Volume 59: Issue 7

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

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.

Context

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.

Objective

To document the current beliefs and practices of practitioners working in MLB regarding HSI prevention.

Design

Cross-sectional study.

Setting

Major League Baseball via an online survey.

Patients or Other Participants

Athletic trainers, physical therapists, and strength and conditioning coaches working in MLB during the 2021 season.

Data Collection and Analysis

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.

Results

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.

Conclusions

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

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.

Objective

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.

Design

Cross-sectional study.

Setting

Laboratory.

Patients or Other Participants

Twelve female netball athletes (age = 20.8 ± 2.6 years, height = 170.0 ± 0.04 cm, mass = 67.5 ± 7.4 kg).

Main Outcome Measure(s)

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.

Results

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).

Conclusions

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.

Pain reduction following massage after induced fatigue is not mediated by changes in muscle stiffness or intramuscular fluid content: a randomized controlled trial with mediation analysis

Guilherme S. NunesPT, PhD,

Brenda Dutra GuterresPT,

Ane Priscila DielPT,

Anna Carolina O. Machado,

Nathália Kolling da RosaPT,

Victória dos Santos TurchettoPT, and

Fábio Juner LanferdiniPE, PhD