As an athletic trainer, I have grown up with the Journal of Athletic Training (JAT). It represents progress in an ever-changing and constantly evolving profession. The JAT is the repository of evidence that has changed thinking and practice, and it will continue to serve this role into the future as our profession continues to grow. Each of the Editors-in-Chief during my professional career has offered a unique vision, resulting in improved quality of the journal and increased visibility and strength of our profession. My plan as the incoming Editor-in-Chief is to continue this tradition
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EDITORIAL
CURRENT CLINICAL CONCEPTS
PT, DPT, OCS,
PT, DPT,
PT, DPT, SCS, and
PT, DPT, CSCS
Thoracic outlet syndrome (TOS) involves inconsistent symptoms, presenting a challenge for medical providers to diagnose and treat. Thoracic outlet syndrome is defined as a compression injury to the brachial plexus, subclavian artery or vein, or axillary artery or vein occurring between the cervical spine and upper extremity. Three common subcategories are now used for clinical diagnosis: neurogenic, arterial, and venous. Postural position and repetitive motions such as throwing, weightlifting, and manual labor can lead to symptoms. Generally, TOS is considered a diagnosis of exclusion for athletes due to the poor accuracy of clinical testing, including sensitivity and specificity. Thus, determining a definitive diagnosis and reporting injury is difficult. Current literature suggests there is not a gold standard diagnostic test. Rehabilitation has been shown to be a vital component in the recovery process for neurogenic TOS and for arterial TOS and venous TOS in postoperative situations.
LOWER EXTREMITY
MSc, GSR,
PhD,
PhD, AEP,
PhD,
CSCS, RSCC, USAW, and
PhD
Hamstring strain injury (HSI) is the most frequently sustained injury in Major League Baseball (MLB). However, the beliefs and practices of practitioners working in MLB regarding HSI risk factors and prevention strategies in baseball athletes have not been documented. To document the current beliefs and practices of practitioners working in MLB regarding HSI prevention. Cross-sectional study. Major League Baseball via an online survey. Athletic trainers, physical therapists, and strength and conditioning coaches working in MLB during the 2021 season. An online survey was conducted, with participants completing the survey once. Questions pertained to risk factor identification, the use and perceived effectiveness of prevention strategies, and barriers to implementation. Descriptive statistics were calculated for each question. A total of 91 responses were received featuring respondents from 28 of 30 MLB organizations. The perceived most important intrinsic risk factors were tolerance to high-speed running for first-time HSI and previous HSI for recurrent injury. The perceived most important extrinsic risk factor for both first-time and recurrent HSI was internal communication between staff. The perceived most effective prevention strategies were managing overall workload, regular exposure to high-speed running, and periodization. The most used prevention strategies were core or lumbopelvic strengthening, traditional resistance-training exercises, and managing overall workload. Approximately half (53%) of respondents reported barriers to effective implementation of HSI prevention strategies, including player and coach buy-in, compliance, workload management, and scheduling. This was the first survey to investigate MLB practitioner beliefs and practices regarding HSI prevention. Responses from practitioners regarding their beliefs about risk factors and appropriate prevention strategies varied, and discrepancies existed between the perceived most effective strategies and those most frequently used.Context
Objective
Design
Setting
Patients or Other Participants
Data Collection and Analysis
Results
Conclusions
MSc,
PhD,
PhD, and
PhD
General and local muscular fatigue is postulated to negatively alter lower limb biomechanics; however, few prospective studies have been done to examine the effect of fatigue on tuck-jump performance. The tuck-jump assessment (TJA) is a criteria-based visual screening tool designed to identify neuromuscular deficits associated with anterior cruciate ligament (ACL) injury. Use of kinetics during the TJA after an intense sport-specific fatigue protocol may identify fatigue-induced neuromuscular deficits associated with ACL injury risk. To examine the effects of a sport-specific fatigue protocol on visually evidenced (2-dimensional) technical performance of repeated tuck jumps and lower limb kinetic stabilization. Cross-sectional study. Laboratory. Twelve female netball athletes (age = 20.8 ± 2.6 years, height = 170.0 ± 0.04 cm, mass = 67.5 ± 7.4 kg). Participants performed 1 set of a TJA before and after a sport-specific fatigue protocol. Paired t tests and effect sizes were used to evaluate differences and the magnitude of differences in TJA scoring criterion, kinetics, and kinetic stabilization prefatigue to postfatigue. A small increase was observed for vertical relative lower extremity stiffness postfatigue (P = .005; Hedges g = 0.45). Peak center-of-mass displacement, time of jump cycle, ground contact time, flight time, jump height, and vertical net impulse decreased with small to moderate effect sizes (P < .01; Hedges g range, 0.41–0.74). No differences were observed for TJA composite scores, peak vertical ground reaction force, and stabilization indices of kinetic variables after the fatigue protocol (P > .05). Kinetic analysis of repeated tuck jumps after a fatigue protocol identified an altered jumping strategy, which was not identifiable via visual 2-dimensional assessment. However, based on kinetic measures, fatigue induces a stiffer jumping strategy, and practitioners should consider assessing load attenuation strategies that may not be visually evident when evaluating ACL-injury risk factors in athletes who are fatigued.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
PhD, ATC,
PhD, LAT, ATC,
PhD,
PhD, LAT, ATC,
PhD,
PhD, LAT, ATC, and
PhD, LAT, ATC
Chronic ankle instability (CAI) is associated with a less flexible and adaptable sensorimotor system. Thus, individuals with CAI may present an inadequate sensory reweighting system, inhibiting their ability to place more emphasis (upweight) on reliable sensory feedback to control posture. However, how individuals with CAI reweight sensory feedback to maintain postural control in bilateral and unilateral stances has not been established. To examine (1) group differences in how the sensory reweighting system changes to control posture in a simple double-limb stance and a more complex single-limb stance (uninjured limb and injured limb) under increased environmental constraints manipulating somatosensory and visual information for individuals with and without CAI and (2) the effect of environmental and task constraints on postural control. Case-control study. Laboratory. A total of 21 individuals with CAI (age = 26.4 ± 5.7 years, height = 171.2 ± 9.8 cm, mass = 76.6 ± 15.17 kg) and 21 individuals without CAI (control group; age = 25.8 ± 5.7 years, height = 169.5 ± 9.5 cm, mass = 72.4 ± 15.0 kg) participated. We examined the equilibrium scores based on the first 10 seconds of trials in which participants completed 6 environmental conditions of the Sensory Organization Test during 3 tasks (double-limb and single-limb [uninjured and injured] stances). Sensory reweighting ratios for sensory systems (somatosensory, vision, and vestibular) were computed from paired equilibrium scores based on the first 10 seconds of the trials. We observed 3-factor interactions between groups, sensory systems, and tasks (F4,160 = 3.754, P = .006) and for group, task, and environment (F10,400 = 2.455, P = .007). The CAI group did not downweight vestibular feedback compared with the control group while maintaining posture on the injured limb (P = .03). The CAI group demonstrated better postural stability than the control group while standing with absent vision (ie, eyes closed), fixed surroundings, and a moving platform on the injured limb (P = .03). The CAI group relied on vestibular feedback while maintaining better postural stability than the control group in injured-limb stance. Group differences in postural control depended on both environmental (absent vision and moving platform) and task (injured limb) constraints.Context
Objectives
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
UPPER EXTREMITY
PhD,
MS,
PT, PhD, DPT, MPH,
PT, PhD, and
PhD, ATC
Photobiomodulation therapy (PBMT) applied as a preconditioning treatment before exercise has been shown to attenuate fatigue and improve skeletal muscle contractile function during high-intensity resistance exercise. Practical implications for preconditioning muscles with PBMT before fatiguing exercise include a safe and noninvasive means to enhance performance and reduce the risk of musculoskeletal injury. To examine the muscle fatigue–attenuating effects of PBMT on performance of the shoulder external-rotator muscle group when applied as a preconditioning treatment before high-intensity, high-volume resistance exercise. Sham-controlled, crossover design. Laboratory. Twenty healthy men (n = 8) and women (n = 12) between the ages of 18 and 30 years. Photobiomodulation therapy was administered using a near-infrared laser (λ = 810/980 N·m, 1.8 W/cm2, treatment area = 80–120 cm2) to the shoulder external-rotator muscles at a radiant exposure of 10 J/cm2. Participants performed 12 sets of isokinetic shoulder exercise. Each set consisted of 21 concentric contractions of internal and external rotation at 60°/s. The sets were subdivided into 3 blocks of exercise (block 1: sets 1–4; block 2: sets 5–8; block 3: sets 9–12). Normalized peak torque (N·m/kg), average peak torque (N·m), total work (N·m), and average power (W). During the last block of exercise (sets 9–12), all performance measures for the active PBMT condition were 6.2% to 10% greater than the sham PBMT values (P < .02 to P < .001). Photobiomodulation therapy attenuated fatigue and improved muscular performance of the shoulder external rotators in the latter stages of strenuous resistance exercise.Context
Objective
Design
Setting
Patients or Other Participants
Intervention(s)
Main Outcome Measure(s)
Results
Conclusions
PT,
MD,
MD, and
PhD, MD
Glenohumeral internal rotation deficit (GIRD) may affect overhead athletes and contribute to shoulder injury. To assess data on passive shoulder range of motion (ROM) in young elite swimmers and to determine the prevalence of anatomical and pure GIRD (aGIRD and pGIRD, respectively) in a large sample size of asymptomatic elite swimmers with a new classification method. Cross-sectional study. Research laboratory. A total of 752 asymptomatic elite swimmers were recruited by voluntary participation (391 males and 361 females; mean age, 15.88 ± 2.31 years). Passive glenohumeral rotational ROM was measured bilaterally to investigate the prevalence of aGIRD and pGIRD. Evaluations were performed with athletes at rest before any training or competition. Glenohumeral internal rotation deficit and associated aGIRD and pGIRD in elite youth swimmers by identifying a standard classification procedure. Glenohumeral internal rotation deficits were found in 136 participants (18.1%). Anatomical GIRD was present in 28 cases (3.7%), whereas pGIRD was observed in 108 cases (14.4%). No significant differences were found regarding GIRD between sex, age, age group, years of training, breathing side, and distance. Swimmers with pGIRD showed significantly less dominant internal rotation, total ROM, and external rotation gain (P < .01) than swimmers with aGIRD; conversely, swimmers with aGIRD showed significantly less nondominant internal rotation, external rotation, and total ROM than swimmers with pGIRD (P < .01). Glenohumeral internal rotation deficit is a relatively common condition in asymptomatic elite youth swimmers; as to not overestimate this condition, aGIRD and pGIRD have to be distinguished. Although they play a role, the respiratory side, dominant limb, and crawl did not have a significant impact on an elite swimmer with GIRD.Context
Objectives
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusion
PhD,
PT,
MEng, PhD student,
PT,
PT,
MEng, PhD,
MEng, PhD,
PT, PhD, and
MD
Shoulder muscles are active during front-crawl swimming to provide propulsion and stabilize the glenohumeral and scapulothoracic joints. Researchers have proposed that fatigue might contribute to altered activation of these muscles and represent a risk factor for injuries. Tensiomyography (TMG) might function as a noninvasive tool to detect changes in contractile measures of the skeletal muscles due to exercise-induced neuromuscular fatigue, though it has not yet been used in the shoulder muscles of swimmers. To assess the effects of a fatiguing swimming protocol on shoulder muscle TMG measures and isometric strength in competitive swimmers. Cross-sectional study. Swimming pool facility. A total of 14 young front-crawl competitive swimmers (11 males and 3 females; age = 21 ± 3 years [range, 17–26 years], height = 1.78 ± 0.06 m, mass = 73.1 ± 9.2 kg). Participants completed TMG and isometric strength assessments before and after 30-minute, high-intensity swim training. The TMG assessment was performed on 7 muscles of the shoulder according to front-crawl biomechanics and the applicability of the technique to obtain data, such as time to contraction and muscle-belly radial displacement. Isometric strength was assessed using a digital handheld dynamometer during shoulder flexion, extension, external rotation, and internal rotation. Fatigue induced a smaller radial displacement, mostly observable in latissimus dorsi (−1.0 mm; 95% CI = −1.7, −0.3 mm; P = .007) and pectoralis major muscles (−1.4 mm; 95% CI = −2.4, −0.4 mm; P = .007). Only shoulder extension showed an isometric strength reduction after the fatiguing protocol (−0.03 N/kg; 95% CI = −0.05, −0.01 N/kg; F1,13 = 4.936; P = .045; ηp2 = 0.275). This study provides preliminary evidence for the usefulness of TMG to detect fatigue-induced changes in contractile properties of the shoulder muscles in swimmers, in particular the latissimus dorsi and pectoralis major.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
CONCUSSION
MD,
MSH,
MS, LAT, ATC,
PhD, MS, and
MD
Concussions incurred during high school athletics are a significant health concern, and studies examining concussions with a symptom resolution time (SRT) of 15 to 28 days have been limited. To compare concussions that had an SRT of 15 to 28 days with concussions that had an SRT of greater than 28 days among US high school athletes. Descriptive epidemiology study. Secondary school athletic training clinics. Secondary school athletes. Concussion frequency, symptom number, and symptom prevalence. Among all 917 reported concussions (of which 50.8% had missing SRT), 88 had an SRT recorded as 15 to 28 days, and 29 had an SRT recorded as greater than 28 days. Greater frequencies of concussions with an SRT of 15 days or more were reported in boys’ sports (n = 78) than girls’ sports (n = 39). Boys’ football (51.7%) and girls’ basketball (11.5%) accounted for the largest proportions of all reported concussions with an SRT of 15 to 28 days; boys’ football (58.6%) accounted for the greatest proportion of concussions reported with an SRT greater than 28 days. The average number of symptoms was 6.3 ± 3.4 for concussions with an SRT of 15 to 28 days and 7.2 ± 3.8 for those with an SRT greater than 28 days. The most frequently reported symptoms in concussions with both SRT of 15 to 28 days and greater than 28 days were headache, dizziness, sensitivity to light, and difficulty concentrating. The prevalence of irritability was higher in concussions with an SRT of 15 to 28 days as compared with concussions with an SRT greater than 28 days (26.1% versus 13.8%); visual problems (48.3% versus 35.2%) and hyperexcitability (24.1% versus 15.9%) were more prevalent in concussions with an SRT greater than 28 days, although differences were not statistically significant. Symptom prevalence and total count were comparable between concussions with an SRT of 15 to 28 days and those with an SRT of greater than 28 days with no statistically significant difference, suggesting that symptom burdens within these groups are more similar than they are different.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
MS,
PhD,
PhD, LAT, ATC, and
PhD, ATC
Athletes with a history of concussion are at a greater risk for lower extremity musculoskeletal injury. Female athletes may be at an even greater risk than male athletes. Previous researchers on postconcussion landing biomechanics have focused on the lower extremities, but the trunk plays a crucial role as an injury risk factor. To compare lower extremity and trunk biomechanics during jump-landing and cutting maneuvers between female athletes with and those without a concussion history. Cross-sectional study. Biomechanics laboratory. A total of 26 athletes (mean ± SD age = 19.0 ± 1.3 years, height = 1.68 ± 0.07 m, mass = 64.02 ± 6.76 kg, body mass index = 22.58 ± 1.97 kg/m2; median [interquartile range] time since most recent concussion = 37.5 months [25.0 months, 65.8 months]) with a concussion history and 38 athletes (age = 19.0 ± 1.1 years, height = 1.71 ± 0.08 m, mass = 64.72 ± 9.45 kg, body mass index = 22.14 ± 1.80 kg/m2) without a concussion history. Peak kinetics (vertical ground reaction force, vertical loading rate, external knee-abduction moment, and external knee-flexion moment) and kinematics (trunk-flexion angle, trunk lateral-bending angle, ankle-dorsiflexion angle, knee-flexion angle, knee-abduction angle, and hip-flexion angle) were obtained during the eccentric portion of jump-landing and cutting tasks. Separate 2 (group) × 2 (limb) between- and within-factors analyses of covariance were used to compare outcomes between groups. We covaried for time since the most recent concussion and the limb that had a history of musculoskeletal injury. Athletes with a concussion history displayed a greater peak knee-abduction angle in their nondominant limb than their dominant limb (P = .01, ηp2 = 0.107) and the nondominant limb of athletes without a concussion history (P = .02, ηp2 = 0.083) during jump landing. They also had less trunk lateral bending during cutting compared with athletes without a concussion history (P = .005, ηp2 = 0.126). Our results indicated landing biomechanics are different between female athletes with and those without a concussion history. This finding may be due to impairments in neuromuscular control postconcussion that may ultimately increase the risk of subsequent lower extremity injury, although further research is warranted given the cross-sectional nature of our study.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
PhD, ATC,
PhD, ATC,
PhD, ATC,
PhD, ATC,
PhD, LAT, ATC,
PhD, MPH, LAT, ATC,
PhD, LAT, ATC,
MS, LAT, ATC,
PhD, LAT, ATC,
PhD,
PhD,
PhD, MEd,
MS, LAT, ATC,
MEd, ATC,
PhD,
MD,
PhD, ATC, and
PhD, ATC
There is strong evidence that racial and ethnic disparities exist in multiple arenas of health and wellness. The causes of racial and ethnic differences in health care are multidimensional; one factor that may affect injury/illness communication, interactions, and outcomes is patient-provider racial and ethnic concordance. At present, it is unclear what role patient-provider racial and ethnic concordance and discordance plays in facilitating concussion care for collegiate athletes. To investigate the presence of athlete–athletic trainer (AT) racial and ethnic concordance and discordance among diagnosed concussion cases and examine if racial and ethnic concordance and discordance influences time (in days) until diagnosis, symptom resolution, or return-to-sport clinical milestones in collegiate athletes. Retrospective cohort study. Collegiate athletics. A total of 694 concussion cases (38.6% [n = 268] sustained by women, 61.4% [n = 426] sustained by men) that occurred within the 2015–2016 through 2019–2020 sport seasons at 9 institutions. The number of days from the date of injury to diagnosis, symptom resolution, and return to sport and from the date of diagnosis to symptom resolution and return to sport. Overall, 68.4% (n = 475) of concussion cases had patient-provider racial and ethnic concordance, and 31.6% (n = 219) were discordant. All concordant pairs included a White athlete and White AT. Time to diagnosis differed between the concordant and discordant groups (median [interquartile range] = 1 [0–2] versus 0 [0–1], respectively) only in the model adjusted for sex, sport type, and availability of an AT (odds ratio [95% CI] = 1.46 [1.07–1.85]). There were no other group differences. One-third of concussion cases had athlete-AT racial and ethnic discordance. Although this group was diagnosed with a concussion 1 day sooner than the concordant group, no differences were observed for any concussion recovery milestones. These findings suggest that patient-provider racial and ethnic concordance may play a minor role in concussion recognition or reporting but not necessarily in the management and recovery thereafter.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
PSYCHOLOGY
MS,
PhD, LICSW,
BS,
MS, and
MD
Psychological skills training improves performance in athletes. However, authors of few studies have looked at the efficacy and satisfaction of mental skills training programs for collegiate athletes. To evaluate the satisfaction of collegiate athletes with a 6-session mental skills course and to assess changes in mental toughness and coping skills before and after the course. Cohort study. Division I collegiate athletic teams. Fifty-four Division I female athletes (mean age = 19.8 years) participated in the program, and 42 (77.7%) completed precourse assessments, which subsequent evaluations were matched to. The Athletic Coping Skills Inventory (ACSI; range, 0–84) and Mental Toughness Index (MTI; range, 8–56) assessed coping skills and mental toughness precourse, immediately postcourse, and 4 months postcourse. Satisfaction was assessed on a 10-point scale. For participants with paired precourse and immediately postcourse data (n = 37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI = 1.1, 4.1; P = .001), and ACSI scores improved by a mean 4.0 points (95% CI = 0.6, 7.4; P = .02). At the 4-month follow-up (n = 25, 46.2%), no change was detected from precourse in mean MTI score (P = .72), but a significant increase of 3.4 points in mean ACSI (95% CI = 0.4, 6.4; P = .03) occurred. Overall satisfaction had a median score of 9/10 (interquartile range, 8–10) at postcourse, and 18 participants (48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Mental toughness and coping skills scores significantly improved at postcourse assessment, with coping skills scores maintaining their effect at 4 months. The improvements identified spark the question of the potential impact of mental skills training programs when studied in larger athlete populations or over more sustained periods of time. Athletes reported being highly satisfied with course content and reported overall positive experiences.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measure(s)
Results
Conclusions
CASE REPORT: DERMATOLOGY
PhD, MPH, ATC, CSCS and
PhD, MS, ATC, CSCS
A 35-year-old intramural male athlete presented to the athletic training staff with a 4.5- × 2.2-cm itchy, painful, swollen, and infected insidious skin lesion on his right lateral malleolus due to an underlying dermatologic deficiency. Suspecting infection, the patient was referred to his nurse practitioner and was diagnosed with atopic dermatitis caused by a ceramide deficiency. He was placed on cefalexin and mupirocin 2% ointment but returned due to the lesion increasing to 8.5 × 6 cm, although the infection seemed controlled. He was instructed to use Ceravé topical cream, clobetasol propionate 5%, and to consume foods rich in healthy oils (omega-3 fatty acids, olive oil). Unmitigated, this lesion could have resulted in severe infection and tissue damage. Atopic dermatitis is relatively common in the general population, but its appearance in healthy athletes highlights that athletic trainers need to be well versed in not just apparent causes of skin ailments (ie, infection) but also root causes.
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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