bluuebunny/crossref_metadata_2025 huggingface dataset:
Rotator Cuff Fatigue and Glenohumeral Kinematics in Participants Without Shoulder Dysfunction
Authors: Teyhen Deydre S. , Miller Joseph M. , Middag Tansy R. , Kane Edward J.
Published: December 2009

Context:

Researchers have established that superior migration of the humeral head increases after fatigue of the rotator cuff muscles. In these studies, the investigators used imaging techniques to assess migration of the humeral head during statically held shoulder positions. Their results may not represent the amount of superior humeral head migration that occurs during dynamic arm elevation.

Objective:

To investigate the effect of rotator cuff fatigue on humeral head migration during dynamic concentric arm elevation (arm at the side [approximately 0°] to 135°) in healthy individuals and to determine the test-retest reliability of digital fluoroscopic video for assessing glenohumeral migration.

Design:

Test-retest cohort study.

Setting:

Research laboratory.

Patients or Other Participants:

Twenty men (age  =  27.7 ± 3.6 years, mass  =  81.5 ± 11.8 kg) without shoulder disorders participated in this study.

Intervention(s):

Three digital fluoroscopic videos (2 prefatigue and 1 postfatigue) of arm elevation were collected at 30 Hz. The 2 prefatigue arm elevation trials were used to assess test-retest reliability with the arm at the side and at 45°, 90°, and 135° of elevation. The prefatigue and postfatigue digital fluoroscopic videos were used to assess the effects of rotator cuff fatigue on glenohumeral migration. All measurements were taken in the right shoulder.

Main Outcome Measure(s):

The dependent measure was glenohumeral migration (in millimeters). We calculated the intraclass correlation coefficient and standard error of the measurement to assess the test-retest reliability. A 2 × 4 repeated-measures analysis of variance was used to assess the effects of fatigue on arm elevation at the 4 shoulder positions.

Results:

The test-retest reliability ranged from good to excellent (.77 to .92). Superior migration of the humeral head increased postfatigue (P < .001), regardless of angle.

Conclusions:

Digital fluoroscopic video assessment of shoulder kinematics provides a reliable tool for studying kinematics during arm elevation. Furthermore, superior migration of the humeral head during arm elevation increases with rotator cuff fatigue in individuals without shoulder dysfunction.
Professional Role Complexity and Job Satisfaction of Collegiate Certified Athletic Trainers
Authors: Brumels Kirk , Beach Andrea
Published: December 2009

Context:

Whenever professionals have multiple role obligations in the workplace, they face potential professional role complexities.

Objective:

To examine whether certified athletic trainers (ATs) employed at the collegiate level experienced professional role complexities, and if so, what effect those complexities had upon their job satisfaction and intent to leave a current position or the profession.

Design:

Survey.

Setting:

We used Internet survey methods to gather information from 1000 randomly selected collegiate ATs regarding the amount of stress they felt due to role complexities.

Patients or Other Participants:

We obtained a random sample of e-mail addresses for 1000 collegiate ATs in the United States and contacted these individuals with an invitation to participate. A total of 348 usable responses were received, for a 36% response rate.

Main Outcome Measure(s):

The role complexity aspect of the survey consisted of 45 questions addressing role ambiguity, role overload, role incongruity, role incompetence, and role conflict. The job satisfaction portion consisted of global questions regarding overall job satisfaction and intent to leave the job or profession.

Results:

A total of 38% of respondents experienced moderate to high stress levels from role overload, whereas 23% and 22% had moderate to high levels of stress from role ambiguity and role conflict, respectively. Clinicians and joint appointees who reported moderate to high levels of stress from role complexity issues had lower job satisfaction and more frequent thoughts of leaving than did their faculty counterparts.

Conclusions:

The majority of collegiate ATs experienced low levels of professional role complexities and were relatively satisfied with their jobs. However, collegiate ATs began to experience less job satisfaction and more thoughts of leaving when moderate to high stress levels occurred due to role ambiguity, overload, incongruity, incompetence, and conflict. Lessening the stress due to role complexities is critical to positive employment experiences for ATs employed in higher education.
The Role of Legitimation in the Professional Socialization of Second-Year Undergraduate Athletic Training Students
Authors: Klossner Joanne
Published: December 2009

Context:

Professional socialization during formal educational preparation can help students learn professional roles and can lead to improved organizational socialization as students emerge as members of the occupation's culture. Professional socialization research in athletic training is limited.

Objective:

To present the role of legitimation and how it influences the professional socialization of second-year athletic training students.

Design:

Modified constructivist grounded theory and case study methods were used for this qualitative study.

Setting:

An accredited undergraduate athletic training education program.

Patients or Other Participants:

Twelve second-year students were selected purposively. The primary sample group (n  =  4) was selected according to theoretical sampling guidelines. The remaining students made up the cohort sample (n  =  8). Theoretically relevant data were gathered from 14 clinical instructors to clarify emergent student data.

Data Collection and Analysis:

Data collection included document examination, observations, and interviews during 1 academic semester. Data were collected and analyzed through constant comparative analysis. Data triangulation, member checking, and peer-review strategies were used to ensure trustworthiness.

Results:

Legitimation from various socializing agents initiated professional socialization. Students viewed trust and team membership as rewards for role fulfillment.

Conclusions:

My findings are consistent with the socialization literature that shows how learning a social or professional role, using rewards to facilitate role performance, and building trusting relationships with socializing agents are important aspects of legitimation and, ultimately, professional socialization.
Evaluation of Athletic Training Students' Clinical Proficiencies
Authors: Walker Stacy E. , Weidner Thomas G. , Armstrong Kirk J.
Published: December 2009

Context:

Appropriate methods for evaluating clinical proficiencies are essential in ensuring entry-level competence.

Objective:

To investigate the common methods athletic training education programs use to evaluate student performance of clinical proficiencies.

Design:

Cross-sectional design.

Setting:

Public and private institutions nationwide.

Patients or Other Participants:

All program directors of athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of January 2006 (n  =  337); 201 (59.6%) program directors responded.

Data Collection and Analysis:

The institutional survey consisted of 11 items regarding institutional and program demographics. The 14-item Methods of Clinical Proficiency Evaluation in Athletic Training survey consisted of respondents' demographic characteristics and Likert-scale items regarding clinical proficiency evaluation methods and barriers, educational content areas, and clinical experience settings. We used analyses of variance and independent t tests to assess differences among athletic training education program characteristics and the barriers, methods, content areas, and settings regarding clinical proficiency evaluation.

Results:

Of the 3 methods investigated, simulations (n  =  191, 95.0%) were the most prevalent method of clinical proficiency evaluation. An independent-samples t test revealed that more opportunities existed for real-time evaluations in the college or high school athletic training room (t189  =  2.866, P  =  .037) than in other settings. Orthopaedic clinical examination and diagnosis (4.37 ± 0.826) and therapeutic modalities (4.36 ± 0.738) content areas were scored the highest in sufficient opportunities for real-time clinical proficiency evaluations. An inadequate volume of injuries or conditions (3.99 ± 1.033) and injury/condition occurrence not coinciding with the clinical proficiency assessment timetable (4.06 ± 0.995) were barriers to real-time evaluation. One-way analyses of variance revealed no difference between athletic training education program characteristics and the opportunities for and barriers to real-time evaluations among the various clinical experience settings.

Conclusions:

No one primary barrier hindered real-time clinical proficiency evaluation. To determine athletic training students' clinical proficiency for entry-level employment, athletic training education programs must incorporate standardized patients or take a disciplined approach to using simulation for instruction and evaluation.
Mechanisms of Noncontact Anterior Cruciate Ligament Injury
Authors: Shimokochi Yohei , Shultz Sandra J.
Published: December 2009

Objective:

To examine and summarize previous retrospective and observational studies assessing noncontact anterior cruciate ligament (ACL) injury mechanisms and to examine such reported ACL injury mechanisms based on ACL loading patterns due to knee loadings reported in in vivo, in vitro, and computer simulation studies.

Data Sources:

We searched MEDLINE from 1950 through 2007 using the key words anterior cruciate ligament + injury + mechanisms; anterior cruciate ligament + injury + mechanisms + retrospective; and anterior cruciate ligament + injury + mechanisms + video analysis.

Study Selection:

We selected retrospective studies and observational studies that specifically examined the noncontact ACL injury mechanisms (n  =  7) and assessed ACL loading patterns in vivo, in vitro, and using computer simulations (n  =  33).

Data Extraction:

The motion patterns reported as noncontact ACL injury mechanisms in retrospective and observational studies were assessed and critically compared with ACL loading patterns measured during applied external or internal (or both) forces or moments to the knee.

Data Synthesis:

Noncontact ACL injuries are likely to happen during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension. Higher ACL loading during the application of a quadriceps force when combined with a knee internal rotation moment compared with an external rotation moment was noted. The ACL loading was also higher when a valgus load was combined with internal rotation as compared with external rotation. However, because the combination of knee valgus and external rotation motions may lead to ACL impingement, these combined motions cannot be excluded from the noncontact ACL injury mechanisms. Further, excessive valgus knee loads applied during weight-bearing, decelerating activities also increased ACL loading.

Conclusions:

The findings from this review lend support to ACL injury prevention programs designed to prevent unopposed excessive quadriceps force and frontal-plane or transverse-plane (or both) moments to the knee and to encourage increased knee flexion angle during sudden deceleration and acceleration tasks.
A Systematic Review of Prophylactic Braces in the Prevention of Knee Ligament Injuries in Collegiate Football Players
Authors: Pietrosimone Brian G. , Grindstaff Terry L. , Linens Shelley W. , Uczekaj Elizabeth , Hertel Jay
Published: December 2009

Objective:

To determine the relative risk reduction associated with prophylactic knee braces in the prevention of knee injuries in collegiate football players.

Data Sources:

An exhaustive search for original research was performed using the PubMed, SportDiscus, and CINAHL databases from 1970 through November 2006, with the search terms knee brace, knee braces, knee bracing and football, prophylactic brace, and prophylactic knee braces.

Study Selection:

Seven studies comparing knee injuries among braced and nonbraced collegiate football players were included. Study methods were assessed using the Physiotherapy Evidence Database (PEDro) scale. PEDro scores ranged from 2 to 5.

Data Extraction:

The number of participants and frequency of knee injuries were used to calculate the relative risk reduction or increase.

Data Synthesis:

We found a relative risk reduction for 3 studies with point estimates of 10% (36% to −26%), 58% (25% to 76%), and 56% (13% to 77%). Four studies demonstrated an increased risk of injury, with point estimates of 17% (19% to −71%), 49% (−31% to −69%), 114% (23% to −492%), and 42% (−18% to −70%).

Conclusions:

Data from existing research are inconsistent. Based on a Strength of Recommendation Taxonomy level of evidence of 2 with a grade B recommendation, we cannot conclusively advocate or discourage the use of prophylactic knee braces in the prevention of knee injuries in collegiate football players.
Return of Postural Control to Baseline After Anaerobic and Aerobic Exercise Protocols
Authors: Fox Zachary G. , Mihalik Jason P. , Blackburn J. Troy , Battaglini Claudio L. , Guskiewicz Kevin M.
Published: December 2009

Context:

With regard to sideline concussion testing, the effect of fatigue associated with different types of exercise on postural control is unknown.

Objective:

To evaluate the effects of fatigue on postural control in healthy college-aged athletes performing anaerobic and aerobic exercise protocols and to establish an immediate recovery time course from each exercise protocol for postural control measures to return to baseline status.

Design:

Counterbalanced, repeated measures.

Setting:

Research laboratory.

Patients Or Other Participants:

Thirty-six collegiate athletes (18 males, 18 females; age  =  19.00 ± 1.01 years, height  =  172.44 ± 10.47 cm, mass  =  69.72 ± 12.84 kg).

Intervention(s):

Participants completed 2 counterbalanced sessions within 7 days. Each session consisted of 1 exercise protocol followed by postexercise measures of postural control taken at 3-, 8-, 13-, and 18-minute time intervals. Baseline measures were established during the first session, before the specified exertion protocol was performed.

Main Outcome Measure(s):

Balance Error Scoring System (BESS) results, sway velocity, and elliptical sway area.

Results:

We found a decrease in postural control after each exercise protocol for all dependent measures. An interaction was noted between exercise protocol and time for total BESS score (P  =  .002). For both exercise protocols, all measures of postural control returned to baseline within 13 minutes.

Conclusions:

Postural control was negatively affected after anaerobic and aerobic exercise protocols as measured by total BESS score, elliptical sway area, and sway velocity. The effect of exertion lasted up to 13 minutes after each exercise was completed. Certified athletic trainers and clinicians should be aware of these effects and their recovery time course when determining an appropriate time to administer sideline assessments of postural control after a suspected mild traumatic brain injury.
Electromyography of 3 Scapular Muscles: A Comparative Analysis of The Cuff Link Device and a Standard Push-Up
Authors: Tucker W. Steven , Campbell Brian M. , Swartz Erik E. , Armstrong Charles W.
Published: December 2009

Context:

The Cuff Link is a closed kinetic chain rehabilitation apparatus for the upper extremity. Limited research has established its effectiveness to elicit muscle activation of the scapular muscles.

Objective:

To determine if scapular muscle activation differs in response to 2 upper extremity closed kinetic chain exercises: Cuff Link and standard push-up.

Design:

A single-group, repeated-measures design.

Setting:

Controlled laboratory.

Patients or Other Participants:

Twenty-eight healthy individuals (13 women: age  =  19.69 ± 1.55 years, height  =  167.44 ± 9.52 cm, mass  =  61.00 ± 8.79 kg; 15 men: age  =  22.00 ± 3.91 years, height  =  181.44 ± 6.60 cm, mass  =  82.36 ± 13.23 kg) with no history of shoulder or low back injury volunteered to participate in this study.

Intervention(s):

Participants performed 10 trials of complete revolutions on the Cuff Link and 10 full–weight-bearing push-ups. We controlled trial velocity and randomized order. Trunk and shoulder positions were normalized to the participant's height. Using surface electromyography, we recorded muscle activity of the serratus anterior, middle trapezius, and lower trapezius. Rectified and smoothed electromyography data for the serratus anterior, middle trapezius, and lower trapezius were normalized as a percentage of the maximal voluntary isometric contractions (%MVIC).

Main Outcome Measure(s):

Mean muscle activity of the serratus anterior, middle trapezius, and lower trapezius. We used paired-samples t tests to analyze the mean data for each condition. The α level was adjusted to .016 to avoid a type I error.

Results:

Middle trapezius %MVIC was greater during push-ups (27.01 ± 20.40%) than during use of the Cuff Link (11.49 ± 9.46%) (P  =  .001). Lower trapezius %MVIC was greater during push-ups (36.07 ± 18.99%) than during use of the Cuff Link (16.29 ± 8.64%) (P  =  .001). There was no difference in %MVIC for the serratus anterior between conditions.

Conclusions:

The push-up demonstrated greater middle trapezius and lower trapezius activation levels compared with the Cuff Link. However, the push-up had a high participant failure rate. Because serratus anterior activation levels were similar, the Cuff Link may be an appropriate alternative for individuals lacking the upper body strength to perform a push-up.
Initial Reliability of The Standardized Orthopedic Assessment Tool (SOAT)
Authors: Lafave Mark R. , Katz Larry , Donnon Tyrone , Butterwick Dale J.
Published: December 2009

Context:

Orthopaedic assessment skills are critical to the success of athletic therapists and trainers. The Standardized Orthopedic Assessment Tool (SOAT) has been content validated.

Objective:

To establish interrater reliability of the SOAT.

Patients or Other Participants:

Thirty-two college students, 10 raters, and 2 standardized patients (SPs) from Calgary, Alberta, Canada.

Design:

Randomized observational study.

Intervention(s):

Students were allowed 30 minutes to complete a mock orthopaedic assessment of an SP with an injury specific to a region of the body (shoulder, knee, or ankle). Using the region-specific SOAT, raters and SPs evaluated students' orthopaedic assessment skills.

Main Outcome Measure(s):

The sum totals of the SOAT for 2 raters and 1 SP were used to calculate each student's performance scores for respective scenarios. Scale reliability analysis (Cronbach α) was completed on the SOAT for each of the 3 body-region examinations.

Results:

The mean overall reliability of 3 SOATs (ie, ankle, knee, and shoulder) was positive: α  =  .85 with the SP scores factored into the equation and α  =  .86 without the SP scores factored into the equation. Reliability for the ankle region was highest (α  =  .91), followed by the knee (α  =  .83) and the shoulder (α  =  .82).

Conclusions:

The study sample size was small, but the results will enable further study with generalization to a broader audience of athletic therapists and athletic trainers. Because a baseline measure of reliability was established using a robust statistical analysis, future researchers can employ more stringent statistical analysis and focus on the effects of various pedagogical techniques to teach and learn the underlying construct of clinical competence in orthopaedic assessment.
Nutrition Concepts for Elite Distance Runners Based on Macronutrient and Energy Expenditure
Authors: Schröder Sandra , Fischer Alexandra , Vock Christina , Böhme Mike , Schmelzer Constance , Döpner Myriam , Hülsmann Olaf , Döring Frank
Published: December 2009

Context:

Elite distance runners (EDR) must optimize their nutrition to maintain their demanding training schedules.

Objective:

To develop a nutrition concept for EDR based on energy and macronutrient expenditures.

Design:

This theoretical study provides calculations for macronutrient and energy expenditures of EDR. Anthropometric and metabolic characteristics of EDR were assumed based on average real EDR.

Setting:

University of Kiel.

Patients Or Other Participants:

Three prototypic types of male EDR described in the literature as type I (TI; body mass  =  72 kg, respiratory quotient  =  0.9 at rest, fast-twitch muscle fibers  =  60% to 70%), type II (TII; body mass  =  67 kg, respiratory quotient  =  0.82 at rest, fast-twitch muscle fibers  =  50%), and type III (TIII; body mass  =  60 kg, respiratory quotient  =  0.75 at rest, fast-twitch muscle fibers  =  30% to 40%).

Main Outcome Measure(s):

We calculated the macronutrient and energy expenditures of the 3 types of EDR according to body mass, respiratory quotient, and percentage of fast-twitch muscle fibers.

Results:

We found that the average energy expenditure was 3750 kcal · d−1 for TI runners, 3463 kcal · d−1 for TII runners, and 3079 kcal · d−1 for TIII runners. The carbohydrate (CHO) expenditure reached an average value of 10.0 g · kg−1 · d−1 for TI runners, 8.0 g · kg−1 · d−1 for TII runners, and 4.7 g · kg−1 · d−1 for TIII runners. When the EDR accomplished running sessions at a pace ≥100% of maximum oxygen consumption, all types of runners had a CHO demand of about 10 g · kg−1 · d−1. The TI and TII runners need a CHO intake of 8 to 10 g · kg−1 · d−1. For the TIII runners, a CHO intake >6 g · kg−1 · d−1 is necessary during anaerobic training sessions.

Conclusions:

Nutrition concepts must be differentiated for EDR according to metabolic and anthropometric characteristics of the runners and their special training emphases.
Work-Family Conflict, Part I: Antecedents of Work-Family Conflict in National Collegiate Athletic Association Division I-A Certified Athletic Trainers
Authors: Mazerolle Stephanie M. , Bruening Jennifer E. , Casa Douglas J.
Published: December 2009

Context:

Work-family conflict (WFC) involves discord that arises when the demands of work interfere with the demands of family or home life. Long work hours, minimal control over work schedules, and time spent away from home are antecedents to WFC. To date, few authors have examined work-family conflict within the athletic training profession.

Objective:

To investigate the occurrence of WFC in certified athletic trainers (ATs) and to identify roots and factors leading to quality-of-life issues for ATs working in the National Collegiate Athletic Association Division I-A setting.

Design:

Survey questionnaire and follow-up, in-depth, in-person interviews.

Setting:

Division I-A universities sponsoring football.

Patients or Other Participants:

A total of 587 ATs (324 men, 263 women) responded to the questionnaire. Twelve ATs (6 men, 6 women) participated in the qualitative portion: 2 head ATs, 4 assistant ATs, 4 graduate assistant ATs, and 2 AT program directors.

Data Collection and Analysis:

Multiple regression analysis was performed to determine whether workload and travel predicted levels of WFC. Analyses of variance were calculated to investigate differences among the factors of sex, marital status, and family status. Interviews were transcribed verbatim and then analyzed using computer software as well as member checks and peer debriefing. The triangulation of the data collection and multiple sources of qualitative analysis were utilized to limit potential researcher prejudices.

Results:

Regression analyses revealed that long work hours and travel directly contributed to WFC. In addition to long hours and travel, inflexible work schedules and staffing patterns were discussed by the interview participants as antecedents to WFC. Regardless of sex (P  =  .142), marital status (P  =  .687), family status (P  =  .055), or age of children (P  =  .633), WFC affected Division I-A ATs.

Conclusions:

No matter their marital or family status, ATs employed at the Division I-A level experienced difficulties balancing their work and home lives. Sources of conflict primarily stemmed from the consuming nature of the profession, travel, inflexible work schedules, and lack of full-time staff members.
Work-Family Conflict, Part II: Job and Life Satisfaction in National Collegiate Athletic Association Division I-A Certified Athletic Trainers
Authors: Mazerolle Stephanie M. , Bruening Jennifer E. , Casa Douglas J. , Burton Laura J.
Published: December 2009

Context:

Previous researchers have shown that work-family conflict (WFC) affects the level of a person's job satisfaction, life satisfaction, and job burnout and intentions to leave the profession. However, WFC and its consequences have not yet been fully investigated among certified athletic trainers.

Objective:

To investigate the relationship between WFC and various outcome variables among certified athletic trainers working in National Collegiate Athletic Association Division I-A settings.

Design:

A mixed-methods design using a 53-item survey questionnaire and follow-up in-depth interviews was used to examine the prevalence of WFC.

Setting:

Division I-A universities sponsoring football.

Patients or Other Participants:

A total of 587 athletic trainers (324 men, 263 women) responded to the questionnaire, and 12 (6 men, 6 women) participated in the qualitative portion of the mixed-methods study.

Data Collection and Analysis:

We calculated Pearson correlations to determine the relationship between WFC and job satisfaction, life satisfaction, and job burnout. Regression analyses were run to determine whether WFC was a predictor of job satisfaction, job burnout, or intention to leave the profession. Interviews were transcribed verbatim and then analyzed using the computer program N6 as well as member checks and peer debriefing.

Results:

Negative relationships were found between WFC and job satisfaction (r  =  −.52, P < .001). Positive were noted between WFC and job burnout (r  =  .63, P < .001) and intention to leave the profession (r  =  .46, P < .001). Regression analyses revealed that WFC directly contributed to job satisfaction (P < .001), job burnout (P < .001), and intention to leave the profession (P < .001).

Conclusions:

Overall, our findings concur with those of previous researchers on WFC and its negative relationships to job satisfaction and life satisfaction and positive relationship to job burnout and intention to leave an organization. Sources of WFC, such as time, inflexible work schedules, and inadequate staffing, were also related to job burnout and job dissatisfaction in this population.
Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach
Authors: Hubbard Tricia J. , Hicks-Little Charlie A.
Published: December 2009

Objective:

To perform a systematic review to determine the healing time of the lateral ankle ligaments after an acute ankle sprain.

Data Sources:

We identified English-language research studies from 1964 to 2007 by searching MEDLINE, Physiotherapy Evidence Database (PEDro), SportDiscus, and CINAHL using the terms ankle sprain, ankle rehabilitation, ankle injury, ligament healing, and immobilization.

Study Selection:

We selected studies that described randomized, controlled clinical trials measuring ligament laxity either objectively or subjectively immediately after injury and at least 1 more time after injury.

Data Extraction:

Two reviewers independently scored the 7 studies that met the inclusion criteria. Because of differences in study designs, a meta-analysis could not be performed. Effect sizes and confidence intervals could be calculated only for 1 study. The percentages of subjective and objective instability were calculated for the remaining studies.

Data Synthesis:

Ankle laxity improved over a period of 6 weeks to 1 year. One author showed stress talar tilt values of 16.10 ± 8.8° immediately after injury and 3.4 ± 3.6° at 3 months after injury. In 2 articles, the authors reported that positive anterior drawer tests were still present in 3% to 31% of participants at 6 months after injury. Additionally, feelings of instability affected 7% to 42% of participants up to 1 year after injury.

Conclusions/Recommendations:

In the studies that we examined, it took at least 6 weeks to 3 months before ligament healing occurred. However, at 6 weeks to 1 year after injury, a large percentage of participants still had objective mechanical laxity and subjective ankle instability. Direct comparison among articles is difficult because of differences in methods. More research focusing on more reliable methods of measuring ankle laxity is needed so that clinicians can know how long ligament healing takes after injury. This knowledge will help clinicians to make better decisions during rehabilitation and for return to play.
Longitudinal Assessment of Noncontact Anterior Cruciate Ligament Injury Risk Factors During Maturation in a Female Athlete: A Case Report
Authors: Myer Gregory D. , Ford Kevin R. , Divine Jon G. , Wall Eric J. , Kahanov Leamor , Hewett Timothy E.
Published: December 2009

Objective:

To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury.

Background:

In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured.

Differential Diagnosis:

Partial or complete tear of the ACL.

Measurements:

The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort.

Findings:

The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth.

Conclusions:

During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.
Thigh Muscle Activity, Knee Motion, and Impact Force During Side-Step Pivoting in Agility-Trained Female Basketball Players
Authors: Wilderman Danielle R. , Ross Scott E. , Padua Darin A.
Published: December 2009

Context:

Improving neuromuscular control of hamstrings muscles might have implications for decreasing anterior cruciate ligament injuries in females.

Objective:

To examine the effects of a 6-week agility training program on quadriceps and hamstrings muscle activation, knee flexion angles, and peak vertical ground reaction force.

Design:

Prospective, randomized clinical research trial.

Setting:

Sports medicine research laboratory.

Patients or Other Participants:

Thirty female intramural basketball players with no history of knee injury (age  =  21.07 ± 2.82 years, height  =  171.27 ± 4.66 cm, mass  =  66.36 ± 7.41 kg).

Intervention(s):

Participants were assigned to an agility training group or a control group that did not participate in agility training. Participants in the agility training group trained 4 times per week for 6 weeks.

Main Outcome Measure(s):

We used surface electromyography to assess muscle activation for the rectus femoris, vastus medialis oblique, medial hamstrings, and lateral hamstrings for 50 milliseconds before initial ground contact and while the foot was in contact with the ground during a side-step pivot maneuver. Knee flexion angles (at initial ground contact, maximum knee flexion, knee flexion displacement) and peak vertical ground reaction force also were assessed during this maneuver.

Results:

Participants in the training group increased medial hamstrings activation during ground contact after the 6-week agility training program. Both groups decreased their vastus medialis oblique muscle activation during ground contact. Knee flexion angles and peak vertical ground reaction force did not change for either group.

Conclusions:

Agility training improved medial hamstrings activity in female intramural basketball players during a side-step pivot maneuver. Agility training that improves hamstrings activity might have implications for reducing anterior cruciate ligament sprain injury associated with side-step pivots.
Dynamic Valgus Alignment and Functional Strength in Males and Females During Maturation
Authors: Schmitz Randy J. , Shultz Sandra J. , Nguyen Anh-Dung
Published: December 2009

Context:

Sex differences in dynamic measures have been established in physically mature populations. Gaining information on maturation's effect on dynamic performance measures implicated in injury risk may enable us to better design injury prevention programs.

Objective:

To examine sex differences in dynamic valgus alignment and triple-hop distance measures across maturational stages in males and females. A secondary purpose was to determine if a field test of strength and power predicts dynamic valgus alignment.

Design:

Cross-sectional study.

Setting:

Laboratory.

Patients or Other Participants:

157 young athletes (78 females, 79 males) aged 9 to 18 years.

Intervention(s):

Subjects performed drop-jump landings and single-leg triple-hop tests as part of a broader injury screening.

Main Outcome Measure(s):

Maturational status was ascertained from self-report questionnaires and grouped according to Tanner stages 1 and 2 (MatGrp1), 3 and 4 (MatGrp2), and 5 (MatGrp3). Frontal-plane knee valgus displacement, which served as a measure of dynamic valgus alignment, and single-leg triple-hop distance were assessed.

Results:

Males demonstrated less dynamic valgus alignment during drop jumps in the latter maturational stages (MatGrp1  =  13.1° ± 8.7°, MatGrp2  =  9.0° ± 6.2°, MatGrp3  =  9.2° ± 9.4°), whereas females increased dynamic valgus alignment throughout maturation (MatGrp1  =  11.5° ± 6.9°, MatGrp2  =  12.8° ± 8.8°, MatGrp3  =  15.5° ± 8.7°). Thus, in the more mature groups, males had less dynamic valgus alignment than females. Both males (MatGrp1  =  393.5 ± 63.7 cm, MatGrp2  =  491.8 ± 95.1 cm, MatGrp3  =  559.3 ± 76.3 cm) and females (MatGrp1  =  360.3 ± 37.1 cm, MatGrp2  =  380.1 ± 44.3 cm, MatGrp3  =  440.0 ± 66.2 cm) increased triple-hop distance, but males increased more. Within each subgroup of MatGrp and sex, triple-hop distance had no predictive ability for dynamic malalignment.

Conclusions:

When dynamic valgus alignment and strength were assessed, sex and maturational status displayed an interaction. However, functional strength did not predict degree of dynamic valgus alignment.
The Relationships Among Sagittal-Plane Lower Extremity Moments: Implications for Landing Strategy in Anterior Cruciate Ligament Injury Prevention
Authors: Shimokochi Yohei , Yong Lee Sae , Shultz Sandra J. , Schmitz Randy J.
Published: December 2009

Context:

Excessive quadriceps contraction with insufficient hamstrings muscle cocontraction has been shown to be a possible contributing factor for noncontact anterior cruciate ligament (ACL) injuries. Assessing the relationships among lower extremity internal moments may provide some insight into avoiding muscle contraction patterns that increase ACL injury risk.

Objective:

To examine the relationships of knee-extensor moment with ankle plantar-flexor and hip-extensor moments and to examine the relationship between knee moment and center of pressure as a measure of neuromuscular response to center-of-mass position.

Design:

Cross-sectional study.

Setting:

Applied Neuromechanics Research Laboratory.

Patients or Other Participants:

Eighteen healthy, recreationally active women (age  =  22.3 ± 2.8 years, height  =  162.5 ± 8.1 cm, mass  =  57.8 ± 9.3 kg).

Intervention(s):

Participants performed a single-leg landing from a 45-cm box onto a force plate. Kinetic and kinematic data were collected.

Main Outcome Measure(s):

Pearson product moment correlation coefficients were calculated among the net peak knee-extensor moment (KEMpk), sagittal-plane ankle (AM) and hip (HM) net internal moments, and anterior-posterior center of pressure relative to foot center of mass at KEMpk (COP).

Results:

Lower KEMpk related to both greater AM (r  =  −0.942, P < .001) and HM (r  =  −0.657, P  =  .003). We also found that more anterior displacement of COP was related to greater AM (r  =  −0.750, P < .001) and lower KEMpk (r  =  0.618, P  =  .006).

Conclusions:

Our results suggest that participants who lean the whole body forward during landing may produce more plantar-flexor moment and less knee-extensor moment, possibly increasing hip-extensor moment and decreasing knee-extensor moment production. These results suggest that leaning forward may be a technique to decrease quadriceps contraction demand while increasing hamstrings cocontraction demand during a single-leg landing.
Pregame Urine Specific Gravity and Fluid Intake by National Basketball Association Players During Competition
Authors: Osterberg Kristin L. , Horswill Craig A. , Baker Lindsay B.
Published: December 2009

Context:

Urine specific gravity (USG) has been used to estimate hydration status in athletes on the field, with increasing levels of hypohydration indicated by higher USG measurements (eg, greater than 1.020). Whether initial hydration status based on a urine measure is related to subsequent drinking response during exercise or athletic competition is unclear.

Objective:

To determine the relationship between pregame USG and the volume of fluid consumed by players in a professional basketball game.

Design:

Cross-sectional study.

Setting:

Basketball players were monitored during Summer League competition.

Patients or Other Participants:

Players (n  =  29) from 5 teams of the National Basketball Association agreed to participate.

Main Outcome Measure(s):

Pregame USG was measured for each player on 2 occasions. Athletes were given ad libitum access to fluid during each game and were unaware of the purpose of the study. Volume of fluid intake was measured for each player. To assess sweat loss, athletes were weighed in shorts before and after each game.

Results:

Sweat loss ranged from 1.0 to 4.6 L, with a mean sweat loss of 2.2 ± 0.8 L. Fluid intake ranged from 0.1 to 2.9 L, with a mean fluid intake of 1.0 ± 0.6 L. Pregame USG was greater than 1.020 in 52% of the urine samples collected and was not correlated with fluid volume consumed during either of the games (r  =  0.15, P  =  .48, and r  =  0.15, P  =  .52, respectively).

Conclusions:

Approximately half of the players began the games in a hypohydrated state, as indicated by USG. Fluid intake during the game did not compensate for poor hydration status before competition. Furthermore, sweat losses in these players during games were substantial (greater than 2 L in approximately 20 minutes of playing time). Therefore, both pregame and during-game hydration strategies, such as beverage availability and player education, should be emphasized.
Personal and Environmental Characteristics Predicting Burnout Among Certified Athletic Trainers at National Collegiate Athletic Association Institutions
Authors: Kania Michelle L. , Meyer Barbara B. , Ebersole Kyle T.
Published: December 2009

Context:

Recent research in the health care professions has shown that specific personal and environmental characteristics can predict burnout, which is a negative coping strategy related to stressful situations. Burnout has been shown to result in physiologic (eg, headaches, difficulty sleeping, poor appetite), psychological (eg, increased negative self-talk, depression, difficulty in interpersonal relationships), and behavioral (eg, diminished care, increased absenteeism, attrition) symptoms.

Objective:

To examine the relationship between selected personal and environmental characteristics and burnout among certified athletic trainers (ATs).

Design:

Cross-sectional survey.

Setting:

A demographic survey that was designed for this study and the Maslach Burnout Inventory–Human Services Survey.

Patients or Other Participants:

A total of 206 ATs employed at National Collegiate Athletic Association (NCAA) institutions as clinical ATs volunteered.

Main Outcome Measure(s):

We assessed personal and environmental characteristics of ATs with the demographic survey and measured burnout using the Maslach Burnout Inventory–Human Services Survey. Multiple regression analyses were performed to examine relationships between specific personal and environmental characteristics and each of the 3 subscales of burnout (emotional exhaustion, depersonalization, personal accomplishment).

Results:

Most ATs we surveyed experienced low to average levels of burnout. Personal characteristics predicted 45.5% of the variance in emotional exhaustion (P < .001), 21.5% of the variance in depersonalization (P < .001), and 24.8% of the variance in personal accomplishment (P < .001). Environmental characteristics predicted 16.7% of the variance in emotional exhaustion (P  =  .005), 14.4% of the variance in depersonalization (P  =  .024), and 10.4% of the variance in personal accomplishment (P  =  .209). Stress level and coaches' pressure to medically clear athletes predicted ratings on all 3 subscales of burnout.

Conclusions:

Our findings were similar to those of other studies of burnout among NCAA Division I ATs, coaches, and coach-teachers. The results also support the Cognitive-Affective Model of Athletic Burnout proposed by Smith. Finally, these results indicate new areas of concentration for burnout research and professional practice.
Recently Certified Athletic Trainers' Undergraduate Educational Preparation in Psychosocial Intervention and Referral
Authors: Stiller-Ostrowski Jennifer Lynn , Ostrowski John A.
Published: December 2009

Context:

“Psychosocial Intervention and Referral” is one of the 12 content areas established by the National Athletic Trainers' Association Education Council and is required to be taught in athletic training education programs (ATEPs). The perceived preparation of athletic trainers (ATs) in this content area has not been evaluated.

Objective:

To explore the preparation level of recently certified ATs within the content area of “Psychosocial Intervention and Referral.”

Design:

Qualitative design involving semistructured, in-depth, focus group interviews.

Setting:

Interviews were conducted at 2 National Collegiate Athletic Association Division I institutions in 2 regions of the United States.

Patients or Other Participants:

A total of 11 recently certified ATs who met predetermined criteria were recruited. The ATs represented a range of undergraduate ATEPs and current employment settings.

Data Collection and Analysis:

Focus group interviews were transcribed verbatim and analyzed deductively. Peer debriefing and member checks were used to ensure trustworthiness.

Results:

The ATEPs are doing an adequate job of preparing ATs for many common communication and interpersonal issues, but ATs report being underprepared to deal with athlete-related issues in the areas of motivation and adherence, counseling and social support, mental skills training, and psychosocial referral.

Conclusions:

Limitations of undergraduate ATEPs regarding preparation of athletic training students within the “Psychosocial Intervention and Referral” content area were identified, with the goal of improving athletic training education. The more we know about the issues that entry-level ATs face, the more effectively we can structure athletic training education.
Shoulder Injuries Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years
Authors: Bonza John E. , Fields Sarah K. , Yard Ellen E. , Dawn Comstock R.
Published: December 2009

Context:

The shoulder is one of the most commonly injured body sites among athletes. Little previous research describes shoulder injury patterns in high school athletes.

Objective:

To describe and compare shoulder injury rates and patterns among high school athletes in 9 sports (football, soccer, basketball, baseball, and wrestling for boys and soccer, volleyball, basketball, and softball for girls).

Design:

Prospective injury surveillance study.

Setting:

Injury data were collected from 100 nationally representative US high schools via High School Reporting Information Online.

Patients or Other Participants:

Athletes from participating high schools injured while involved in a school-sanctioned practice or competition in 1 of the above sports during the 2005–2006 and 2006–2007 school years.

Main Outcome Measure(s):

Shoulder injury rates, diagnoses, severity, and mechanisms.

Results:

During the 2005–2006 and 2006–2007 school years, athletes in this study sustained 805 shoulder injuries during 3 550 141 athlete-exposures (AEs), for an injury rate of 2.27 shoulder injuries per 10 000 AEs. This corresponds to an estimated 232 258 shoulder injuries occurring nationwide during this time. Shoulder injuries were more likely to occur during competition than practice (rate ratio  =  3.01, 95% confidence interval  =  2.62, 3.46). Shoulder injury rates per 10 000 AEs were highest in football (5.09), wrestling (4.34), and baseball (1.90). Common shoulder injury diagnoses included sprains/strains (39.6%), dislocations/separations (23.7%), contusions (11.5%), and fractures (6.6%). Although 44.8% of athletes sustaining a shoulder injury returned to play in less than 1 week, 22.9% were out of play for more than 3 weeks, and 6.2% of shoulder injuries required surgery. Common mechanisms of shoulder injury included player-to-player contact (57.6%) and contact with the playing surface (22.8%).

Conclusions:

High school shoulder injury rates and patterns varied by sport. Continued surveillance is warranted to understand trends and patterns over time and to develop and evaluate evidence-based preventive interventions.