bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity and Reliability of Limits-of-Stability Testing: A Comparison of 2 Postural Stability Evaluation Devices
Authors: Pickerill Marie L. , Harter Rod A.
Published: March 2017

Context: A lack of published comparisons between measures from commercially available computerized posturography devices and the outcome measures used to define the limits of stability (LOS) makes meaningful interpretation of dynamic postural stability measures difficult.

Objectives: To compare postural stability measures between and within devices to establish concurrent and construct validity and to determine test-retest reliability for LOS measures generated by the NeuroCom Smart Balance Master and the Biodex Balance System.

Design: Cross-sectional study.

Setting: Controlled research laboratory.

Patients or Other Participants: A total of 23 healthy participants with no vestibular or visual disabilities or lower limb impairments.

Intervention(s): The LOS were assessed during 2 laboratory test sessions 1 week apart.

Main Outcome Measure(s): Three NeuroCom LOS variables (directional control, endpoint excursion, and movement velocity) and 2 Biodex LOS variables (directional control, test duration).

Results: Test-retest reliability ranged from high to low across the 5 LOS measures (intraclass correlation coefficient [2,k] = 0.82 to 0.48). Pearson correlations revealed 4 significant relationships (P < .05) between and within the 2 computerized posturography devices (r = 0.42 to −0.65).

Conclusions: Based on the wide range of intraclass correlation values we observed for the NeuroCom measures, clinicians and researchers alike should establish the reliability of LOS testing for their own clinics and laboratories. The low to moderate reliability outcomes observed for the Biodex measures were not of sufficient magnitude for us to recommend using the LOS measures from this system as the gold standard. The moderate Pearson interclass correlations we observed suggest that the Biodex and NeuroCom postural stability systems provided unique information. In this study of healthy participants, the concurrent and construct validity of the Biodex and NeuroCom LOS tests were not definitively established. We recommend that this study be repeated with a clinical population to further explore the matter.
Functional Ankle Instability and Health-Related Quality of Life
Authors: Arnold Brent L. , Wright Cynthia J. , Ross Scott E.
Published: March 2017

Context: To our knowledge, no authors have assessed health-related quality of life (HR-QOL) in participants with functional ankle instability (FAI). Furthermore, the relationships between measures of ankle functional limitation and HR-QOL are unknown.

Objective: To use the Short Form–36v2 Health Survey (SF-36) to compare HR-QOL in participants with or without FAI and to determine whether HR-QOL was related to functional limitation.

Design: Cross-sectional study.

Setting: Sports medicine research laboratory.

Patients or Other Participants: Sixty-eight participants with FAI (defined as at least 1 lateral ankle sprain and 1 episode of giveway per month) or without FAI were recruited (FAI group: n = 34, age = 25 ± 5 years, height = 1.71 ± 0.08 m, mass = 74.39 ± 12.78 kg, Cumberland Ankle Instability Tool score = 19.3 ± 4; uninjured [UI] group: n = 34, age = 23 ± 4 years, height = 1.69 ± 0.08 m, mass = 67.94 ± 11.27 kg, Cumberland Ankle Instability Tool score = 29.4 ± 1).

Main Outcome Measure(s): All participants completed the SF-36 as a measure of HR-QOL and the Foot and Ankle Ability Measure (FAAM) and the FAAM Sport version (FAAMS) as assessments of functional limitation. To compare the FAI and UI groups, we calculated multiple analyses of variance followed by univariate tests. Additionally, we correlated the SF-36 summary component scale and domain scales with the FAAM and FAAMS scores.

Results: Participants with FAI had lower scores on the SF-36 physical component summary (FAI = 54.4 ± 5.1, UI = 57.8 ± 3.7, P = .005), physical function domain scale (FAI = 54.5 ± 3.8, UI = 56.6 ± 1.2, P = .004), and bodily pain domain scale (FAI = 52.0 ± 6.7, UI = 58.5 ± 5.3, P < .005). Similarly, participants with FAI had lower scores on the FAAM (FAI = 93.7 ± 8.4, UI = 99.5 ± 1.4, P < .005) and FAAMS (FAI = 84.5 ± 8.4, UI = 99.8 ± 0.72, P < .005) than did the UI group. The FAAM score was correlated with the physical component summary scale (r = 0.42, P = .001) and the physical function domain scale (r = 0.61, P < .005). The FAAMS score was correlated with the physical function domain scale (r = 0.47, P < .005) and the vitality domain scale (r = 0.36, P = .002).

Conclusions: Compared with UI participants, those with FAI had less HR-QOL and more functional limitations. Furthermore, positive correlations were found between HR-QOL and functional limitation measures. This suggests that ankle impairment may reduce overall HR-QOL.
Incidence of Injuries in High School Softball and Baseball Players
Authors: Shanley Ellen , Rauh Mitchell J. , Michener Lori A. , Ellenbecker Todd S.
Published: March 2017

Context: Participation in high school sports has grown 16.1% over the last decade, but few studies have compared the overall injury risks in girls' softball and boys' baseball.

Objective: To examine the incidence of injury in high school softball and baseball players.

Design: Cohort study.

Setting: Greenville, South Carolina, high schools.

Patients or Other Participants: Softball and baseball players (n = 247) from 11 high schools.

Main Outcome Measure(s): Injury rates, locations, types; initial or subsequent injury; practice or game setting; positions played; seasonal trends.

Results: The overall incidence injury rate was 4.5/1000 athlete-exposures (AEs), with more injuries overall in softball players (5.6/1000 AEs) than in baseball players (4.0/1000 AEs). Baseball players had a higher initial injury rate (75.9/1000 AEs) than softball players (66.4/1000 AEs): rate ratio (RR) = 0.88, 95% confidence interval (CI) = 0.4, 1.7. The initial injury rate was higher than the subsequent injury rate for the overall sample (P < .0001) and for softball (P < .0001) and baseball (P < .001) players. For both sports, the injury rate during games (4.6/1000 AEs) was similar to that during practices (4.1/1000 AEs), RR = 1.22, 95% CI = 0.7, 2.2. Softball players were more likely to be injured in a game than were baseball players (RR = 1.92, 95% CI = 0.8, 4.3). Most injuries (77%) were mild (3.5/1000 AEs). The upper extremity accounted for the highest proportion of injuries (63.3%). The incidence of injury for pitchers was 37.3% and for position players was 15.3%. The rate of injury was highest during the first month of the season (7.96/1000 AEs).

Conclusions: The incidence of injury was low for both softball and baseball. Most injuries were minor and affected the upper extremity. The injury rates were highest in the first month of the season, so prevention strategies should be focused on minimizing injuries and monitoring players early in the season.
Approved Clinical Instructors' Perspectives on Implementation Strategies in Evidence-Based Practice for Athletic Training Students
Authors: Hankemeier Dorice A. , Van Lunen Bonnie L.
Published: March 2017

Context: Understanding implementation strategies of Approved Clinical Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice.

Objective: To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students.

Design: Qualitative study.

Setting: Telephone interviews.

Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed.

Data Collection and Analysis: We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data.

Results: The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP.

Conclusions: Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking.
Preferences for and Barriers to Formal and Informal Athletic Training Continuing Education Activities
Authors: Armstrong Kirk J. , Weidner Thomas G.
Published: March 2017

Context: Our previous research determined the frequency of participation and perceived effect of formal and informal continuing education (CE) activities. However, actual preferences for and barriers to CE must be characterized.

Objective: To determine the types of formal and informal CE activities preferred by athletic trainers (ATs) and barriers to their participation in these activities.

Design: Cross-sectional study.

Setting: Athletic training practice settings.

Patients or Other Participants: Of a geographically stratified random sample of 1000 ATs, 427 ATs (42.7%) completed the survey.

Main Outcome Measure(s): As part of a larger study, the Survey of Formal and Informal Athletic Training Continuing Education Activities (FIATCEA) was developed and administered electronically. The FIATCEA consists of demographic characteristics and Likert scale items (1 = strongly disagree, 5 = strongly agree) about preferred CE activities and barriers to these activities. Internal consistency of survey items, as determined by Cronbach α, was 0.638 for preferred CE activities and 0.860 for barriers to these activities. Descriptive statistics were computed for all items. Differences between respondent demographic characteristics and preferred CE activities and barriers to these activities were determined via analysis of variance and dependent t tests. The α level was set at .05.

Results: Hands-on clinical workshops and professional networking were the preferred formal and informal CE activities, respectively. The most frequently reported barriers to formal CE were the cost of attending and travel distance, whereas the most frequently reported barriers to informal CE were personal and job-specific factors. Differences were noted between both the cost of CE and travel distance to CE and all other barriers to CE participation (F1,411 = 233.54, P < .001).

Conclusions: Overall, ATs preferred formal CE activities. The same barriers (eg, cost, travel distance) to formal CE appeared to be universal to all ATs. Informal CE was highly valued by ATs because it could be individualized.
Hip Muscle Activity During 3 Side-Lying Hip-Strengthening Exercises in Distance Runners
Authors: McBeth Joseph M. , Earl-Boehm Jennifer E. , Cobb Stephen C. , Huddleston Wendy E.
Published: March 2017

Context:

Lower extremity overuse injuries are associated with gluteus medius (GMed) weakness. Understanding the activation of muscles about the hip during strengthening exercises is important for rehabilitation.

Objective:

To compare the electromyographic activity produced by the gluteus medius (GMed), tensor fascia latae (TFL), anterior hip flexors (AHF), and gluteus maximus (GMax) during 3 hip-strengthening exercises: hip abduction (ABD), hip abduction with external rotation (ABD-ER), and clamshell (CLAM) exercises.

Design:

Controlled laboratory study.

Setting:

Laboratory.

Patients or Other Participants:

Twenty healthy runners (9 men, 11 women; age = 25.45 ± 5.80 years, height = 1.71 ± 0.07 m, mass = 64.43 ± 7.75 kg) participated.

Intervention(s):

A weight equal to 5% body mass was affixed to the ankle for the ABD and ABD-ER exercises, and an equivalent load was affixed for the CLAM exercise. A pressure biofeedback unit was placed beneath the trunk to provide positional feedback.

Main Outcome Measure(s):

Surface electromyography (root mean square normalized to maximal voluntary isometric contraction) was recorded over the GMed, TFL, AHF, and GMax.

Results:

Three 1-way, repeated-measures analyses of variance indicated differences for muscle activity among the ABD (F3,57 = 25.903, P<.001), ABD-ER (F3,57 = 10.458, P<.001), and CLAM (F3,57 = 4.640, P=.006) exercises. For the ABD exercise, the GMed (70.1 ± 29.9%), TFL (54.3 ± 19.1%), and AHF (28.2 ± 21.5%) differed in muscle activity. The GMax (25.3 ± 24.6%) was less active than the GMed and TFL but was not different from the AHF. For the ABD-ER exercise, the TFL (70.9 ± 17.2%) was more active than the AHF (54.3 ± 24.8%), GMed (53.03 ± 28.4%), and GMax (31.7 ± 24.1 %). For the CLAM exercise, the AHF (54.2 ± 25.2%) was more active than the TFL (34.4 ± 20.1%) and GMed (32.6 ± 16.9%) but was not different from the GMax (34.2 ± 24.8%).

Conclusions:

The ABD exercise is preferred if targeted activation of the GMed is a goal. Activation of the other muscles in the ABD-ER and CLAM exercises exceeded that of GMed, which might indicate the exercises are less appropriate when the primary goal is the GMed activation and strengthening.
Discriminating Between Copers and People With Chronic Ankle Instability
Authors: Wikstrom Erik A. , Tillman Mark D. , Chmielewski Terese L. , Cauraugh James H. , Naugle Keith E. , Borsa Paul A.
Published: March 2017

Context:

Differences in various outcome measures have been identified between people who have sprained their ankles but have no residual symptoms (copers) and people with chronic ankle instability (CAI). However, the diagnostic utility of the reported outcome measures has rarely been determined. Identifying outcome measures capable of predicting who is less likely to develop CAI could improve rehabilitation protocols and increase the efficiency of these measures.

Objective:

To determine the diagnostic utility and cutoff scores of perceptual, mechanical, and sensorimotor outcome measures between copers and people with CAI by using receiver operating characteristic curves.

Design:

Case-control study.

Setting:

Sports medicine research laboratory.

Patients or Other Participants:

Twenty-four copers (12 men, 12 women; age = 20.8 ± 1.5 years, height = 173 ± 11 cm, mass = 78 ± 27 kg) and 24 people with CAI (12 men, 12 women; age = 21.7 ± 2.8 years, height = 175 ± 13 cm, mass = 71 ± 13 kg) participated.

Intervention(s):

Self-reported disability questionnaires, radiographic images, and a single-legged hop stabilization test.

Main Outcome Measure(s):

Perceptual outcomes included scores on the Foot and Ankle Disability Index (FADI), FADI-Sport, and a self-report questionnaire of ankle function. Mechanically, talar position was quantified by measuring the distance from the anterior tibia to the anterior talus in the sagittal plane. Sensorimotor outcomes were the dynamic postural stability index and directional indices, which were calculated during a single-legged hop stabilization task.

Results:

Perceptual outcomes demonstrated diagnostic accuracy (range, 0.79–0.91), with 95% confidence intervals ranging from 0.65 to 1.00. Sensorimotor outcomes also were able to discriminate between copers and people with CAI but with less accuracy (range, 0.69–0.70), with 95% confidence intervals ranging from 0.37 to 0.86. The mechanical outcome demonstrated poor diagnostic accuracy (0.52).

Conclusions:

The greatest diagnostic utility scores were achieved by the self-assessed disability questionnaires, which indicated that perceptual outcomes had the greatest ability to accurately predict people who became copers after their initial injuries. However, the diversity of outcome measures that discriminated between copers and people with CAI indicated that the causal mechanism of CAI is probably multifactorial.
Sex Differences, Hormone Fluctuations, Ankle Stability, and Dynamic Postural Control
Authors: Ericksen Hayley , Gribble Phillip A.
Published: March 2017

Context:

Hormonal fluctuation as a risk factor in anterior cruciate ligament injury has been investigated with conflicting results. However, the influence of hormone fluctuations on ankle laxity and function has not been thoroughly examined.

Objective:

To examine the potential hormone contributions to ankle laxity and dynamic postural control during the preovulatory and postovulatory phases of the menstrual cycle using an ankle arthrometer and the Star Excursion Balance Test in healthy women. The cohort group consisted of male control participants.

Design:

Cohort study.

Setting:

Research laboratory.

Patients or Other Participants:

Twenty healthy women (age = 23.8 ± 6.50 years, height = 163.88 ± 8.28 cm, mass = 63.08 ± 12.38 kg) and 20 healthy men (age = 23.90 ± 4.15 years, height = 177.07 ± 7.60 cm, mass = 80.57 ± 12.20 kg).

Intervention(s):

Ankle stability was assessed with anterior-posterior and inversion-eversion loading. Dynamic postural control was assessed with the posteromedial reaching distance of the Star Excursion Balance Test.

Main Outcome Measure(s):

Female participants used ovulation kits for 3 months to determine the time of ovulation; during their preovulatory and postovulatory phases, they were tested in the laboratory with an ankle arthrometer and the Star Excursion Balance Test. Male participants were tested on similar dates as controls. For each dependent variable, a time by side by sex repeated-measures analysis of variance was performed. Statistical significance was set a priori at P < .05.

Results:

For anterior-posterior laxity, a side main effect was noted (F1,38 = 10.93, P = .002). For inversion-eversion laxity, a sex main effect was seen (F1,38 = 10.75, P = .002). For the posteromedial reaching task, a sex main effect was demonstrated (F1,38 = 8.72, P = .005). No influences of time on the dependent variables were evident.

Conclusions:

Although women presented with more ankle inversion-eversion laxity and less dynamic postural control, hormonal fluctuations during the menstrual cycle (preovulatory compared with postovulatory) did not affect ankle laxity or dynamic postural control, 2 factors that are associated with ankle instability.
Limb Blood Flow After Class 4 Laser Therapy
Authors: Larkin Kelly A. , Martin Jeffrey S. , Zeanah Elizabeth H. , True Jerry M. , Braith Randy W. , Borsa Paul A.
Published: March 2017

Context:

Laser therapy is purported to improve blood flow in soft tissues. Modulating circulation would promote healing by controlling postinjury ischemia, hypoxia, edema, and secondary tissue damage. However, no studies have quantified these responses to laser therapy.

Objective:

To determine a therapeutic dose range for laser therapy for increasing blood flow to the forearm.

Design:

Crossover study.

Setting:

Controlled laboratory setting.

Patients or Other Participants:

Ten healthy, college-aged men (age = 20.80 ± 2.16 years, height = 177.93 ± 3.38 cm, weight = 73.64 ± 9.10 kg) with no current history of injury to the upper extremity or cardiovascular conditions.

Intervention(s):

A class 4 laser device was used to treat the biceps brachii muscle. Each grid point was treated for 3 to 4 seconds, for a total of 4 minutes. Each participant received 4 doses of laser therapy: sham, 1 W, 3 W, and 6 W.

Main Outcome Measure(s):

The dependent variables were changes in blood flow, measured using venous occlusion plethysmography. We used a repeated-measures analysis of variance to analyze changes in blood flow for each dose at 2, 3, and 4 minutes and at 1, 2, 3, 4, and 5 minutes after treatment. The Huynh-Feldt test was conducted to examine differences over time.

Results:

Compared with baseline, blood flow increased over time with the 3-W treatment (F3,9 = 3.468, P < .011) at minute 4 of treatment (2.417 ± 0.342 versus 2.794 ± 0.351 mL/min per 100 mL tissue, P = .032), and at 1 minute (2.767 ± 0.358 mL/min per 100 mL tissue, P < .01) and 2 minutes (2.657 ± 0.369 mL/min per 100 mL tissue, P = .022) after treatment. The sham, 1-W, and 6-W treatment doses did not change blood flow from baseline at any time point.

Conclusions:

Laser therapy at the 3-W (360-J) dose level was an effective treatment modality to increase blood flow in the soft tissues.
Left Ventricle Fibrosis Associated With Nonsustained Ventricular Tachycardia in an Elite Athlete: Is Exercise Responsible? A Case Report
Authors: Poussel Mathias , Djaballah Karim , Laroppe Julien , Brembilla-Perrot Béatrice , Marie Pierre-Yves , Chenuel Bruno
Published: March 2017

Objective:

To emphasize the potentially harmful effects of high-intensity exercise on cardiac health and the fine line between physiologic and pathologic adaptation to chronic exercise in the elite athlete. This case also highlights the crucial need for regular evaluation of symptoms that suggest cardiac abnormality in athletes.

Background:

Sudden cardiac death (SCD) of young athletes is always a tragedy because they epitomize health. However, chronic, high-intensity exercise sometimes has harmful effects on cardiac health, and pathologic changes, such as myocardial fibrosis, have been observed in endurance athletes. In this case, a highly trained 30-year-old cyclist reported brief palpitations followed by presyncope feeling while exercising. Immediate investigations revealed nonsustained ventricular tachycardia originating from the left ventricle on a stress test associated with myocardial fibrosis of the left ventricle as shown with magnetic resonance imaging. Despite complete cessation of exercise, life-threatening arrhythmia and fibrosis persisted, leading to complete restriction from competition.

Differential Diagnosis:

Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, myocarditis, postmyocarditis, use of drugs and toxic agents, doping, and systemic disease.

Treatment:

The arrhythmia could not be treated with catheter ablation procedure or drug suppression. Therefore, the athlete was instructed to withdraw completely from sport participation and to have a medical follow-up twice each year.

Uniqueness:

To our knowledge, no other report of left ventricle exercise-induced fibrosis associated with life-threatening arrhythmia in a living young elite athlete exists. Only postmortem evidence supports such myocardial pathologic adaptation to exercise.

Conclusions:

To prevent SCD in young athletes, careful attention must be paid to exercise-related symptoms that suggest a cardiac abnormality because they more often are linked to life-threatening cardiovascular disease.
Application of Statistics in Establishing Diagnostic Certainty
Authors: Denegar Craig R. , Cordova Mitchell L.
Published: March 2017

The examination and assessment of injured and ill patients leads to the establishment of a diagnosis. However, the tests and procedures used in health care, including procedures performed by certified athletic trainers, are individually and collectively imperfect in confirming or ruling out a condition of concern. Thus, research into the utility of diagnostic tests is needed to identify the procedures that are most helpful and to indicate the confidence one should place in the results of the test. The purpose of this report is to provide an overview of selected statistical procedures and the interpretation of data appropriate for assessing the utility of diagnostic tests with dichotomous (positive or negative) outcomes, with particular attention to the interpretation of sensitivity and specificity estimates and the reporting of confidence intervals around likelihood ratio estimates.
Hydration Behaviors Before and After an Educational and Prescribed Hydration Intervention in Adolescent Athletes
Authors: Cleary Michelle A. , Hetzler Ronald K. , Wasson Darcy , Wages Jennifer J. , Stickley Christopher , Kimura Iris F.
Published: March 2017

Context:

The effectiveness of education in modifying hydration behaviors in adolescent athletes is unclear.

Objective:

To assess the hydration status and behaviors of female athletes before and after a 1-time educational intervention and prescribed hydration intervention in a warm, humid, tropical environment.

Design:

Cohort study.

Setting:

Non–air-conditioned gymnasium in a tropical environment (indoor wet bulb globe temperature  =  24.0 ± 0.2°C).

Patient or Other Participants:

Thirty-six female adolescent elite volleyball players (age  =  14.8 ± 0.8 years, height  =  168.2 ± 8.2 cm, mass  =  60.8 ± 9.0 kg, body mass index  =  21.7 ± 2.7, body surface area  =  1.65 ± 0.14 m2, body surface area to mass ratio  =  2.71 ± 0.18 m2·kg−1·10−2) participated.

Intervention(s):

Four observational periods consisting of 3 practices per observational period separated by 48 hours. The 4 periods included a control period, educational intervention, prescribed hydration intervention (PHI), and observational follow-up (OF-U). After the control period, an educational intervention consisting of a slide presentation was provided to the participants, followed by a week of observation. In the PHI, a precalculated volume of water based on individual sweat rate was consumed every 20 minutes during each 2-hour practice. During all other periods, participants consumed their fluid of choice ad libitum. The order of the treatment periods was not randomized and was the same for all participants.

Main Outcome Measure(s):

Prepractice to postpractice changes in body mass (ΔBM), percentage of body mass lost (%BML), urine specific gravity, urine color, urine osmolality, sweat rate, and volume of fluid consumed (Fvol).

Results:

The PHI was the only period during which participants maintained body mass (ΔBM  =  0.05 ± 1.3%); Fvol consumed was greatest during this time (Fvol  =  1.3 ± 0.4 L; F1,3  =  34.869, P ≤ .001). The ΔBM was less for the PHI (ΔBM  =  0.05 ± 0.9 kg, %BML  =  0.04 ± 1.3%) than the OF-U period (ΔBM  =  −0.7 ± 1.1 kg, %BML  =  −1.2 ± 1.9%; F1,3  =  6.220, P  =  .01). The Fvol (1.3 ± 0.4 L) and percentage of fluid consumed (143.7 ± 110.8%) to restore sweat loss for the PHI period were higher than for any other period (F1,3  =  34.869, P ≤ .001). None of the participants experienced serious dehydration in any of the conditions.

Conclusions:

A 1-time education session alone was not successful in changing hydration behaviors. However, prescribing individualized hydration protocols improved hydration for adolescents exercising in a warm, humid environment.
Ankle Strength and Force Sense After a Progressive, 6-Week Strength-Training Program in People With Functional Ankle Instability
Authors: Smith Brent I. , Docherty Carrie L. , Simon Janet , Klossner Joanne , Schrader John
Published: March 2017

Context:

Although strength training is commonly used to rehabilitate ankle injuries, studies investigating the effects of strength training on proprioception have shown conflicting results.

Objective:

To determine the effects of a 6-week strength-training protocol on force sense and strength development in participants with functional ankle instability.

Design:

Randomized controlled clinical trial.

Setting:

University athletic training research laboratory.

Patients or Other Participants:

A total of 40 participants with functional ankle instability were recruited. They were randomly placed into a training group (10 men, 10 women: age  =  20.9 ± 2.2 years, height  =  76.4 ± 16.1 cm, mass  =  173.0 ± 7.9 kg) or control group (10 men, 10 women: age  =  20.2 ± 2.1 years, height  =  78.8 ± 24.5 cm, mass  =  173.7 ± 8.2 kg).

Intervention(s):

Participants in the training group performed strength exercises with the injured ankle 3 times per week for 6 weeks. The protocol consisted of a combination of rubber exercise bands and the Multiaxial Ankle Exerciser, both clinically accepted strengthening methods for ankle rehabilitation. The progression of this protocol provided increasingly resistive exercise as participants changed either the number of sets or resistance of the Thera-Band or Multiaxial Ankle Exerciser.

Main Outcome Measure(s):

A load cell was used to measure strength and force sense. Inversion and eversion strength was recorded to the nearest 0.01 N. Force-sense reproduction was measured at 2 loads: 20% and 30% of maximal voluntary isometric contraction.

Results:

Increases in inversion (F1,38  =  11.59, P < 0.01, ηp2  =  0.23, power  =  0.91) and eversion (F1,38  =  57.68, P < .01, ηp2  =  0.60, power  =  0.99) strength were found in the training group at the posttest when compared with the control group. No significant improvements were noted in force-sense reproduction for either group.

Conclusions:

Strength training at the ankle increased strength but did not improve force sense.
Glenohumeral Rotational Motion and Strength and Baseball Pitching Biomechanics
Authors: Hurd Wendy J. , Kaufman Kenton R.
Published: March 2017

Context:

Addressing loss of shoulder range of motion and rotator cuff weakness in injury-prevention programs might be an effective strategy for preventing throwing arm injuries in baseball pitchers. However, the influence of these clinical measures on pitching biomechanics is unclear.

Objective:

To evaluate the relationships among clinical measures of shoulder rotational motion and strength and 3-dimensional pitching biomechanics and to evaluate the presence of coupling between the shoulder and the elbow during pitching to provide insight into the influence of clinical shoulder characteristics on elbow biomechanics.

Design:

Cross-sectional study.

Setting:

Biomechanics laboratory.

Patients or Other Participants:

A total of 27 uninjured male high school baseball pitchers (age  =  16 ± 1.1 years, height  =  183 ± 7 cm, mass  =  83 ± 12 kg).

Main Outcome Measure(s):

Clinical measures included shoulder internal- and external-rotation range of motion and peak isometric internal- and external-rotator strength. Three-dimensional upper extremity biomechanics were assessed as participants threw from an indoor pitching mound to a target at regulation distance. Linear regressions were used to assess the influence of clinical measures on the peak shoulder internal and external rotation moments and the peak elbow-adduction moment.

Results:

We found a positive relationship between clinically measured internal-rotator strength and shoulder external-rotation moment (R2  =  0.181, P  =  .04) during pitching. We also noted an inverse relationship between clinically measured external-rotation motion and the elbow-adduction moment (R2  =  0.160, P  =  .04) and shoulder internal-rotation moment (R2  =  0.250, P  =  .008) during pitching. We found a positive relationship between peak shoulder internal-rotation moment and the peak elbow-adduction moment (R2  =  0.815, P < .001) during pitching.

Conclusions:

This study provides insight into the effects of shoulder strength and motion on pitching biomechanics and how these clinical measures might contribute to throwing arm injuries in the baseball pitcher. A relationship also was identified between peak shoulder and elbow moments in the throwing arm during pitching, providing biomechanical support for addressing clinical shoulder characteristics as a potential strategy for preventing elbow injury.
Trunk-Rotation Flexibility in Collegiate Softball Players With or Without a History of Shoulder or Elbow Injury
Authors: Aragon Veronica J. , Oyama Sakiko , Oliaro Scott M. , Padua Darin A. , Myers Joseph B.
Published: March 2017

Context:

Throwing is a whole-body motion that requires the transfer of momentum from the lower extremity to the upper extremity via the trunk. No research to date examines the association between a history of shoulder or elbow injury and trunk flexibility in overhead athletes.

Objective:

To determine if injury history and trunk-rotation flexibility are associated and to compare trunk-rotation flexibility measured using 3 clinical tests: half-kneeling rotation test with the bar in the back, half-kneeling rotation test with the bar in the front, and seated rotation test in softball position players with or without a history of shoulder or elbow injury.

Design:

Cross-sectional design.

Setting:

University softball facilities.

Patients or Other Participants:

Sixty-five female National Collegiate Athletic Association Division I softball position players.

Intervention(s):

Trunk-rotation flexibility was measured with 3 clinical tests. Recent injury history was obtained using a questionnaire and verified by the certified athletic trainer.

Main Outcome Measure(s):

Binomial regression models were used to determine if injury history was associated with flexibility categories (high, normal, or limited tertiles) for each of the 6 (3 tests × 2 directions) trunk-rotation flexibility measures. Trunk-rotation flexibility measures from 3 clinical tests were compared between participants with and without a history of shoulder or elbow injury using analysis-of-variance models.

Results:

When measured using the half-kneeling rotation test with the bar in the back and the seated rotation test, injury history and forward trunk-rotation flexibility were associated. However, no mean group differences were seen in trunk-rotation flexibility between participants with and without a history of shoulder or elbow injury.

Conclusions:

Limited forward trunk-rotation flexibility may be a risk factor for shoulder or elbow injuries. However, further study is needed to confirm the study finding.
Recovery After High-Intensity Intermittent Exercise in Elite Soccer Players Using VEINOPLUS Sport Technology for Blood-Flow Stimulation
Authors: Bieuzen François , Pournot Hervé , Roulland Rémy , Hausswirth Christophe
Published: March 2017

Context

Electric muscle stimulation has been suggested to enhance recovery after exhaustive exercise by inducing an increase in blood flow to the stimulated area. Previous studies have failed to support this hypothesis. We hypothesized that the lack of effect shown in previous studies could be attributed to the technique or device used.

Objective

To investigate the effectiveness of a recovery intervention using an electric blood-flow stimulator on anaerobic performance and muscle damage in professional soccer players after intermittent, exhaustive exercise.

Design

Randomized controlled clinical trial.

Setting

National Institute of Sport, Expertise, and Performance (INSEP).

Patients or Other Participants

Twenty-six healthy professional male soccer players.

Intervention(s)

The athletes performed an intermittent fatiguing exercise followed by a 1-hour recovery period, either passive or using an electric blood-flow stimulator (VEINOPLUS). Participants were randomly assigned to a group before the experiment started.

Main Outcome Measures(s)

Performances during a 30-second all-out exercise test, maximal vertical countermovement jump, and maximal voluntary contraction of the knee extensor muscles were measured at rest, immediately after the exercise, and 1 hour and 24 hours later. Muscle enzymes indicating muscle damage (creatine kinase, lactate dehydrogenase) and hematologic profiles were analyzed before and 1 hour and 24 hours after the intermittent fatigue exercise.

Results

The electric-stimulation group had better 30-second all-out performances at 1 hour after exercise (P = .03) in comparison with the passive-recovery group. However, no differences were observed in muscle damage markers, maximal vertical countermovement jump, or maximal voluntary contraction between groups (P > .05).

Conclusions

Compared with passive recovery, electric stimulation using this blood-flow stimulator improved anaerobic performance at 1 hour postintervention. No changes in muscle damage markers or maximal voluntary contraction were detected. These responses may be considered beneficial for athletes engaged in sports with successive rounds interspersed with short, passive recovery periods.
A Comparison Between Performance on Selected Directions of the Star Excursion Balance Test and the Y Balance Test
Authors: Coughlan Garrett F. , Fullam Karl , Delahunt Eamonn , Gissane Conor , Caulfield Brian M. , Sci Med
Published: March 2017

Context:

The Star Excursion Balance Test (SEBT) is a widely accepted method of assessing dynamic postural stability. The Y Balance Test (YBT) is a commercially available device for measuring balance that uses 3 (anterior, posteromedial, and posterolateral) of the 8 SEBT directions and has been advocated as a method for assessing dynamic balance. To date, no studies have compared reach performance in these tests in a healthy population.

Objective:

To determine whether any differences exist between reach distance performance for the anterior, posteromedial, and posterolateral directions of the SEBT and the YBT.

Design:

Descriptive laboratory study.

Setting:

University motion analysis laboratory.

Patients or Other Participants:

A total of 20 healthy active male participants (age = 22.50 ± 3.05 years, height = 1.78 ± 0.82 m, weight = 79.48 ± 11.32 kg, body mass index = 24.96 ± 2.56 kg/m2).

Intervention(s):

Participants carried out 3 trials in each reach direction on each leg on the SEBT and the YBT a minimum of 1 week apart.

Main Outcome Measure(s):

The means of the 3 trials in each direction on each leg on both tests were calculated. Data were collected after 4 practice trials in each direction. Paired t tests and Bland-Altman plots were used to compare reach distances between the SEBT and the YBT.

Results:

Participants reached farther in the anterior direction on the SEBT than on the YBT. No differences were observed in the posteromedial and posterolateral directions.

Conclusions:

Differing postural-control strategies may be used to complete these tasks. This finding has implications for the implementation and interpretation of these dynamic balance tests.
Expected Prevalence From the Differential Diagnosis of Anterior Knee Pain in Adolescent Female Athletes During Preparticipation Screening
Authors: Foss Kim D. Barber , Myer Gregory D. , Chen Stephen S. , Hewett Timothy E.
Published: March 2017

Context

Anterior knee pain is a common disorder in female athletes with an undefined cause. The relative prevalence of specific patellofemoral disorders associated with anterior knee pain in adolescent females remains undetermined.

Objective

To determine the prevalence of specific patellofemoral disorders obtained using the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening.

Design

Descriptive epidemiology study.

Setting

Preparticipation screening evaluations at a county public school district in Kentucky.

Patients or Other Participants

A total of 419 unique middle and high school–aged female athletes.

Main Outcome Measure(s)

Participants were evaluated by physicians for anterior knee pain over 3 consecutive basketball seasons. Given the longitudinal nature of this study, some participants were tested longitudinally over multiple years.

Results

Over the course of 3 basketball seasons, 688 patient evaluations were performed. Of these, 183 (26.6%) were positive for anterior knee pain. A statistically significant difference was noted in the prevalence of anterior knee pain by school level, with 34.4% (n = 67) in high school–aged athletes versus 23.5% (n = 116) in middle school–aged athletes (P < .05). In the 1376 knees evaluated, patellofemoral dysfunction was the most common diagnosis, with an overall prevalence of 7.3% (n = 100). The only diagnosis shown to be statistically different between age levels was Sinding-Larsen-Johansson disease or patellar tendinopathy, with 38 cases (9.7%) in high school–aged and 31 (3.1%) in middle school–aged athletes (P < .05).

Conclusions

Anterior knee pain was present in 26.6% of the adolescent female athletes screened over 3 years. Symptoms of anterior knee pain likely persist after middle school–aged onset and reach peak prevalence during the high school years.
Anterior Glenohumeral Laxity and Stiffness After a Shoulder-Strengthening Program in Collegiate Cheerleaders
Authors: Laudner Kevin G. , Metz Betsy , Thomas David Q.
Published: March 2017

Context:

Approximately 62% of all cheerleaders sustain some type of orthopaedic injury during their cheerleading careers. Furthermore, the occurrence of such injuries has led to inquiry regarding optimal prevention techniques. One possible cause of these injuries may be related to inadequate conditioning in cheerleaders.

Objective:

To determine whether a strength and conditioning program produces quantifiable improvements in anterior glenohumeral (GH) laxity and stiffness.

Design:

Descriptive laboratory study.

Setting:

University laboratory.

Patients or Other Participants:

A sample of 41 collegiate cheerleaders (24 experimental and 17 control participants) volunteered. No participants had a recent history (in the past 6 months) of upper extremity injury or any history of upper extremity surgery.

Intervention(s):

The experimental group completed a 6-week strength and conditioning program between the pretest and posttest measurements; the control group did not perform any strength training between tests.

Main Outcome Measure(s):

We measured anterior GH laxity and stiffness with an instrumented arthrometer. We conducted a group × time analysis of variance with repeated measures on time (P < .05) to determine differences between groups.

Results:

A significant interaction was demonstrated, with the control group having more anterior GH laxity at the posttest session than the strengthening group (P = .03, partial η2 = 0.11). However, no main effect for time (P = .92) or group (P = .97) was observed. In another significant interaction, the control group had less anterior GH stiffness at the posttest session than the strengthening group (P = .03, partial η2 = 0.12). Main effects for time (P = .02) and group (P = .004) were also significant.

Conclusions:

Cheerleaders who participate in a shoulder-strengthening program developed less anterior GH laxity and more stiffness than cheerleaders in the control group.
Practices of Weight Regulation Among Elite Athletes in Combat Sports: A Matter of Mental Advantage?
Authors: Pettersson Stefan , Ekström Marianne Pipping , Berg Christina M.
Published: March 2017

Context

The combination of extensive weight loss and inadequate nutritional strategies used to lose weight rapidly for competition in weight-category sports may negatively affect athletic performance and health.

Objective

To explore the reasoning of elite combat-sport athletes about rapid weight loss and regaining of weight before competitions.

Design

Qualitative study.

Setting

With grounded theory as a theoretical framework, we employed a cross-examinational approach including interviews, observations, and Internet sources. Sports observations were obtained at competitions and statements by combat-sport athletes were collected on the Internet.

Patients or Other Participants

Participants in the interviews were 14 Swedish national team athletes (9 men, 5 women; age range, 18 to 36 years) in 3 Olympic combat sports (wrestling, judo, and taekwondo).

Data Collection and Analysis

Semistructured interviews with 14 athletes from the Swedish national teams in wrestling, judo, and taekwondo were conducted at a location of each participant's choice. The field observations were conducted at European competitions in these 3 sports. In addition, interviews and statements made by athletes in combat sports were collected on the Internet.

Results

Positive aspects of weight regulation other than gaining physical advantage emerged from the data during the analysis: sport identity, mental diversion, and mental advantage. Together and individually, these categories point toward the positive aspects of weight regulation experienced by the athletes. Practicing weight regulation mediates a self-image of being “a real athlete.” Weight regulation is also considered mentally important as a part of the precompetition preparation, serving as a coping strategy by creating a feeling of increased focus and commitment. Moreover, a mental advantage relative to one's opponents can be gained through the practice of weight regulation.

Conclusions

Weight regulation has mentally important functions extending beyond the common notion that combat-sport athletes reduce their weight merely to gain a physical edge over their opponents.
Clinical Integration and How It Affects Student Retention in Undergraduate Athletic Training Programs
Authors: Young Allison , Klossner Joanne , Docherty Carrie L. , Dodge Thomas M. , Mensch James M.
Published: March 2017

Context

A better understanding of why students leave an undergraduate athletic training education program (ATEP), as well as why they persist, is critical in determining the future membership of our profession.

Objective

To better understand how clinical experiences affect student retention in undergraduate ATEPs.

Design

Survey-based research using a quantitative and qualitative mixed-methods approach.

Setting

Three-year undergraduate ATEPs across District 4 of the National Athletic Trainers' Association.

Patients or Other Participants

Seventy-one persistent students and 23 students who left the ATEP prematurely.

Data Collection and Analysis

Data were collected using a modified version of the Athletic Training Education Program Student Retention Questionnaire. Multivariate analysis of variance was performed on the quantitative data, followed by a univariate analysis of variance on any significant findings. The qualitative data were analyzed through inductive content analysis.

Results

A difference was identified between the persister and dropout groups (Pillai trace = 0.42, F1,92 = 12.95, P = .01). The follow-up analysis of variance revealed that the persister and dropout groups differed on the anticipatory factors (F1,92 = 4.29, P = .04), clinical integration (F1,92 = 6.99, P = .01), and motivation (F1,92 = 43.12, P = .01) scales. Several themes emerged in the qualitative data, including networks of support, authentic experiential learning, role identity, time commitment, and major or career change.

Conclusions

A perceived difference exists in how athletic training students are integrated into their clinical experiences between those students who leave an ATEP and those who stay. Educators may improve retention by emphasizing authentic experiential learning opportunities rather than hours worked, by allowing students to take on more responsibility, and by facilitating networks of support within clinical education experiences.