHE progressions by creating differentiated stimuli that best match the strength capacities of individuals and address their specific needs.Background
Objective
Data Collection and Analysis
Results
Commentary
RUNNING MEDICINE
BS,
BS, and
PhD, ATC
Assessment of running mechanics has traditionally been conducted in laboratory settings; the advancement of wearable technology permits data collection during outdoor training sessions. Exploring changes in running mechanics across training-session types may assist runners, coaches, and sports medicine clinicians in improving performance and managing the injury risk. To examine changes in running mechanics on the basis of routine training-session types. Descriptive observational study. Field based, university. Running mechanics data (ie, impact g, stride length, braking g, total shock g, cadence, and ground contact time) for National Collegiate Athletic Association Division I distance runners (n = 20 men) were collected using RunScribe sensors mounted to the laces during training sessions (long run [LR], interval run [IR], or recovery run [RR]) during a 1-week period. Repeated-measures analysis of covariance with Greenhouse–Geisser correction and training-session pace as a covariate indicated no statistically significant differences in spatiotemporal or kinetic measures across the 3 training-session types. Cadence and stride length were inversely related in all training sessions (LR: r = −0.673, P = .004; IR: r = −0.893, P < .001; RR: r = −0.549, P = .023). Strong positive correlations were seen between impact g and total shock in all training sessions (LR: r = 0.894, P < .001; IR: r = 0.782, P = < .001; RR: r = 0.922, P < .001). Ground contact time increased with stride length during LR training sessions (r = 0.551, P = .027) and decreased with braking g in IR training sessions (r = −0.574, P = .016) and cadence in RR training sessions (r = −0.487, P = .048). Running mechanics in collegiate distance runners were not statistically different among training-session types when training-session pace was controlled. The use of wearable technology provides a tool for obtaining necessary data during overland training to inform training and program design.Context
Objective
Design
Setting
Methods
Results
Conclusions
MS, ATC,
MS, ATC,
PT, PhD, ATC, and
MD
DOI: 10.4085/85.22
A 34-year-old female athlete experienced pain, tightness, and sensation changes in her lower legs and feet when reaching approximately 1 mile (1.6 km) of her run. After a wick catheter test, an orthopaedic surgeon diagnosed her with chronic exertional compartment syndrome (CECS) and declared her eligible to undergo fasciotomy surgery. A forefoot gait is theorized to delay the symptom onset of CECS and decrease the amount of discomfort the runner experiences. The patient opted for a 6-week gait retraining program to try to alleviate her symptoms nonsurgically. The purpose of our report is to provide information about the contributing factors of CECS and to determine if gait retraining is an effective alternative to invasive surgery. After 6 weeks of gait retraining, the patient was able to run without experiencing any CECS symptoms. Also, her compartment pressures were reduced, leading the surgeon to no longer recommend fasciotomy.
EXERTIONAL HEAT ILLNESS
PhD,
MD, and
MD
A 14-year-old runner indigenous to the tropics collapsed during his first 10-km race in a hot and humid climate. Dizziness, stumbling, and loss of consciousness were symptoms of exertional heat stroke. Two days postcollapse, blood tests revealed elevated hepatic transaminases consistent with hepatic injury. We discuss the return-to-competition progression, which included a gradual increase in exercise duration, initially in a cool and then in a tropical climate, and 2 field-based (wet-bulb globe temperature > 29.0°C) running evaluations that simulated the environmental conditions and training intensity the athlete would encounter in his sport. The thermoregulatory results guided the training progression, his tolerance to running in the heat improved, blood values normalized, and he was cleared to compete in a tropical climate. This exploration case report presents a novel field-based protocol that replicates the physiological demands of training in the tropics to evaluate thermoregulatory responses during exercise-heat stress in young runners after exertional heat stroke to facilitate a safe return to competition.
PhD, LAT, ATC,
BS, ATC, and
Cold-water immersion (CWI) is essential to treat patients with exertional heatstroke (EHS). Experts recommend that patients with EHS be immersed in water between 1.7°C and 15°C within 30 minutes of collapse. Some clinicians fill cooling tubs several hours before exercise, keep the tub in hot conditions, and then add ice in the event of an EHS emergency. No data exist on whether adding ice to water at the time of treatment is as effective as keeping water in the recommended range. To (1) compare the cooling rates of individuals immersed in a water bath kept at 10°C (CON) or 17°C water with 75.7 L (20 gal) of ice added to it immediately upon immersion (ICE) and (2) examine perceptual responses before, during, and after cooling. Crossover study. Laboratory. Twelve individuals (7 men, 5 women; age = 22 ± 2 years, height = 176.0 ± 12.8 cm, mass = 74.5 ± 10.6 kg). Participants exercised in the heat until rectal temperature was 39.5°C. They then immersed themselves in CON (initial water volume = 681 ± 7.6 L, 10.0°C ± 0.03°C) or ICE (initial water volume = 605.7 ± 7.6 L water at 17.0°C ± 0.03°C with 75.7 L ice) until rectal temperature was 38°C. Thermal sensation and environmental symptoms questionnaire (ESQ) responses were recorded before, during, and after exercise and cooling. Rectal temperature cooling rates, thermal sensation, ESQ responses. Participants exercised for similar durations (CON = 39.6 ± 18.2 minutes, ICE = 38.8 ± 14.3 minutes, Z11 = 0.94, P = .38) and had similar thermal sensation and ESQ scores immediately postexercise each day (P values > .05). They cooled quickly and at similar rates in both conditions (CON = 0.20°C ± 0.06°C/min, ICE = 0.21°C ± 0.12°C/min, t12 = 0.72, P = .49). Perception data were similar between conditions during and after cooling (P < .05). Clinicians can cool patients with EHS quickly by adding ice to water that has warmed to above expert recommendations. Adding ice to a water bath at the time of EHS emergencies could save time, energy, and resources instead of always maintaining water bath temperatures within expert-recommended ranges.Context
Objectives
Design
Setting
Patients or Other Participants
Interventions
Main Outcome Measure(s)
Results
Conclusions
MENTAL HEALTH
PhD, ATC,
PhD, and
MEd, ATC
Recently, the athletic training community has paid increased attention to collegiate student-athlete mental health, mental health treatment-seeking behavior, and the effects of mental health factors on athletic and academic performance. Ongoing efforts to better educate and equip athletic trainers to help student-athletes in this regard should result in improved mental health–related outcomes. To examine changes in the mental health of student-athletes over the past decade compared with that of nonathlete students. Cross-sectional study. Colleges and universities in the United States. Varsity athletes (athletes; n = 54 479) and nonathlete students (nonathletes; n = 448 301) who completed the National College Health Assessment between 2011 and 2019. Surveys included responses (self-reported) to questions in 5 mental health–related categories: recent mental health symptoms, recent mental health diagnosis, mental health treatment-seeking behavior, receiving mental health information from the institution, and the recent effect of mental health factors on academic performance. Athletes consistently described lower symptom and diagnosis rates compared with nonathletes, except for attempted suicide, substance abuse, and eating disorders. Rates of diagnosis increased over time in both groups but remained lower in athletes. Treatment-seeking behavior and openness to future treatment increased over time in both groups but remained lower in athletes. Athletes received more information on stress reduction, substance abuse, eating disorders, and handling distress or violence compared with nonathletes. Both groups received information more frequently over time. Athletes reported fewer academic effects, especially for depression and anxiety, but these effects grew over time in both groups. The effects of injuries and extracurricular activities on academic performance were greater in athletes than in nonathletes. Athletes described overall lower levels of mental health symptoms, diagnoses, and academic effects compared with nonathletes. Whereas the rates in nonathletes climbed over the past decade, the rates in athletes broadly remained flat or climbed less rapidly. Increasingly positive attitudes toward treatment were encouraging, but the deficit in athletes relative to nonathletes persisted. Ongoing efforts of athletic trainers to educate athletes and guide them to mental health resources are needed to continue, or better yet to accelerate, the observed positive trends in information dissemination and treatment-seeking behavior.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
PROFESSIONAL CONCERNS
PhD,
PhD, and
PhD, LAT, ATC
Stress is a leading cause of burnout in working professionals, including athletic trainers (ATs). One consequence of burnout for ATs is lower perceptions of well-being, which have implications for mental and physical health. Physical activity is known to help reduce stress. Thus, activity may help reduce stress and burnout in ATs while enhancing well-being. To examine a theoretically based mediating model whereby leisure time physical activity was linked to subjective well-being by way of ATs’ perceived stress and burnout. Cross-sectional study. Online survey during the fall sports season. Practicing certified ATs (N = 163; mean age = 30.5 ± 6.7 years). Via a secure link, participants completed a survey that measured leisure time planned physical activity, work-related stress, burnout, and perceived life satisfaction. Latent variable analysis was used to examine the hypothesized mediating model. Minutes spent in moderate or vigorous activity were not associated with stress. Minutes spent walking were negatively associated with perceived stress (β = −0.18, P < .001). Stress was positively associated with exhaustion (β = 0.89, P < .001), negatively associated with personal accomplishment (β = −0.70, P < .001), and positively associated with depersonalization (β = 0.71, P < .001). Exhaustion was negatively associated (β = −0.57, P < .001) and personal accomplishment was positively associated (β = 0.31, P = .013) with well-being. Minutes spent walking were positively linked to well-being via stress and exhaustion. The negative relationship between stress and well-being was mediated by exhaustion and personal accomplishment. Leisure time walking was indirectly and positively linked to well-being. Walking could be a strategy to reduce stress and burnout in ATs and thereby improve well-being.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
PhD, ATC,
BS,
MS, ATC,
PhD, ATC, and
MS, ATC
DOI: 10.4085/227.22
Work-life balance continues to be a focal point of athletic training research, particularly due to the job challenges and demands of health care providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance (FRP). To examine the relationships between work-family conflict (WFC), FRP, and various demographic variables among athletic trainers employed in the collegiate setting. Cross-sectional online survey. Collegiate setting. A total of 586 collegiate athletic trainers (females = 374, males = 210, sex variant or nonconforming = 1, preferred not to answer = 1). Data were collected through an online survey (Qualtrics) in which participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptive information and frequencies. Mann-Whitney U tests were performed to identify differences among groups. Participants’ mean scores were 28.19 ± 6.01 and 45.86 ± 11.55 for the FRP and WFC scales, respectively. Mann-Whitney U tests revealed differences between men and women for WFC scores (U = 344 667, P = .021). The FRP score was moderately negatively correlated with the WFC total score (rs[584] = −0.497, P < .001) and predicted the WFC score (b = 72.02, t582 = −13.30, P = .001). The Mann-Whitney U test demonstrated that married athletic trainers (47.20 ± 11.92) had higher WFC scores than those who were not married (43.48 ± 11.78; U = 19847.00, P = .003). Mann-Whitney U analysis (U = 32 096.00, P = .001) also revealed a difference between collegiate athletic trainers with children (48.16 ± 12.44) and those without children (44.68 ± 10.90). Collegiate athletic trainers experienced more WFC with marriage and having children. We propose that the time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to be able to spend time with their families; however, when such time is highly limited, then WFC increases.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Landon B. LempkePhD, ATC,
Benjamin L. BrettPhD, and
Douglas P. TerryPhD,ABPP
Driving After Concussion: Clinical Measures Associated with Post-concussion
Kumiko Hashida,
Julia Drattell,
Kim Love,
Robert C. Lynall,
Russell K. Gore,
Hannes Devos, and
Julianne D. Schmidt
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Yi-Hsuan WengPT, MS,
Tsun-Shun HuangPT, PhD, and
Jiu-Jenq LinPT, PhD
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
Joosung Kim,
Arlette C. Perry,
Kevin A. Jacobs,
Brian Arwari,
Soyeon Ahn, and
Kyung-Min Kim
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
Nikki RommersPT PhD,
Lieselot LongéPT MSc,
Winnie DebeckerPT MSc,
Nikie PeetersPT MSc,
Bruno TassignonPT PhD,
Eva HuysmansPT PhD,
Koen PutmanPT PhD,
Johan VanlauweMD PhD,
David BeckwéePT PhD,
Nicky Van MelickPT PhD, and
Christophe EechautePT PhD
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X
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