Context:

Despite the efficacy of injury prevention programs, ACL injury rates have remained steady, which may be due to limited knowledge of which groups/athletes are greatest at risk of sustaining an ACL injury.

Objective:

The purpose of our study was to characterize ACL injury rate (IR) across sports, sex, and levels of play to identify high-risk groups per season.

Data Sources:

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched electronic databases of PubMed and EBSCohost.

Study Selection:

Inclusion criteria required that studies noted level of play, number of ACL injuries, and total number of athletes. We excluded studies if the injury was a secondary one, the total population was unclear or noted only cases of reconstruction.

Data Extraction:

We extracted data on sport, sex, level of play, number of ACL injuries, and total number of athletes.

Data Synthesis:

The electronic literature search yielded 9469 studies for initial review, and at the end of the search, a total of 89 studies were included in our meta-analysis. The highest risk sports were female semi-pro handball (IR=0.045/athlete-year), female professional basketball (IR=0.027/athlete-year), and female professional alpine skiing (IR=0.025/athlete-year). Across all the sports, sex and levels there were large gaps in the data and variability in the injury rates.

Conclusions:

There was variability in injury risk rates across competition level, sex and sport, with the highest risk of ACL injury in semi-professional and professional sports. While female athletes demonstrated greater risk of ACL injury than male athletes, it’s unknown if this was true in every sport or level due to gaps in the data. Practitioners should understand the impact of sex and sport differences in ACL injury risk to guide the best evidenced-based risk reduction strategies.

Context:

Females with patellofemoral pain (PFP) commonly have hip muscle weakness in comparison to females without PFP. One underlying mechanism for this muscle weakness is inhibition. Although the presence of muscle weakness is well documented in females with PFP, few authors have investigated gluteus medius inhibition in this population. Females are twice as likely to suffer from PFP when compared to males, therefore this study will focus on the female population.

Objective:

To compare voluntary activation of the gluteus medius between females with and without PFP.

Design:

Case-control study.

Setting:

Laboratory.

Patients or Other Participants:

28 female participants: 13 pain-free controls (age = 21.6 ± 3.6 years, height = 1.66 ± 0.06 m, mass = 65.4 ± 11.3 kg) and 15 with PFP (age = 22.3 ± 3.2 years, height = 1.66 ± 0.07 m, mass = 75.3 ± 22.6 kg, duration of pain = 3.5-96 months).

Main Outcome Measure(s):

Standing hip abduction normalized strength (N·m/kg), superimposed burst force and gluteus medius central activation ratio (CAR). Linear modeling was utilized to compare forces and CAR between groups while controlling for age, mass, and hip abduction force.

Results:

Females with PFP had lower gluteus medius CAR than controls. Overall, after controlling for participant age, mass and gluteus medius MVIC, the PFP group had an average gluteus medius CAR 2.5% lower than the pain-free control group (Control= 98.4±.01%, PFP=95.9±.65%, p=.004).

Conclusions:

Females with PFP had reduced voluntary activation of the gluteus medius, when assessed with a superimposed burst. Due to the wide range of CAR values found (74-99%), inhibition was present in some of the participants. This provides evidence that assessment of gluteal voluntary activation could assist with targeted treatment programs for individuals presenting with PFP.

Context:

Incomplete neurological recovery following concussion has been linked to increased lower extremity musculoskeletal injury (LEMI) risk. Incorporating cognitive demands into jump-landing tasks may offer better insights into neurological recovery post-concussion and its connection to injury risk.

Objective:

To compare unilateral knee biomechanics during jump-landing tasks across different levels of motor and cognitive demands between individuals with a recent concussion and matched controls.

Design:

Cross-sectional cohort study

Setting:

Biomechanics laboratory

Patients or Other Participants:

We recruited 26 college students with a recent concussion (22 women; age=19.7 ± 1.2; Tegner scale=7.0 ± 2.2; time since recent concussion=5.4 ± 3.2 months) and 26 healthy reference without concussion history (22 women; age=19.9 ± 1.3; Tegner scale=7.0 ± 2.0)

Main Outcome Measure:

Unilateral and limb symmetry of knee biomechanics were assessed during initial ground contact and the landing phase of jump-landing tasks. Limb symmetry was determined by the absolute difference between limbs for knee flexion and abduction angle, internal knee extension and adduction moments, vertical, and posterior ground reaction force (pGRF). Separate repeated measure ANOVAs with mixed designs examined group, condition, and group-by-condition interaction, with α=0.05.

Results:

No group differences were observed in most outcome measures for either limb or limb symmetry across all jump-landing tasks, except the concussion history group had lower non-dominant peak pGRF compared to healthy reference group (F1,50= 3.461, p= 0.016, η2= 0.111). Both groups demonstrated higher peak knee flexion, abduction angle, and peak knee adduction moments, but lower peak knee extension moment, and peak vertical ground reaction force on both limbs during double-leg versus single-leg conditions. No other significant findings were observed.

Conclusions:

The concussion history group demonstrated similar knee biomechanical profiles to healthy reference group during landing, even with added cognitive demands in jump landing tasks. Elevated LEMI risk post-concussion may not be detectable through jump landing biomechanics.

Context:

There are many professional challenges associated with being a member of the lesbian(L), gay(G), bisexual(B), transgender(T), queer(Q), Intersex (I), asexual(A) and others (+) (LGBTQIA+) community in healthcare and athletics. Previous research has explored perceptions of LGBTQIA+ athletes, coaches, nursing, and physicians; however, there is a paucity of research examining the challenges of LGBTQIA+ community members as athletic trainers (ATs) within the profession.

Objective:

The purpose of this study was to explore challenges of LGBTQIA+ athletic trainers specifically related to the profession of athletic training.

Design:

Qualitative study

Setting:

Individual phone or virtual interviews.

Patients or Other Participants:

Thirty ATs identifying as LGBTQIA+ (aged 32±11 years).

Data Collection and Analysis:

Participants were interviewed following a semi-structured interview guide. Data were analyzed through phenomenological reduction. Trustworthiness was established via member checking, peer review, and multi-analyst triangulation.

Results:

Three themes emerged: 1) the job search, 2) acceptance athletic training, and 3), neutrality from other ATs. When looking for jobs, there are considerations cisgender and heterosexual ATs may not consider, such as inclusive policies, spouse healthcare, or even if they were overlooked for a job due to sexual orientation or identity. LGBTQIA+ athletic trainers seek acceptance, support, and a true sense of belonging in the profession, regardless of their personal identities. Potentially one of the largest challenges is neutrality from other ATs, in which ATs are not openly hostile or discriminatory, but they are also not doing anything to provide support to or advocate for LGBTQA+ ATs.

Conclusions:

Participants identified challenges associated with being an AT and LGBTQIA+. As LGBTQIA+ ATs enter the job market, they should actively search for organizations that have inclusive, nondiscrimination policies. Organizations should ensure they display and follow inclusive policies. Education for all ATs on acceptance, working with LGBTQIA+ patients and colleagues, and creating safe spaces are needed.

Context:

Baseball pitching load is linked to injury in adolescent baseball athletes, however, it is unclear if pitch counts are a good indicator of total upper extremity load during baseball pitching.

Objective:

The purpose of this study is to 1) determine the recovery time-course of 8 musculoskeletal variables after a single live pitching bout and 2) determine the association 9 between pitch counts, rating of perceived exertion, and arm-specific session rating of perceived 10 exertion on musculoskeletal changes after live game pitching in adolescent baseball athletes.

Design:

Cross Sectional

Setting:

Competitive Baseball Games

Participants:

36 adolescent baseball pitchers (16.1±0.9 years, 178.2±10.4 cm, 71.5±10.2 kg)

Main Outcome Measures:

Internal (IRROM) and external (ERROM) shoulder range of motion, internal (IRPF) and external (ERPF) shoulder rotation peak force, and infraspinatus cross sectional area (CSA) and echo intensity (EI) were collected prior to pitching (PRE), immediately after pitching (POST), and on days 1 (D1), 3 (D3), and 5 (D5) after pitching. Pitch count and rating of perceived exertion (RPE) was collected during the pitching bout, and an arm-specific session rating of perceived exertion (aRmPE) score was calculated as the product of pitch count and RPE. Linear mixed models were used to determine the recovery time-course on both arms and to determine the association between the load variables (pitching count, RPE, aRmPE) and the change in the musculoskeletal variables on the dominant arm.

Results:

IRROM was highest on D3 (mean difference: 3.31, t=3.12, p=0.019), ERPF decreased at POST(-11.53, t=3.51, p=0.005) and increased at D5 (14.8, t=4.52, p<0.001). IRPF was lowest at POST and highest at D5 (19.14, t=4.18, p<0.001). There was no significant (p>0.057) association between load variables and musculoskeletal variables.

Conclusions:

Baseball specific pitching load metrics did not predict musculoskeletal changes following live game pitching. Future research should investigate pitching load variables that better predict musculoskeletal changes.

Context:

The monetary costs of sport-related injuries are significant, but complexity in public and private payers and disparate injury-reporting systems create challenges in accurately estimating their economic impact. Few studies have characterized the cost of athletic training services for sport-related injuries.

Objective:

To describe the treatment and cost characteristics of high school athletic training services provided to student-athletes for knee and ankle cases.

Design:

Cross-sectional study

Setting:

Secondary schools

Patients:

High school student-athletes receiving athletic training services for knee and ankle cases

Main Outcome Measure(s):

Treatment and costs characteristics of athletic training services provided to high school student-athletes for knee and ankle cases, including comparison of total cost of care by gender, sport, and injury severity outcome.

Results:

Between 2014-2019, 219 knee and 400 ankle cases and their associated treatments were documented by athletic trainers in the National Athletic Treatment, Injury and Outcomes Network Surveillance Program. Therapeutic exercises and ankle strapping were the most commonly documented services. The median estimated total cost of care was $124.20 (IQR $75.44-$231.64) per knee case and $148.58 (IQR $27.00-287.10) per ankle case. Median total cost of care varied across injury severity.

Conclusion:

This study provides insights into the cost characteristics of high school athletic training services. While costs were generally lower than previous reports, the findings highlight the worth of athletic training services in managing knee and ankle cases and underscore the need for improved documentation and cost data collection to further demonstrate the economic value of athletic training services.

Objective

To assess whether combining electrotherapies with therapeutic exercise (TEx) for chronic ankle instability (CAI) is more effective than TEx alone.

Data Sources

PubMed, MEDLINE, SPORTDiscus, and Web of Science were searched to ascertain studies relevant to this review published from inception until September 2024.

Study Selection

Studies included were randomized control trials, including human participants with no restriction on sex, age, or setting, with an intervention of electrotherapy in combination with TEx compared with TEx alone for treating CAI.

Data Extraction

Each article was reviewed to establish if a type of electrotherapy was used with TEx for rehabilitating CAI and compared to TEx alone.

Data Synthesis

3118 articles were found for review, with 7 studies meeting the inclusion criteria. The 7 studies were then divided into 4 groups: Stochastic Resonance Stimulation (SRS), Transcutaneous Electrical Nerve Stimulation (TENS), Transcranial Direct Current Stimulation (aTDCS), and Neuromuscular Electrical Stimulation (NMES) for comparison.

Conclusion

The findings from the studies included in this review suggested that combining electrotherapy with TEx has preferable functional outcome measures than TEx alone when rehabilitating CAI.

Context:

Massage therapy is a common intervention for athletic recovery. However, its effects on fatigue, muscle stiffness, and intramuscular fluid content, or the mechanism for pain reduction remain uncertain.

Objective:

To evaluate the immediate and subacute effects (24-72 hours) of massage on pain, fatigue, muscle stiffness, and intramuscular fluid content in university athletes following an induced fatigue protocol. Additionally, we investigated whether changes in muscle stiffness and intramuscular fluid content mediate the effects of massage on pain and fatigue.

Design:

Randomized controlled clinical trial.

Settings:

Laboratory.

Patients or Other Participants:

Eighty-six university athletes, who completed a quadriceps fatigue protocol involving isokinetic concentric contractions.

Interventions:

Participants receive either a 10-minute massage therapy targeting the quadriceps, or a sham control intervention. They were applied immediately after the fatigue protocol and repeated 48 hours later.

Main Outcome Measures:

Pain and fatigue were assessed using numeric rating scales. Muscle stiffness and intramuscular fluid content were evaluated using ultrasound elastography and echo intensity, respectively.

Results:

Massage therapy reduced pain immediately after the intervention compared to sham group by -1.4 points (95% CI -2.8 to -0.1). No differences were observed for pain at subsequent time points or for fatigue, muscle stiffness, or intramuscular fluid content at any time. Mediation analysis did not reveal indirect effects of changes in muscle stiffness or intramuscular fluid content on changes in pain or fatigue.

Conclusions:

Massage therapy provides immediate pain relief following induced fatigue but does not produce lasting effects on pain, fatigue, muscle stiffness, or intramuscular fluid content. The observed pain reduction was not mediated by changes in muscle stiffness or intramuscular fluid content.

Context:

Individuals with acute lateral ankle sprain (ALAS) demonstrate balance deficits and altered neural excitability associated with acute injury symptoms. However, it is unknown whether corticospinal excitability is altered during standing after ALAS and which factors are associated with its neural change.

Objective:

To determine the alteration of corticospinal excitability during single-leg standing and its relationship with postural control and acute injury symptoms following ALAS

Design:

Case-Control Study.

Setting:

Research Laboratory.

Setting:

Research Laboratory.

Patients or Other Participants:

Fourteen individuals with ALAS and 14 uninjured matched controls participated.

Main Outcome Measure (s):

We measured the normalized motor evoked potential (MEP) in the fibularis longus using transcranial magnetic stimulation at 100%, 120%, and 140% of the active motor threshold (AMT) while maintaining a single-leg stance. Postural control during the same balance task was evaluated on a force plate by analyzing center-of-pressure (COP) parameters.

Results:

Individuals with ALAS showed a higher normalized MEP at AMT100% (29%, P = 0.019) and greater COP velocities (total: 23%, P = 0.030; anterior-posterior: 20%, P = 0.013) and COP area (29%, P = 0.031) during single-leg standing compared to uninjured controls. Further, correlation analyses revealed that a higher normalized MEP was not associated with acute injury symptoms (swelling: r_s = 0.387, 23 pain: r = -0.084, P > 0.05) but moderately with a greater total COP velocity (r_s = 0.543, P = 0.048).

Conclusions:

Following ALAS, corticospinal excitability in the fibularis longus is altered during a single-leg stance, and the level of excitability is associated with an increased rate of postural sways. These findings suggest a compensatory supraspinal mechanism for impaired postural control following ALAS. A future longitudinal study is warranted to determine whether these early neurobehavioral changes persist throughout the recovery period following the injury.

Context:

Post-concussion driving assessment has been limited to driving simulators, which are not clinically feasible. There is a need to equip clinicians with tools that can assist in making recommendations on return to driving.

Objective:

To determine the association between clinical measures and driving simulator performance in college students within a week of a concussion.

Design:

Cross-sectional.

Setting:

Laboratory.

Patients or Other Participants:

Forty-three college students with concussion and 46 controls.

Main Outcome Measures:

Clinical outcomes include: total symptom score, dual-task tandem gait completion time and dual-task cost (the percentage increase in completion under dual-task and single-task), Complex Figure performance, Useful Field of View performance, and Vestibular Ocular Motor Screening (VOMS) symptom provocation score. Driving simulator outcomes include: the number of collisions, speed exceedances, stop signs missed, centerline crossings, and road edge excursions. Within each of the drive segments, we collected standard deviation of speed (SDS) and lane position (SDLP). Separate models for each clinical assessment and driving outcome with negative binomial and linear regression models were used.

Results:

Greater dual-task cost was associated with increased road edge excursions (p=.018) and SDS (p=.009). Higher VOMS symptom provocation was associated with less SDS (all p<.050). A higher Complex Figure copy score was associated with decreased centerline crossings (p=.001), road edge excursions (p<.001), SDS (p<.001), and SDLP (all p<.050). A slower Complex Figure copy completion time was associated with lower SDS (p=.010). A higher Complex Figure delayed score was associated with fewer road edge excursions and lower SDLP (all p<.050). Longer Complex Figure delayed completion time was associated with greater SDS (p=.03).

Conclusions:

Dual-task and Complex Figure might be useful when assessing post-concussion driving ability. Higher VOMS symptom provocation was associated with better driving performance, possibly indicating individuals experiencing vestibular-oculomotor symptoms may adopt more cautious strategies.

Context:

Assessments used after concussion provide strong diagnostic accuracy and aid in initial healthcare planning, but can have limited utility after the acute timeframe. Current concussion assessments have low ecological validity in assessing return-to-sport readiness. We developed a functional assessment protocol, the Functional Assessment of Neurocognition in Sport (FANS) to address these limitations.

Objective:

To evaluate the psychometric properties of FANS, including test-retest reliability, minimal detectable change, and divergent validity.

Design:

Repeated measure design at two-timepoints, 14-days apart.

Setting:

Clinical laboratory.

Patients or Other Participants:

Seventeen healthy, physically active individuals (age:21.9±3.2years, 58.8% female; 76.5% no lifetime concussion history).

Main Outcome Measures:

Participants completed FANS at two timepoints, and conventional clinical assessments (symptom checklist, balance, computerized neurocognitive testing) at the first timepoint. FANS examined 7-cognitive domains (verbal memory, visual memory, reaction time, processing speed, cognitive-motor flexibility, delayed verbal memory, delayed visual memory) through incorporating neuropsychological test paradigms with whole-body cognitive-movement tasks. We used intraclass correlation coefficients (ICC_3,k) with 95% confidence intervals (95% CI) and Pearson r correlations to evaluate test-retest reliability and divergent validity.

Results:

All FANS outcomes displayed acceptable test-retest reliability (ICCs ≥ 0.63), with the lowest being verbal memory’s interference subtest. Standard errors of measurement and minimal detectable changes overall displayed small values relative to score ranges. Correlations between FANS and conventional clinical assessments demonstrated select FANS reaction time and processing speed outcomes exceeding the divergent validity threshold with computerized neurocognitive testing reaction time (r range: -0.79-0.77).

Conclusions:

FANS overall displayed acceptable test-retest reliability comparable to more traditional neurocognitive test platforms, and acceptable divergent validity. FANS reaction time and processing speed may partially overlap with computerized neurocognitive testing reaction time, and warrants further examination in a clinical population. Though FANS is reliable and valid for use, future research is needed to establish FANS utility for return-to-sport readiness.

Context:

Although compromised shoulder posture impacts scapular biomechanics, the interplay between shoulder posture and scapular kinematics during the dynamic pitching motion in high school baseball pitchers remains unexplored.

Objective:

To characterize the shoulder postures of baseball pitchers and investigate their relationships with scapular biomechanics during pitching.

Design:

Cross-sectional study.

Setting:

Laboratory.

Participants:

38 high school baseball pitchers (age:16.9 ± 0.9).

Main Outcome Measure(s):

Shoulder posture was determined by acromial distance (AD), pectoralis minor index (PMI), scapular index (SI), and forward shoulder angle (FSA) in the dominant arm. The scapular kinematics and associated muscle activation (upper trapezius [UT], serratus anterior [SA], lower trapezius, biceps brachii [BB], triceps brachii [TB], anterior deltoid) during pitching were recorded.

Results:

There was a moderate to strong negative correlation between AD and upward rotation (r = -0.47 to -0.55, p < 0.003) and a moderate positive correlation between AD and anterior tilt (r = 0.40 to 0.44, p = 0.005 to 0.013). PMI and FSA also showed moderate negative correlations with anterior tilt (PMI: r = -0.37, p < 0.05; FSA: r = -0.34 to -0.42, p < 0.04). AD had moderate to strong positive correlations with UT, SA, BB, TB, and anterior deltoid activation (r = 0.36 to 0.59, p < 0.03), while SI showed moderate negative correlations with UT, BB, and anterior deltoid activation (r = -0.33 to -0.40, p < 0.05). FSA displayed a moderate negativecorrelation with SA and BB activation (r = -0.32 to -0.40, p < 0.05).

Conclusions:

Shoulder posture has a significant moderate to strong correlation with scapular biomechanics during pitching in high school baseball pitchers. Forward shoulder postures with scapular biomechanics alterations during pitching may increase the risk of shoulder fatigue or injuries. Thus, the maintenance of an appropriate shoulder posture is a critical factor in reducing injuries and maximizing performance in pitchers.

Objective:

Determine differences in running biomechanics in female endurance runners between days when they did and did not report menstrual cycle-related symptoms.

Methods:

Observational study. Subjects were provided RunScribe sensors to attach to their shoes to collect biomechanical data when running. Daily during the study period, subjects were sent a text message to complete a survey asking about their wellness, menstrual status, and training status. Descriptive measures (mean ± SD) were generated for whether runners reported being asymptomatic or symptomatic during runs and run workout details. Paired sample t-tests were executed to identify differences in impact Gs, braking Gs, pronation excursion, maximum pronation velocity, foot strike type, and gait speed between runs on days participants reported having menstrual-related symptoms (symptomatic) or not (asymptomatic). Participants needed to have recorded runs spanning the entire data collection window to be included for comparative analyses.

Results:

Twenty-seven university club runners (age 20.5 ± 1.5) participated in the study. All runners (n = 27) experienced at least one menstrual cycle-related symptom during data collection. The average number of asymptomatic runs was 22.3 ± 17.1 and symptomatic runs was 9.1 ± 7.5. Daily mileage averaged 4.3 ± 1.9 miles and total mileage was 154.2 ± 115.4 miles. Fourteen runners had run data viable for pairwise sampling. There was no significant difference in biomechanical measures between symptomatic or asymptomatic days (p > .05).

Conclusion:

This study prospectively monitored distance runners' activity while simultaneously recording symptoms related to the menstrual cycle. While runners reported fewer days running when symptomatic, we did not identify a difference in objective biomechanical measures between asymptomatic or symptomatic runs. Perceived symptom burden was present in this sport population and may warrant further exploration of perceived expectations of the menstrual cycle to athletic performance.

Context:

While bone health remains a critical concern for women of all ages, there exists limited research on the comprehensive incidence of fractures among female collegiate athletes.

Objective:

To describe the epidemiology of sport-related fractures across women's National Collegiate Athletic Association (NCAA) sports.

Design:

Descriptive epidemiology study

Setting:

Injury surveillance in collegiate women's sports.

Patients or Other Participants:

Women competing in NCAA sports during 2009/10-2018/19.

Main Outcome Measure(s):

We examined fracture frequencies and distributions by sport, mechanism of injury, the injured body part, and injury history. We used a Bayesian framework to estimate fracture rates (per 10,000 AEs) by sport and event type.

Results:

The NCAA ISP recorded 944 fractures across all women's sports during the study period, and fractures were most frequently reported among lower extremity body parts. Fractures were most commonly reported as non-contact/overuse injuries (39.0%), although equipment/apparatus contact mechanisms accounted for > 60% of fractures reported in field hockey and ice hockey. Fracture recurrence was most prevalently noted in track and field (17.8%) and gymnastics (17.6%). The posterior mean overall injury rate was 2.16 per 10,000 AEs (95% Credible Interval: [1.39, 3.44]), and the highest overall rate was estimated in gymnastics (Posterior mean= 6.29; 95% Credible Interval: [3.70, 10.31]).

Conclusions:

Our findings indicate that fractures in women's gymnastics, lower leg fractures and fractures attributed to non-contact/overuse mechanisms, particularly among long-distance runners, warrant further attention in this population. Our results can inform targeted research efforts aimed at better understanding and improving bone health outcomes for female athletes.

Objective:

To evaluate the longitudinal changes in knee sagittal kinematics pre- and post-anterior cruciate ligament reconstruction (ACLR) during varying walking speeds in non-laboratory environments. A secondary objective describing the hip and ankle joint kinematics.

Design:

Longitudinal observational study.

Setting:

Hospital.

Patients or Other Participants:

Forty ACLR patients and 17 healthy matched controls were recruited.

Main Outcome Measure(s):

Knee joint sagittal kinematics measured using seven inertial measurement units at pre-surgery, three-, and five-months post-surgery while walking at slow, normal, and fast speeds.

Results:

At pre-surgery, compared to the contralateral limb, the injured knee exhibited greater minimum flexion during normal and fast walking (p≤.008) and exhibited less knee flexion at the first peak (p=.006). SPM revealed significant differences throughout the gait cycle at all speeds (p≤.033). Compared to controls, the injured knee had greater minimum flexion during normal and slow walking (p≤.025). At three months, compared to the contralateral limb, the injured knee showed increased minimum flexion across all speeds (p≤.005) and exhibited less knee flexion at the first peak during fast walking (p<.001). SPM indicated significant differences throughout the gait cycle at all speeds (p≤.028). Compared to controls, the injured knee remained more flexed at the minimum angle across all speeds (p<.001) and exhibited less knee flexion at the first peak during slow walking (p=.031). At five months, differences between limbs were reduced, with significant differences in minimum flexion at all speeds (p≤.027). SPM differences were limited to specific gait cycle portions during normal and fast walking (p≤.011). Compared to controls, the injured knee remained more flexed at the minimum angle during slow and normal walking (p≤.005). Lastly, hip adaptations resolved while ankle asymmetries persisted during terminal stance.

Conclusions:

ACLR patients demonstrated progressive improvements in knee sagittal kinematics, indicating a recovery trend. However, the recovery was non-linear across different walking speeds.

Context

Sleep has been suggested to be a modifier of recovery following a concussion and is associated with greater symptomatology and number of days until symptom resolution. However, the physiological mechanism for why sleep disturbances occur remains poorly understood. Alterations in time spent in stages of a sleep cycle following a concussion may contribute to recovery.

Objective

The purpose of our study was to use a non-invasive, sensor-derived measure of sleep stages to determine differences between collegiate athletes with or without a concussion, acutely following injury (<72 hours).

Design

Case-control.

Setting

Division 1 collegiate athletics.

Participants

Division 1 Collegiate athletes diagnosed with a concussion were compared to healthy-matched controls based on health history, demographics and sport.

Interventions

Individuals in both groups were provided with and instructed to wear an OURA ring actigraphy device, nightly, within 72 hours of their concussion.

Main Outcome Measures

Differences in sensor-derived time spent in Light, Deep, rapid eye- movement (REM) sleep, time awake, and total sleep time between groups.

Results

A total of 18 athletes were included in our analyses (9 concussed, 9 controls) with an average age of 19.3+ 1.3 years. Individuals with a concussion spent less time in deep sleep (113.1±33.1 vs 134.4±51.1 minutes, p=0.03), and more time awake (90.22±30.0 vs 49.28±11.5 minutes, p=0.02) compared to individuals without a concussion. No significant differences were found for time spent in total sleep time, Light or REM sleep.

Conclusion

Acutely following concussion, individuals may demonstrate changes in sleep stages. Our results suggest that time spent in different stages of sleep may be a potential mechanism underlying recovery from concussion. Our results provide an important step in using wearable sensors to better understand sleep disturbances following concussion to help mitigate risk of a prolonged recovery.

Context

Mental health screenings are recommended during preparticipation physical examinations. The Mental Health-Related Survey (MHRS), a 9-item questionnaire adapted from the 18-item Mental Health Screening Form-III, is suggested in three consensus and/or position statements. However, there is no evidence on the effectiveness of the MHRS.

Objective

To assess the validity of the MHRS for mental health screening in collegiate student- athletes.

Design

Cross-sectional study.

Setting

University athletic program.

Patients

515 NCAA Division II student-athletes (20±1 years old).

Main Outcome Measures

Participants completed the MHRS, PHQ-9 for depression, and GAD-7 for anxiety. A stratified sample underwent a neuropsychiatric interview (MINI). Descriptive statistics and Pearson correlations were performed. An area under the curve (AUC) analysis compared the MHRS to the MINI. Validity was determined using sensitivity, specificity, Youden’s index, predictive values, and accuracy.

Results

322 student-athletes (62.5%) indicated ‘yes’ to one or more items on the MHRS, suggesting they would require a mental health referral. Women indicated more ‘yes’ answers than men (p<0.001). Average scores were 2.21±3.06 on the PHQ-9 and 2.66±3.87 on the GAD-7. Using a cut score of 6, 68 individuals (13.2%) reported clinically relevant depression, and 76 (14.8%) reported anxiety. PHQ-9 and GAD-7 scores strongly correlated with MHRS scores (PHQ-9: r=0.713, p<0.001; GAD-7: r=0.745, p<0.001). The MHRS had a specificity of 24.6%, a sensitivity of 93.9%, and overall accuracy of 40.14%. The AUC score was 0.762. We identified a new cutoff score for the MHRS of ≥4; however, the sensitivity of 63.6% and specificity of 76.3% raise concerns regarding how well this tool can rule out and in clinically significant symptoms of mental health conditions.

Conclusion

Most student-athletes indicated ‘yes’ to at least one item on the MHRS, warranting a mental health referral. The MHRS showed high sensitivity but low specificity, indicating low clinical utility as a screening tool.

Context:

Sport-related concussion is a common injury among National Collegiate Athletic Association football athletes. Beginning with the 2016 season, Ivy League Conference coaches voted to ban player- on-player tackling from all in-season practices. BLINDED have enforced a no-tackle approach in practices since 2010.

Objective:

To examine the association between tackling technique and head contact risk, and compare base rates of techniques used in the 2016 season between an Ivy League team with a longstanding no- tackle practice policy vs. the rest of the league.

Design:

Cross-sectional study.

Setting:

Ivy League College Football Conference.

Patients or Other Participants:

Two-hundred-thirty-seven Ivy League defensive football players that participated in the 2016 season.

Main Outcome Measure(s):

Tackles (N=3,701) across 237 Ivy League defensive football players in the 2016 season were coded based on predetermined classifications, which were combined to create unique tackle combinations/techniques. Associations among tackling techniques, head impact risk, and team (BLINIDED vs. other Ivy League teams) were evaluated using logistic regression, yielding odds ratios (OR) for head contact.

Results:

Low-risk tackle characteristics for head contact during a tackle were neutral neck position (OR=0.1), back contact area (OR=0.3), pursuing momentum (OR=0.5), and quarterback sack momentum (OR=0.3). Low-risk tackle techniques were high-back-neutral (OR=0.1), low-back-neutral (OR=0.2), and medium-back-neutral (OR=0.1). High-risk tackle characteristics were flexion (OR=14.2) and extension (OR=3.8) neck positioning, front contact (OR=2.2), blowup (OR=2.5), and cut (OR=3.0). High-risk tackle techniques included low-side-flexion (OR=4.9), low-front-flexion (OR=9.9), medium-side-flexion (OR=15.5), and medium-front-flexion (OR=11.4). Relative to BLINDED, other teams demonstrated higher odds of using high-risk techniques (low-side-flexion OR=3.5; low-front-flexion OR=3.9; medium- side-flexion OR=6.3; medium-front-flexion OR=2.3) and reduced odds of using low-risk tackle combinations (high-side-neutral OR=0.4; high-back-neutral OR=0.6; medium-side-neutral OR=0.8).

Conclusions:

Tackling techniques are associated with head contact risk, and by extension, player safety. BLINDED, who have a longstanding policy of practicing without player-on-player tackling, showed reduced use of high-risk tackling techniques.

Context

Psychosocial factors are important to consider throughout concussion recovery. Coping skills may play a role post-injury by influencing the stress response and health-promoting behaviors (e.g., rehabilitation adherence). However, limited evidence exists examining coping skills throughout concussion recovery in college-aged individuals.

Objective

To compare (1) changes in coping skills between acute and full medical clearance (FMC) visits in college-aged individuals diagnosed with concussion and healthy controls, and (2) determine the association between coping skills and recovery outcomes following concussion.

Design

Prospective cohort study

Setting

University laboratory

Patients or Other Participants

96 college-aged individuals (concussion group: N=64, age=21.33±2.37 years; control group: N=32, age=21.54±2.54 years) were enrolled.

Main Outcome Measures

The Athletic Coping Skills Inventory (ACSI-28) was completed at acute (within 5 days of concussion) and FMC (within 3 days of clearance) visits. A 2 × 2 mixed ANOVA determined differences in total and subscale scores between groups (concussion vs. control) from acute to FMC visit. Multiple linear regressions determined the association between acute ACSI-28 scores and recovery for the concussion group, with statistical significance set a priori at p<0.05 for both tests.

Results

The concentration subscale was significantly lower for the concussion group at the initial visit (F_(1,94)=7.28, p=0.01). The main effect of time showed both groups’ ACSI-28 total score significantly increased from acute to FMC visit (F_(1,94)=22.08, p<0.001). There were no significant differences in total scores between groups at either visit (p>0.05). Additionally, no associations were found between ACSI-28 scores and concussion recovery outcomes when controlling for sex, race, history of depression/anxiety, and acute visit symptom severity (symptom resolution: B=0.06, p=0.62; FMC: B=0.09, p=0.46).

Conclusions

Only coping-related concentration skills from the ACSI-28 are impaired during the acute stage of concussion recovery but improve by the FMC visit. Other coping skills associated with the ACSI-28 remain unaffected throughout concussion recovery in college-aged individuals.

Context

Anterior cruciate ligament (ACL) injuries are prevalent in active populations, posing significant health risks. Despite advancements in surgery and rehabilitation, effectively preventing long-term health complications remains a significant challenge, underscoring the critical importance of developing effective ACL injury prevention strategies. Existing research into the risk of ACL injuries, in relation to lower extremity strength and demographic factors, often presents conflicting findings. These studies are frequently limited by small sample sizes or a narrow focus on specific muscle groups.

Objective

To explore the association between lower extremity strength, as measured by maximum voluntary isometric contraction (MVIC), demographic factors, and the risk of ACL injuries in a large sample of military cadets.

Design

Prospective Cohort Study

Setting

Military service academies

Patients or Other Participants

A total of 2,187 female and 3,432 male military cadets were recruited from three US military service academies.

Intervention(s)

Cadets underwent baseline testing in the summer prior to their freshman year. Testing included demographics and MVICs for six muscle groups including the quadriceps, hamstrings, gluteus maximus, gluteus medius, and hip internal and external rotators. Cadets were prospectively followed for primary ACL injury incidence, from date of enrollment to graduation from service academy.

Main Outcome Measure(s)

Multivariable logistic regression analyses were conducted to examine the association between MVIC values and primary ACL injury risk while controlling for demographic factors.

Results

There were 101 (38 females, 63 males) cadets that went on to sustain a primary ACL injury within their time at the academy. The results of this study found that greater gluteus maximus strength (OR = 0.32; P = 0.007) was associated with a decreased risk of ACL injury in military cadets. Cadets matriculating with higher BMI (OR = 1.09, P = 0.01) was associated with an increased risk of primary ACL injury in military cadets. All other factors were not statistically significant for predicting primary ACL injury risk.

Conclusion

This study suggests that greater gluteus maximus strength may have a protective effect against prospective ACL injury. Conversely, higher BMI appears to be a risk factor for prospective ACL injury. These findings may have important implications for the identification of at-risk individuals for targeted ACL injury prevention programs in military cadet populations.

Context

Diverse representation in athletic training leadership is essential for fostering inclusion and innovation in the profession. Despite efforts to enhance leadership diversity, disparities persist, underscoring the need to explore barriers to leadership and the effectiveness of leadership in meeting the needs of athletic trainers (ATs).

Objective

To examine racial and ethnic differences in ATs’ desire, pursuit, and attainment of leadership positions in the profession in addition to perceptions of current leadership effectiveness.

Design

Cross-sectional, web-based survey.

Participants

A purposeful sample of 1,173 racially and ethnically diverse ATs from an organized professional network followed by a random sample of 6,000 members of the National Athletic Trainers' Association (NATA). A total of 488 participants completed the survey for a 14.7% response rate.

Data Collection and Analysis

Data were collected via a web-based survey, including 7 demographic items, 4 Likert-scale items, and 5 open-ended questions. Independent samples Kruskal-Wallis tests, chi-square tests, and ANOVA tests were used to compare differences between subgroups, with pairwise testing conducted using the Bonferroni correction.

Results

Irrespective of race and ethnicity, most ATs expressed desire for and pursuit of leadership positions in the profession. 56.5% of ATs reported attaining such roles, primarily at departmental or institutional levels. African American ATs perceived greater barriers to attaining leadership positions due to their race and ethnicity and felt their needs were less met by current leadership as compared to white counterparts.

Conclusions

Systemic biases and in-group favoritism may impede attainment of leadership positions in athletic training organizations and influence perceptions of leadership effectiveness for racial and ethnic minority ATs. Consequently, there is a pressing need for intentional efforts to diversify leadership within athletic training and foster more inclusive leadership. Implementing strategies, such as diversifying selection processes and promoting allyship, are critical to ensuring equitable opportunities and advancing diversity within leadership.

Context:

Exertional heatstroke (EHS) is a leading cause of death in athletes and the warfighter. Polar Life Pod (PLP) and ice sheet cooling (ISC) are two of the more portable cooling techniques to treat EHS and show promise for treating patients when large volumes of water or immersion devices (e.g., tubs) are not available. “Ideal” cooling rates consistent with excellent EHS prognoses exceed 0.16°C/min while “acceptable” rates are between >0.08°C/min and 0.15°C/min. No research has compared the cooling effectiveness of the Polar Life Pod (PLP), a body bag-like device, to ISC following simulated military conditioning exercise.

Objective:

Determine if PLP or ISC reduced rectal temperature (T_REC) differently and at ‘acceptable’ or ‘ideal’ cooling rates.

Design:

Randomized, counterbalanced, crossover study

Setting:

Laboratory

Patients or Other Participants:

Fourteen participants (10 men, 4 women; age: 22±3y; mass:73.8±17.8kg; ht:168.5±7.8cm)

Interventions:

Participants donned a military uniform and rucksack and marched in the heat (temperature=∼37.5°C; relative humidity=∼40%) until T_REC was 39.5°C. Then they undressed and were wrapped in bed sheets presoaked in ice water (≤0.89±0.33°C) or lay in PLP filled with water (151.4±3.8L; 4.22±0.95°C) until T_REC was 38°C.

Main Outcome Measures:

T_REC and cooling durations; calculated T_REC cooling rates

Results:

Participants exercised in similar clothing, environmental conditions, and durations (PLP=50.5±9.9min, ISC=48.9±10.9min, P=0.38). PLP cooling rates differed from ISC and were ‘ideal’ whilst ISC rates were ‘acceptable’ (PLP=0.22±0.08°C/min; ISC=0.11±0.05°C/min, P<0.001).

Conclusions:

PLP lowered T_REC twice as quickly as ISC and at rates consistent with favorable EHS outcomes. PLP’s faster cooling rates were likely due to it utilizing conductive and convective cooling, treating a larger body surface area, and providing a larger heat sink than ISC. PLP and ISC can be utilized to treat EHS, but PLP is preferred because it reduced T_REC faster, utilized less ice, and required the same number of personnel and coolers as ISC.

Context

There is a need for evidence-based clinical care guidelines for perinatal athletes in the athletic training profession. Limited research on perinatal athletes, in science, exercise, and sports medicine has resulted in barriers to providing patient-centered care for this population.

Objectives

To inspire discussions of female-centric healthcare among athletic trainers to better understand patient values, encourage clinician collaboration and shared decision-making, promote equal representation of males and females in sports medicine research, advocate for safe and effective training guidelines for perinatal athletes, and establish organizational support for providing patient-centered care to pregnant and postpartum athletes.

Description

General guidelines have been established by the American College of Obstetricians and Gynecologists (ACOG) for recreational exercise, but most of the current literature in sports medicine is lacking recommendations for perinatal competitive and elite athletes. A call to action is required from athletic training education, clinical practice, research, and professional organizations.

Clinical and Research Advantages

Examining perinatal athletes’ needs will bring focus to a marginalized population in sports medicine. Comprehensive guidelines and practical coaching methods in the athletic training profession have the potential to improve the monitoring of perinatal health and patient outcomes.

Context

While researchers have previously identified that most athletic trainers (ATs) do not negotiate their salary, little is known about employers’ expectations and behaviors relative to establishing and negotiating salaries for the ATs they hire.

Objective

To examine employers’ expectations and behaviors regarding AT salary negotiation.

Design

Cross-sectional.

Setting

Web-based survey.

Patients or Other Participants

413 employers who are in a role that requires them to negotiate salary offers with prospective AT employees and who have minimally hired one AT into the organization they work for accessed the survey from a random sample of 7,000 ATs (6% access rate); 324 employers (age=43.8±10.6 years) completed the entire survey (78% completion rate).

Main Outcome Measure(s)

A validated survey was used to collect employer demographics, employment organization characteristics, and employer perspectives on negotiation. Chi-square analyses with Bonferonni adjustments were used to determine relationships between organizational factors or employer demographics on employers’ negotiation expectations and behaviors.

Results

67.3% of employers expect the candidate to negotiate their salary, and 66.3% reported they are provided the salary range by someone else from their organization. More employers of rurally-located organizations offer in the upper 1/3 of the available range when compared to suburban or urban settings (p=.014). Employers of public organizations also offer more in the upper 1/3 of the available salary range compared to private organizations (p=.025). More employers who were not healthcare providers have withdrawn an employment offer due to negotiation attempts (p=.005).

Conclusions

The lack of organizational influence on negotiation expectations indicates that negotiation attempts do not need to be tailored to specific work settings. ATs may need to adjust expectations when negotiating with publicly-funded or rurally-located organizations, as the offer may already be towards the upper end of the available range. Employers expect ATs to negotiate their salary when offered a position.

Context:

As an essential core competency for high-quality healthcare, health information technology (HIT) leverages the use of technology, such as electronic record systems, to collect and use patient care information to make informed clinical decisions. There is a dearth of information regarding professional athletic training students’ (ATSs’) use of HIT professional behaviors during clinical experiences.

Objective:

To assess HIT professional behaviors ATSs engage with during clinical experience patient encounters (PEs).

Design:

Multisite panel design.

Setting:

12 professional athletic training programs.

Participants:

363 ATSs enrolled across the participating professional athletic training programs entered patient encounter information within E*Value during their scheduled clinical experiences.

Data Collection and Analysis:

Characteristics of PEs (length of encounter, student role, clinical site type) were tracked in E*Value by students over three semesters. We used generalized estimating equation models to analyze the likelihood that students included HIT professional behaviors during 30,518 PEs.

Results:

Clinical site type (p=0.04), length of encounter (p<0.001), and student role (p<0.001) had the greatest influence on students’ documentation of PEs in electronic records systems; PEs occurring at the college/university setting, longer PEs, and full student autonomy increased the likely of this professional behavior. Length of encounter (p<0.001) and clinical site type (p<0.001) influenced students’ use of information documented in electronic records systems to assist with clinical decision-making; PEs longer than 60 minutes and PEs in the clinic setting increased this professional behavior likelihood.

Conclusions:

Since HIT is integral to providing high-quality patient care, and its use is developed and improved upon across the continuum of the professional career, program administrators and preceptors must seek out opportunities for students to engage in HIT behaviors during clinical experiences. Secondary school clinical sites, sites that typically have shorter patient encounters, and preceptors that offer less autonomy are most in need of intentional efforts toward HIT inclusion.

Context:

Patellar tendinopathy (PT) is a highly prevalent overuse injury in volleyball. However, little is known if and how the risk for developing PT is increased through fatigue-induced alterations during repetitive jump-landing activities in volleyball.

Objective:

The purpose of this study was to explore fatigue-induced risk factors for PT during a spike jump-landing task in volleyball.

Design:

Prospective cohort study.

Setting:

3D biomechanical laboratory screening.

Patients or Other Participants:

Seventy-nine adult, male volleyball players.

Main Outcome Measure(s):

At baseline (pre-season), 3D full-body kinematics and kinetics were collected while performing a spike jump before and after a volleyball-specific fatigue protocol. Throughout the season, players were followed for the occurrence of PT and survival analysis with competing risks was performed to identify significant predictors for the development of PT (p < 0.05).

Results:

During follow-up, 10 of the 79 players developed PT (13%). Players with significantly less hip flexion during the horizontal landing/push-off phase of the spike jump after fatigue were at higher risk for developing PT (HR = 0.898; 95% CI 0.826 to 0.977; p = 0.023) as well as players with a significantly more elongated rectus femoris muscle-tendon unit (HR = 3.258; 95% CI 1.136 to 9.343; p = 0.032).

Conclusions:

Despite the low (injured) sample size of this study, preliminary research findings indicate less hip flexion and more elongated rectus femoris muscle-tendon units during landing after fatigue as potential risk factors for developing PT. Future prevention programs for PT may wish to focus on hip-specific exercises and technique modifications (e.g., more hip flexion during landing) under fatigued circumstances.

Context:

Individuals after anterior cruciate ligament reconstruction (ACLR) participate in less physical activity compared to uninjured peers. Physical activity in this population is important for both short and long-term health, particularly to reduce the risk of chronic conditions (eg, obesity, osteoarthritis).

Objective:

The purpose of this study was to assess the feasibility and acceptability of implementing a walking program early after ACLR.

Design:

Explanatory Mixed Methods Study

Setting:

Telehealth

Patients or Other Participants:

Ten individuals (60% female, mean age 20.2 ± 3.9 years old, mean BMI 22.6 ± 2.9 kg/m² ) within 8 weeks of a unilateral ACLR

Intervention:

A 12-week personalized progressive walking program to increase daily steps utilizing weekly virtual visits with a physical therapist.

Main Outcome Measures:

Quantitative data included rates of appointment attendance, activity monitor wear compliance, adverse events, and achievement of daily step goals. Qualitative analysis of field notebooks collected throughout the intervention and semi-structured post intervention interviews were performed to explain the quantitative feasibility metrics using a case study approach.

Results:

Participants wore their activity monitor 92.3% of days, attended 94.2% of appointments, met their recommended physical activity goal 54.8% of days, and 50% of individuals reached their physical activity target at least 50% of weeks. No adverse events related to the walking program were reported. Program-level and participant-level themes that promoted successful physical activity goal achievement were identified.

Conclusions:

This study demonstrated mixed feasibility and acceptability of a progressive walking program early after ACLR. Participants demonstrated high adherence to wearing an activity monitor and completing weekly virtual physical activity program sessions. However, daily physical activity goals were only met approximately half of the time. Clinicians and researchers can use the themes identified from the qualitative analysis in future program designs to promote physical activity after ACLR.

Context:

The Open Landing Error Scoring System (OpenLESS) is a novel tool for automating the LESS to assess lower extremity movement quality during a jump-landing task. With the growing use of clinical measures to monitor outcomes and limited time during clinical visits, there is a need for automated systems. OpenLESS is an open-source tool that uses a markerless motion capture system to automate the LESS using 3D kinematics.

Objective:

To describe the development of OpenLESS, examine its validity against expert rater LESS scores in healthy and clinical cohorts, and assess its intersession reliability in an athlete cohort.

Design:

Cross-Sectional

Participants:

92 total adult participants from three distinct cohorts: a healthy university student cohort (12 males, 14 females; age=23.0±3.8 years; height=171.9±8.3 cm; mass=75.4±18.9 kg), a post-anterior cruciate ligament reconstruction (ACLR) cohort (8 males, 19 females; age=21.4±5.7 years, height=173.5±12.5 cm; mass=73.9±13.1 kg; median 33 months post surgery), and a field-based athlete cohort (39 females; age=25.0±4.7 years, height=165.0±7.1cm; mass=63.5±8.6kg).

Main Outcome Measures(s):

The OpenLESS software interprets movement quality from kinematics captured by markerless motion capture. Validity and reliability were assessed using intraclass correlation coefficients (ICC), standard error of measure (SEM), and minimal detectable change (MDC).

Results:

OpenLESS agreed well with expert rater LESS scores for healthy (ICC_2,k=0.79) and clinically relevant, post-ACLR cohorts (ICC_2,k=0.88). The automated OpenLESS system reduced scoring time, processing all 353 trials in under 25 minutes compared to the 35 hours (~6 minutes per trial) required for expert rater scoring. When tested outside laboratory conditions, OpenLESS showed excellent reliability across repeated sessions (ICC_2,k>0.89), with a SEM of 0.98 errors and MDC of 2.72 errors.

Conclusions:

OpenLESS is a promising, efficient tool for automated jump-landing assessment, demonstrating good validity in healthy and post-ACLR populations, and excellent field reliability, addressing the need for objective movement analysis.

Context:

Although the relationship between workload and injury incidence has recently gained attention, data on the acute-to-chronic workload ratio (ACWR) and injury incidence in Taekwondo remain unavailable.

Objective:

To report the injury incidence related to the categorized ACWR, calculated using the rolling average (RA) and exponentially weighted moving average (EWMA) methods, for musculoskeletal injuries in Taekwondo.

Design:

Descriptive epidemiologic study.

Setting:

Data were prospectively collected through Taekwondo training facilities and competition venues.

Patients or Other Participants:

A total of 110 collegiate Taekwondo players (58 females; 54 males) were studied over three consecutive seasons in 2020, 2021, and 2022.

Main Outcome Measures(s):

The traumatic and gradual onset of musculoskeletal injury (rate, body location, type, mechanism, and severity) and workloads (duration of training and competitions) were recorded. ACWRs for each injury were calculated using the RA and EWMA and categorized as either high (> 1.5), relatively high (1.3 – 1.5), moderate (0.8 – 1.3), or low (<0.8).

Results:

Of the 841 injuries (training: 16 per 1,000 hours; competition: 548 per 1,000 hours), the ankle (n=86/501, 17% in traumatic) and thigh (n=106/340, 31% in gradual onset) were the most predominantly injured body locations. Contusion (n=201/501, 40% in traumatic) and muscle cramps/spasm (n=201/501, 75% in gradual onset) were the most frequent injury types. Although the most predominant mechanism was overuse (n=331/841, 40%), 32% of the injuries (n=230/721) took > 28 days to recover from injury. The greatest number of traumatic (RA: n=224/501, 45%; EWMA: n=259/501; 52%) and gradual onset (RA: n=118/340, 35%; EWMA: n=165/340; 49%) injuries were recorded under the moderate ACWR.

Conclusions:

The moderate ACWR range (0.8 – 1.3), which was considered as the “sweet spot” in team sports, was calculated to be the “danger zone” in Taekwondo. The high injury risk related workload could be used for planning training schedules.

Objective:

Growing evidence has suggested clinical efficacy for the use of anodal transcranial direct current stimulation (atDCS) when combined with motor interventions in patients with chronic ankle instability (CAI). However, no studies have compared multiple approaches for improving motor function with atDCS in patients with CAI. We therefore aimed to determine the efficacy of atDCS over the motor or frontal cortex when combined with a four-week motor planning intervention on neural function, performance, and patient-reported outcomes in patients with CAI.

Design:

Double-blind, sham-controlled, parallel randomized control trial.

Methods:

Participants (n=44, 15 males, 29 females, 23.6±6.1 yrs) were assessed for outcome measures of cortical and reflexive excitability; performance measures of dynamic balance, muscle activation, reaction times, and cognitive performance on a dual-task balance test; and patient-reported outcome measures at baseline, mid-training (week 2), post-training (week 4), and retention (week 6). After baseline testing, participants were randomized to receive atDCS over the motor cortex, frontal cortex, or a sham current during rehabilitation exercises over four weeks. Participants reported for eight training sessions where they were instrumented for atDCS while performing obstacle walking, dual-task balance, and agility exercises. Analyses between groups and time points were performed with mixed linear models (α=0.05).

Results:

Forty-six individuals were recruited & randomized with 37 completing the investigation (motor=14, frontal=11, sham=12). No differences across groups or times were observed in neural excitability or muscle activation variables (P>0.05). Significant improvements in dynamic postural stability indices were observed from baseline across all groups (P<0.05). Improvements were observed for foot & ankle function, perceived disablement, and the Global Rating of Change at post-training and retention (p<0.001).

Conclusions:

Improvements in patient function were observed across all groups, suggesting the motor planning intervention improved function, regardless of atDCS application. Observing benefits from atDCS may be dependent on proper pairing of rehabilitation exercise with electrode location.

Context: Screening programs to identify negative ulnar nerve adaptations in throwing athletes can help minimize injury risk and individualize treatment programs prior to the onset of symptoms. However, it is currently unclear how the ulnar nerve structurally adapts chronically in professional baseball pitchers.

Objective: To compare ulnar nerve ultrasound structural characteristics between the throwing (dominant) and non-throwing control (non-dominant) elbows in professional pitchers, with a secondary purpose of comparing ultrasound structural characteristics between subluxating and non-subluxating ulnar nerves.

Design: Cross-sectional study.

Setting: The beginning of the 2022 Minor League Baseball spring training of a single professional baseball organization.

Participants: All asymptomatic professional baseball pitchers from a single organization.

Main Outcome Measures: Bilateral elbow ultrasound examinations by a musculoskeletal radiologist for subsequent image quantification of ulnar nerve properties (echogenicity, area, circularity), as well as to identify ulnar nerve subluxation.

Results: Overall, 67 male professional baseball pitchers were enrolled. No significant bilateral differences in ulnar nerve cross-sectional area (dominant: 0.2 cm² vs. non-dominant: 0.2 cm², p=0.4), echogenicity (137 pixel intensity vs. 128 pixel intensity, p=0.07), or circularity (0.67 vs. 0.69, p=0.4) were observed. Ulnar nerve echogenicity was significantly lower in subluxating dominant ulnar nerves compared to non-subluxating dominant ulnar nerves (127 pixel intensity vs. 143 pixel intensity, p=0.006), while no significant differences in ulnar nerve area (0.2 mm² vs. 0.2 mm², p=0.1) or circularity (0.68 vs. 0.66, p=0.4) were observed between groups.

Conclusions: The ulnar nerve of the throwing elbow had similar cross-sectional area, echogenicity, and circularity compared to the non-dominant ulnar nerve. Nerve echogenicity was significantly decreased in subluxating ulnar nerves, however further research is necessary to determine why this difference exists and the potential direction of causality.

Objectives: To compare strength parameters and pain ratings across three different positions for

isometric hip abduction and adduction strength testing.

Design: Cross-sectional study.

Setting: Two elite European football academies.

Participants: Male football players (n=188, mean age 15.5 ± 1.6) from the U14-U19 teams.

Methods: Isometric hip abduction and adduction were tested in 3 different positions on the ForceFrame: bent-leg with knees on pads, straight-leg with ankles on pads, and straight-leg with knees on pads. The order was randomised. The outcome measures were maximum isometric hip adduction and abduction strength (F_max), limb symmetry index (LSI), hip adduction-to-abduction strength ratio and hip/groin pain numeric rating scale (NRS).

Results: Correlation was moderate to high for F_max in hip adduction (r = 0.64 to 0.73) and abduction (r = 0.78 to 0.84), but low for LSI and strength ratios (r = 0.06 to 0.48). Pain was reported by 19% and 13% of players during adduction and abduction respectively, with the majority (11% and 10%) only reporting pain in one of the three positions.

Conclusions: The findings suggest that maximal strength values from the three test positions can be compared (i.e. using a conversion factor). The interchangeability of test positions is otherwise limited, due to inconsistent pain ratings and low correlation for LSI and strength ratios.

Context: Shoulder and elbow problems are common among athletes in overhead sports, making 7 it essential to understand the characteristics of active athletes with arm trouble to improve and prevent upper extremity disorders. The Kerlan-Jobe Orthopaedic Clinic (KJOC) Score is widely used to evaluate upper extremity functionality in this population.

Objective: (1) To compare the KJOC score between athletes with and without arm trouble in various overhead sports; and (2) to clarify the relationship between subjective competitive levels and functional characteristics using correlation analysis of the KJOC score questions.

Design: Cross-sectional study

Setting: College athletes from baseball, basketball, swimming, tennis, and track and field 15 throwing teams completed the KJOC score questionnaire. Participants were categorized into two groups based on their responses regarding current functional status: (1) playing without arm trouble (asymptomatic group) and (2) playing with arm trouble (symptomatic group).

Participants: 401 college athletes from overhead sports.

Main Outcome Measure(s): The Mann-Whitney U test was used to compare the overall KJOC scores and the scores of individual questions between symptomatic and asymptomatic groups. Spearman's rank correlation analysis determined the relationships between Q10 (subjective competitive level) and Q1-9 (upper extremity functionality).

Results: The symptomatic group had significantly lower KJOC scores than the asymptomatic group across all sports (P < 0.001). Several individual question scores also differed significantly between groups, although the specific questions varied by sport. Correlation analysis revealed the association between Q10 and other functional scores with sport-specific variations.

Conclusions: These findings demonstrate that impaired upper extremity function and its relationship to competition levels in athletes with arm trouble vary across different sports disciplines.

Context: Baseball is a popular sport in the United States, with widespread play among secondary school student-athletes. Baseball-related injuries may vary based on community-level socioeconomic status of schools.

Objective: To describe the injuries sustained by secondary school baseball players from schools categorized by community-level socioeconomic status.

Design: Cross-sectional study design.

Setting: Data (2014/15-2018/19 academic years) were obtained from the National Athletic Treatment, Injury, and Outcomes Network (NATION-SP)

Participants: Secondary school baseball athletes.

Main Outcome Measures: Frequencies and percentages of injuries, injury rates, and competition/practice injury rate ratios (IRR) were reported by the community-level socioeconomic status (ie, affluent, average wealth, disadvantaged) where each school is located.

Results: NATION-SP captured 320 baseball injuries across 140,619 total athlete exposures (AEs), for an overall injury rate of 2.4/1,000 AEs. Of those, 52% occurred among athletes in 24 schools situated in affluent communities, 15.6% occurred in 12 schools from average wealth communities, and 32.5% occurred in 12 schools located in disadvantaged communities. The largest injury rate was schools located in disadvantaged communities (3.3/1000 AE), followed by affluent (2.3/1000 AE) and average wealth (1.4/1000 AE) communities. On average, schools from affluent and disadvantaged communities had higher injury rates during competition than during practice (affluent: IRR=1.5, 95% CI=1.11, 2.05; disadvantaged: IRR=1.6, 95% CI=1.12, 2.41). Frequencies of many injury characteristics were consistent in schools across community-level socioeconomic status with contact, sprain/strain, and non-timeloss ranking highest in terms of injury mechanism, diagnosis, and time loss, respectively. Shoulder/clavicle was most frequent body part injured in schools in average and disadvantaged wealth communities, and ankle was most frequent in schools in affluent communities.

Conclusions: Baseball athletes playing in schools located in disadvantaged wealth communities had the largest overall injury rate, followed by schools in affluent, and average wealth communities. Across most injury characteristics, a consistent trend emerged regardless of community-level disadvantage, with the highest baseball injury rates resulting from contact mechanisms, diagnosed as sprains or strains, and classified as non-time- loss injuries. While many injury patterns are consistent across socioeconomic communities, examining injuries through the lens of community-levels of disadvantage provides insight into subtle differences that could information targeted prevention strategies or resource needs.

Context Lean sports, endurance running, have been at the forefront of disordered eating and body image research, particularly in female populations. Yet, little is known about how athletic men and women differ in body checking behaviors, a known risk factor for body dissatisfaction and disordered eating, across sport type and athletic status.

Objective The purpose of this study was to examine gender differences on measures of eating behavior and body checking between full-time collegiate student-athletes and nonathletes.

Design Cross-sectional study.

Setting NCAA DI collegiate athletics.

Participants Two-hundred fifty-nine full-time college students (n = 174 student-athletes, 85 nonathletes)

Main Outcome Measures Primary outcomes included self-reported disordered eating behavior and body checking behavior through the EAT-26 and the Body Checking Questionnaire (BCQ) and the Male BCQ (MBCQ). We explored differences based on sport type, team, individual, or nonathlete, and gender identity.

Results There was a statistically significant multivariate main effect of gender F(10, 464) = 9.219, p<0.001, 𝜂 ² = 0.166, and a significant multivariate interaction of gender and sport type F(15, 699) = 2.806, p=0.001, 𝜂 ² = 0.057. Follow-up comparisons for team sport athletes showed that women scored significantly higher (p<0.001) on the MBCQ compared to men. Women team sport athletes also scored significantly higher on the MBCQ than women nonathletes (p < 0.001). Conversely, nonathlete men scored significantly higher on the MBCQ than men team and individual sport athletes (p = 0.003 and p = 0.048, respectively).

Conclusions Findings suggest that body checking behaviors traditionally studied as masculine occur more frequently in women than men. This effect seems to be driven by women team sport athletes, who reported engaging in more body checking behaviors on the MBCQ than nonathletes. Therefore, assessments based on traditional views of maleness and femaleness may overlook significant risk factors for eating disorders (ED) in college athletes.

Clinical Problem: Implementation and sustainability of a clinical electronic medical record (EMR) allowing for multiple billable encounters in an athletic medicine practice.

Environment: Division-I collegiate athletics clinic.

Variables: For ATs to complete billable documentation clinicians must: use an electronic health record (EHR), understand and appropriately use Current Procedural Terminology (CPT) and International Classification of Diseases version 10 (ICD-10) codes, understand patient encounter types, Relative Value Units (RVUs), and the role of a service provider related to incident-to capability.

Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.

Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.

Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.

Findings: ATs were able to be reimbursed by some insurance companies. The use of the clinical EMR resulted in athletic trainers billing 13 CPT codes and insurance reimbursement as high as $38,000 per fiscal year in the 5 years since implementation.

Outcome: Documentation in a clinical-based record has standardized communication between members of the athletic medicine team, generated revenue, and is used as a tool to measure productivity and demonstrate the fiscal value of the athletic trainer.

Lessons Learned: ATs must buy-in to and understand the need to shift from an “athletic trainer specific EMR” to a clinical based EMR. Although the quantity of documentation does not change, the quality and structure of the notes must meet CMS guidelines. This significant change requires policy updates and demands that ATs in this system re-structure documentation practices. Creating a culture of growth is critical, allowing others to see that while this method is different, ATs can complete this level of documentation. (298 words)

Context:There is a 2-4x increased risk for musculoskeletal injury after concussion. A potential reason for the increased risk is aberrant biomechanics. The majority of prior research has focused on single-task biomechanics, but dual-task biomechanics may better represent athletic competition.

Objective:To compare (1) jump landing and cutting biomechanics, (2) dual-task cost cognitive outcomes, and (3) perceived task difficulty/demands under single- and dual- task conditions (no-counting, serial 3s, serial 7s) between individuals with and without a concussion history.

Design:Cross-sectional.

Setting:Biomechanics laboratory.

Participants:Twenty-three individuals with (age:20.2±1.9years, BMI:22.9±2.7kg/m², 60.9% female, 44.7 months [95% confidence interval=23.6, 65.7] post-concussion) and 23 individuals without (age: 20.7±1.7years, BMI: 22.4±2.3kg/m², 60.9% female) a concussion history participated.

Main Outcome Measures:Jump landing and cutting trunk lower extremity kinematics and kinetics under single- and dual-task conditions. Cognitive accuracy and response rate during dual-tasking. NASA Task Load Index questionnaire.

Results:During the jump landing, all participants exhibited a significantly faster reaction time during no counting versus serial 3s (p<0.001, Hedge’s g=1.187) and serial 7s (p<0.001, Hedge’s g=1.526). During the cutting, all participants exhibited a significantly faster reaction time during no counting versus serial 3s (p<0.001, Hedge’s g=0.910) and serial 7s (p<0.001, Hedge’s g=1.261), and serial 3s versus serial 7s (p=0.002, Hedge’s g=0.319). All participants reported lower task demands during jump landing and cutting for no counting versus serial 3s (p<0.001) and serial 7s (p<0.001), and serial 3s versus serial 7s (p<0.001).

Conclusion:Concussion history did not affect any of our outcomes, possibly because lingering biomechanical deficits may have resolved in our sample. Task demands did increase with increasing cognitive load, which may be beneficial for progressively manipulating the dual-task cognitive component during rehabilitation.

Scientific inquiry aims to minimize bias and ensure accurate conclusions. A critical yet often overlooked issue in sports medicine and exercise science research is the family-wise error rate (FWER) and experimental-wise error rate (EWER), which increase with multiple statistical

inferences, inflating the risk of Type I errors. While FWER corrections are standard in post-hoc ANOVA tests, they are inconsistently applied in broader research contexts. Using an example from our research team of over 67 million regression models, we illustrate how failing to correct for FWER can create spurious findings. Approximately 3 million (4.4%) models were

statistically significant (p<0.05), aligning with the expected false-positive rate. This underscores the necessity of solutions such as preregistration, false discovery rate control, and Bayesian approaches. Without proper corrections, erroneous conclusions may mislead clinical decision- making and potentially harm patients, highlighting the importance of rigorous statistical methods in evidence-based sports medicine.

Context:

Anterior cruciate ligament (ACL) tears represent a significant health and economic burden in high school athletes. Despite evidence showing lower extremity injury prevention programs (IPPs) are effective at preventing ACL injury, IPPs lack widespread adoption.

Objective:

Compare the cost-benefit of implementation of an injury prevention program versus standard warm-up in a national high school soccer population using a health system perspective.

Design:

Cost Benefit Analysis.

Setting:

Simulation of nationwide implementation of an IPP for United States high school soccer players.

Patients or Other Participants:

Data for high school soccer players from the 2018-2019 season.

Main Outcome Measure(s):

Return on investment was calculated using the cost of ACL treatment prevented with IPP use and the cost of IPP implementation.

Results:

IPP implementation was the preferred strategy with a return on investment of $7.51 saved in ACL treatment costs prevented for every dollar spent on IPP implementation in our full model. When separating analysis by insurance type, private payors continued to show profitability while public payors failed to break even. The total net monetary benefit was over $60 million when simulating national-level IPP implementation.

Conclusions:

IPP implementation has the potential to generate significant medical cost savings in short-term ACL treatment costs, especially for private payors, when implemented in a national high school soccer population. The expected cost-benefit of IPPs should encourage broader implementation efforts and the inclusion of economically relevant stakeholders.

Context: Recent studies exploring chronic ankle instability (CAI) have found alterations in cutaneous reflexes of musculature surrounding the ankle which may contribute to perceived instability and recurrent LAS seen in this population. CAI is considered a multifaceted condition, making it difficult to determine the underlying cause of these altered reflexes.

Objective: To observe how mechanical laxity of the ankle affects lower limb cutaneous reflexes and perceived instability during gait and how surgical intervention to correct laxity affects these measures.

Design: Clinical Case Report

Setting: Research Laboratory

Patient: A physically active 25-year-old female (64in;130lbs) with 7 previous lateral ankle sprains (LAS) and met CAI diagnostic criteria based on CAI questionnaire scores. The patient underwent a Broström reconstruction of the CFL via allograft and partial synovectomy.

Main Outcome Measures: CAI questionnaire scores, middle latency lower limb cutaneous reflexes, and perceived instability following sural nerve stimulation during gait.

Results: Post-surgery, the patient’s CAIT and FAAM questionnaire scores aligned with those of a healthy individual. PL reflexes were diminished or inhibitory during the stance phases of gait. Pronounced variability of PL reflexes may have contributed to this lack of facilitation. BF facilitation at midstance was absent during both testing sessions while BF and RF facilitation was generally reduced post-surgical intervention. The patient’s average perceived instability following sural stimulation was markedly reduced from the pre-surgical (6.5±0.48) to post-surgical (1.9±0.24) session.

Conclusions: Mechanical instability likely contributed to the reflex variations seen in this patient pre- surgically, while the enhanced static stability provided by the surgical procedure may have reduced the need for dynamic stability via lower limb cutaneous reflexes observed in the follow-up session. Identifying the specific limitations experienced by an individual with CAI will allow for a more effective monitoring and treatment and provide improved long-term health-related quality of life outcomes.

Context:

Social determinants of health are known to affect overall access to youth sports, however, it is not fully understood how multiple social determinants of health may impact access to school-based athletic training services.

Objective:

To determine the relationship between Social Vulnerability Index (SVI) scores on access to high school-based athletic trainers in California

Design:

Retrospective, cross-sectional study

Setting:

Online survey

Patients or Other Participants:

California Interscholastic Federation (CIF) high school respondents of the 2022-23 Participation Census

Main Outcome Measures:

Association between Social Vulnerability Index scores and access to school-based athletic trainer services

Methods:

This study uses data from CIF high school respondents of the 2022-23 Participation Census. School addresses were used to extract SVI scores from the U.S. Census Bureau. Separate multivariable logistic regressions and generalized linear mixed effects models assessed the relationships between access to school-based athletic training services and SVI scores at the census and county levels.

Results:

There were 1,598 respondent schools (65% public, 24% private, and 11% charter). 49% of schools reported having an athletic trainer, of which 41% were certified. Adjusted analyses revealed that increased vulnerability in household characteristics was associated with lower odds of access to athletic trainers and certified athletic trainers at both county (OR: 0.89 (95% CI: 0.80, 0.99); p = .04) and census tract levels (OR: 0.93 (95% CI: 0.89, 0.97); p = .002). Increased vulnerability in socioeconomic status was associated with lower odds of having an certified athletic trainer at the census tract level (OR: 0.94 (95% CI: 0.89, 0.98); p = .006), but not the county level (p = .16).

Conclusions:

Increased vulnerability in household characteristics is associated with decreased odds of access to high school-based athletic training services.

Context

Student-run health clinics (SRHC) are commonly utilized to provide clinical experiences to students in healthcare education programs as well as healthcare services to a target community. Recent reports on athletic training SRHCs (AT-SRHCs) with a client population of university students, employees and/or community members have reported positive patient outcomes and high patient satisfaction, however there is limited data about the treated conditions, services and value provided by AT-SRHC.

Objective

To track utilization of athletic training services at a free AT-SRHC.

Design

Retrospective chart review from September 2022-May 2024.

Setting

University-based AT-SRHC.

Patients

97 patients (52 males, 44 females, 1 not documented; age 32.6±13.7 years, range: 18-65 years old; 50 employees, 47 students).

Main Outcome Measures

Data were extracted from an electronic medical record and scheduling software. Variables extracted included patient demographics, appointment numbers, mechanism of injury, injured body part, days since injury, injury diagnosis, injury severity, and common procedural terminology (CPT) codes. Data were analyzed descriptively.

Results

Sixty-four percent (226/352) of available appointment sessions were reserved. The 3 most commonly injured body areas were the knee (n=26, 23.9%), shoulder (n=23, 21.1%), and thigh (n=13, 11.9%). The 3 most common diagnoses were sprains/strains (n=51, 46.8%), overuse conditions (e.g. epicondylitis, impingement, tendonitis; n=18, 16.5%), and nonspecific joint pain (n=22, 20.2%). The 3 most common CPT codes were for therapeutic exercise (n=136), athletic training evaluation (n=98), and manual therapy (n=78). Estimates for the total value of services range from $6,901 to $13,498 ($39.89-78.03 per session).

Conclusions

Services at an AT-SRHC were utilized by a small portion of the campus population during its first 2 years of operation. Data provides preliminary insight into AT-SRHC service utilization and value. Additional organizations may benefit from developing an AT-SRHC to provide access to affordable care and student clinical experiences.

Context:

Parents are key decisionmakers for 1 the health and wellness of their children. Despite the benefits of engaging in physical activity, parental concerns about concussion may create hesitancy towards sport participation. The magnitude of concussion-related anxiety perceptions and factors that influence these beliefs in parents of youth athletes are largely unknown.

Objective:

To determine the prevalence of concussion-related anxiety perceptions in parents of youth athletes and establish the associations among concussion-related anxiety and demographic variables (i.e., parent sex, parent concussion history, child concussion history, parent concussion education).

Design:

Cross-sectional paper survey.

Setting:

Youth sports.

Patients or Other Participants:

452 parents (60% female; mean age = 40.4±13.0 years) of youth athletes (8-14 years old) who participated in soccer, ice hockey, lacrosse, and football (i.e., higher concussion risk sports) in Pennsylvania and Michigan.

Main outcomes Measures:

Survey items were adapted from the Perceptions of Concussion Inventory for Athletes (PCI-A) to pertain to perceptions about their child. Parents also completed a demographic survey regarding concussion-related topics.

Results:

Overall, 73.2% of parents found the possibility of their child sustaining a concussion to be upsetting, 61.5% were fearful of their child sustaining a concussion, and 45.1% reported that the thought of their child having a concussion makes them feel anxious. Only 4.6% of parents suggested that concussions do not worry them. The lack of a personal concussion history and being female were associated with greater concussion-related anxiety in parents.

Conclusions:

This study provides evidence that parents of youth athletes have anxiety about their child sustaining a concussion, while also contributing to the understanding of what factors are related to such anxiety (i.e., female parent; no parent history of concussion). Negative parental concussion beliefs may contribute to the reduction in contact sport participation and should be directly addressed in concussion education specific to youth sport participation.

Context:

The importance of analyzing head impact exposure among football players is well established, yet few studies have explored the differences across position groups in high school athletes. Better understanding of these differences may provide optimized intervention strategies for coaches and healthcare providers.

Objective:

To quantify the difference of head impacts per exposure (Imp/E) and impact burden high school football player position groups.

Design:

Prospective observational.

Setting:

High school athletic fields during Fall sports seasons.

Patients and Participants:

200 football players from three high school varsity teams including 69 offensive/defensive linemen, 51 linebackers/running backs/tight ends and 80 cornerbacks/safeties/wide receivers (16.1±0.9yrs, 177.9±7.8cm, 86.4±22.7) categorized as linemen, backers, and skills players respectively.

Main Outcome Measures:

Imp/E across positions, teams, session type, and seasons. Cumulative head impact burden per location (front, top, right, left, back) across position groups.

Results:

Significant differences in Imp/E were found between position groups (P<0.001), where the backers group, (3.77[95% CI: 3.146, 4.395]) experienced higher total Imp/E compared to linemen (1.47[ 95% CI: 0.983, 1.96]) and skill players (1.56[95% CI: 1.11, 2.01]). Total accumulated burden of head impacts was significant (F(2,194) = 4.938, P<0.008), with backers (4622.85g’s [95% CI: 3077.43, 6168.27]) significantly (P=0.011) higher than linemen (2657.70g’s [95% CI: 2045.61, 3269.19 ]) and skill players (2875.7g’s [95% CI: 2216.38, 3535.01]) (P=0.022). Front location impact burden (F(2, 194) = 7.784, P<0.001) revealed backers (1606.24g’s [95% CI: 977.89, 2234.58]) also significantly (P=0.008) higher than both linemen (768.24g’s [95% CI: 433.84, 1102.64]) and skill players (567.75g’s [95% CI: 360.71, 774.78]) (P<0.001).

Conclusion:

Linebackers, tight ends, and running backs experienced more Imp/E and higher cumulative burden than other positions, which highlights the potential influence of specific positional requirements during football participation. Coaches and healthcare providers should be aware that a position’s role during play may directly relate to changes in head impact risk.

Objective:

Our aim was to perform a systematic review of Return-to-Learn literature with the intent of determining what items are necessary to form a comprehensive Return-to-Learn policy.

Data Sources:

We searched CINAHL, Embase, PubMed, Scopus, Google Scholar, and WorldWideScience.org using 25 search terms including return to learn, adolescents, concussion management, concussion AND children, concussion AND department of education, concussion AND secondary schools, concussion AND middle school, concussion AND primary school, concussion AND policy AND procedures, concussion AND 504 plans.

Study Selection:

Eligible studies were (i) published between 2009 and 2022; (ii) originally published in English in a peer-reviewed journal; (iii) have a full text available; (iv) discuss the K-12 population; (v) contain one of the following terms in the body of the document: Return to Learn, RTL, Return to School, Return to Classroom, or Return to Academics; (vi) identify RTL as a primary aim of the document.

Data Extraction:

The Qualitative Assessment and Review Instrument and JBI Meta-Analysis of Statistics Assessment and Review Instrument tools were used to extract data from eligible studies. Extraction occurred independently by two researchers.

Data Synthesis

Review yielded 32,766 articles, with 58 meeting inclusion criteria. Two qualitative themes and five subthemes aggregated with six quantitative narratives to produce five converged findings: 1) members and point person, 2) overcoming barriers to communication, 3) increasing concussion knowledge and training in the school system, 4) recommendations in the classroom, and 5) tackling the invisible injury.

Conclusions:

Less than one-third of included articles reported data from younger (K-8) cohorts, therefore, the converged findings represent significant facets of high school Return-to-Learn that stakeholders should embed into novel and revised state concussion legislation. Subsequent efforts should seek to appraise current state Return-to-Learn laws for existing use of evidence-based practice and begin accumulating data specific to younger students and school professionals that monitor and teach these individuals such that commensurate policy recommendations can then be made.

Objective

This research systematically assesses the effects of low-load blood flow restriction on the cross-education of muscle strength and volume, providing evidence-based guidance for clinicians and rehabilitation therapists.

Method

The literature search utilized databases such as PubMed, Web of Science, and Embase. Quality assessment employed the Cochrane Collaboration's RCT bias evaluation tool. Data synthesis, forest plot creation, and publication bias assessment were performed with Reman 5.4 software. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202440038.

Result

Six meta-analyses, encompassing 259 undergraduate students, were performed. Results indicated a markedly enhanced cross-education effect in muscle strength induction via blood flow restriction, surpassing that of traditional unilateral training and control groups. Nonetheless, the cross-education impact on muscle volume induction showed no notable variance among the groups.

Conclusion

Blood flow restriction has been shown to effectively induce cross-education in muscle strength. Nevertheless, additional research is required to determine its impact on muscle strength. Nevertheless, additional research is required to determine its impact on muscle volume cross-education. Reduced exercise intensity with blood flow restriction may augment neural activation, implying possible advantages in rehabilitative training for individuals with neurological conditions—meriting additional investigation.

Objective

To determine impairments on self-reported/performance-based function in individuals with patellofemoral pain (PFP) as well as physical and non-physical factors potentially related with these impairments.

Data sources

We searched MEDLINE, Embase, CINAHL, Web of Science, and SPORTDiscus databases from inception until January 2024.

Study selection

We included studies comparing self-reported/performance-based measures of function between individuals with PFP and their pain-free limbs or pain-free individuals.

Data extraction

Two independent researchers extracted the key information from each study.

Data synthesis

We performed meta-analyses for each self-reported/performance-based measure of function and meta-regressions to identify factors that might explain meta-analyses outcomes. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included 83 studies (2807 individuals with PFP and 2518 pain-free individuals). We identified very low to high certainty evidence that individuals with PFP have reduced self-reported (large effect sizes, standardized mean difference [SMD], -1.99; 95% confidence interval [CI]:-2.41,-1.57 to SMD, -4.87; 95% CI:-6.97,-2.77) and performance-based (small to large effect sizes: SMD, -.30; 95% CI:-.58, -.02 to SMD, -1.21; 95% CI:-2.71, -.29) measures of function compared to pain-free individuals, but there are no differences between limbs in individuals with unilateral PFP for the most of performance-based measures of function (small to moderate effect sizes, SMD, -.20; 95% CI:-.68, .27 to SMD, -.49; 95% CI:-1.02, .03). Age, body mass index, duration of symptoms and self-reported pain did not significantly explain self-reported function, whereas age did not significantly explain performance-based function (R2 25 <.01 to .02, p =.145 to .914).

Conclusion

Our results highlight the negative impact of PFP on self-reported and performance- based function, which seems to also affect the pain-free limb. Self-reported and performance- based measures of function should be considered when assessing individuals with PFP. None of the factors investigated explained impaired self-reported and performance-based function.

Context

Athletic trainers (ATs) can manage nonurgent, musculoskeletal emergency department (ED) visits. Little is known about what populations are most likely to use the ED for nonurgent, sports-related musculoskeletal injuries.

Objective

Our object is to provide national-level evidence on whether high-school age population with public insurance or lower socioeconomic status were more likely to have ED visits for nonurgent injuries.

Design

Cross-sectional study.

Setting

Secondary data analysis of the 2017-2019 Nationwide Emergency Department Sample (NEDS).

Patients or Other Participants

ED visits for high school-age patients with a sports-related musculoskeletal injury.

Main Outcome Measures

We used a multi-step process and AT scope of care threshold to classify ED visits for musculoskeletal injuries as urgent and nonurgent. National estimates of the proportions of visit, patient, and hospital characteristics by urgent, nonurgent, and total injury ED visits were reported. Survey weighted logistic regression was used to calculate odds ratios of an ED visit being for a nonurgent injury based on a patient s insurance type and socioeconomic status.

Results

For ED visits for musculoskeletal injuries in a high school-age, sports exposed population, 52.93% (95% CI: 51.11, 54.73) were for nonurgent injuries. Patients with public insurance were more likely (OR = 1.39; 95% CI: 1.35, 1.44) to have an ED visit for a nonurgent injury compared to ED visits for patients with private insurance. Patients from the lowest estimated neighborhood income quartiles were more likely (OR = 1.10; 95% CI: 1.02, 1.20) to have an ED visit for a nonurgent injury compared to ED visits for patients in the highest estimated income quartile.

Conclusions

Our results suggest opportunities to reduce nonurgent ED use using AT services exist, especially in high school-age athletes from vulnerable populations.

Context

Knee joint effusion and quadriceps strength and activation deficits are common consequences of anterior cruciate ligament (ACL) injury and reconstruction. The presence of an effusion may initiate or worsen the quadriceps dysfunction present after ACL trauma. In simulated effusion studies, evidence indicates an inverse relationship between effusion size and quadriceps dysfunction. While this relationship was not found in patients after ACL injury, prior research was limited by a subjective clinical assessment of effusion grade.

Objective

The purpose of this study was to determine if the size of the knee joint effusion, measured via ultrasound, after ACL injury and reconstruction influences quadriceps strength and activation.

Design

Descriptive Laboratory Study.

Setting

Research Laboratory.

Patients or Other Participants

41 individuals (23 females, age=21.8±7.5years, height =171.7±7.9cm, 15 mass =72.3±14.2kg), with an ACL injury reported for 2 sessions [one before 16 reconstruction and one ∽16 weeks after ACL reconstruction].

Main Outcome Measure

Three ultrasound images of the suprapatellar pouch and three trials of quadriceps strength and activation using the interpolated twitch technique were gathered from the ACL knee. Effusion cross-sectional area was measured using ImageJ, averaged and inputted into linear regression models to predict muscle strength and interpolated twitch activation. Analyses were considered significant at p≤0.05.

Results

No relationship was found between effusion size and strength (R² = 0.086) or activation (R²=0.056) after ACL injury (p>0.05). After reconstruction, however, there was a small negative relationship between effusion size 24 and activation (R²=0.122; Standardized β=−0.349; p=0.025), while no relationship was found for effusion size and strength (R²=0.000; p≤0.05).

Conclusions

The size of the effusion after ACL injury does not influence strength or activation. However, after ACL reconstruction, effusion size does have a small influence on quadriceps activation, with a larger effusion being related to lower activation. Prior research using simulated effusions appear to overestimate the effects of effusion on quadriceps function.

Context

Lower extremity joint (LE) kinematics during landing tasks are important predictors of injury risk and performance outcomes in athletes.

Objective

To establish sex-related differences and normative ranges for LE kinematics during the jump-landing task in a large cohort of healthy military service academy cadets.

Design

Cross-Sectional Study.

Setting

US Air Force, Naval, and Military Academies.

Participants

5308 cadets (2062 females [38.8%]).

Main Outcome Measure(s)

Sex-related differences in LE kinematics were analyzed using independent samples t-tests. Mean differences (MD) and effect sizes (d) were reported for interpretability. Normative ranges for hip and knee joint angles were established separately for males and females at initial contact (IC) and 50% of the stance phase.

Results

Compared to males, moderate effect sizes (d ≥ .5) were observed for knee external rotation (negative value) where females displayed greater motion at IC and at 50% stance (MD: - 3.9˚ and -5.0˚, respectively, p < .001). The following findings were of small effect size (.2 ≥ d > .5). Females exhibited less knee and hip flexion at IC (MD: -1.8˚ and -0.5˚, respectively, p < .001) and at 50% stance (MD: -4.1˚ and -4.6˚, respectfully, p < .001). This was accompanied by females having greater knee valgus (negative value) and hip adduction at IC (MD: -2.2˚ and 1.06˚, respectively, p < .001) and at 50% stance (MD: -3.2˚ and 1.8˚, respectfully, p < .001).

Conclusion

This study establishes normative ranges for LE kinematics during the jump-landing task in a large cohort of healthy military service academy cadets entering their first year. Sex- related differences in LE kinematics were observed, highlighting the importance of considering sex as a factor in the evaluation of lower extremity movement quality and management of injury risk.