bluuebunny/crossref_metadata_2025 huggingface dataset:
Concentric and Eccentric Torque of the Hip Musculature in Individuals With and Without Patellofemoral Pain
Authors: Boling Michelle C. , Padua Darin A. , Alexander Creighton R.
Published: December 2009

Context:

Individuals suffering from patellofemoral pain have previously been reported to have decreased isometric strength of the hip musculature; however, no researchers have investigated concentric and eccentric torque of the hip musculature in individuals with patellofemoral pain.

Objective:

To compare concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain.

Design:

Case control.

Setting:

Research laboratory.

Patients or Other Participants:

Twenty participants with patellofemoral pain (age  =  26.8 ± 4.5 years, height  =  171.8 ± 8.4 cm, mass  =  72.4 ± 16.8 kg) and 20 control participants (age  =  25.6 ± 2.8 years, height  =  169.5 ± 8.9 cm, mass  =  70.0 ± 16.9 kg) were tested. Volunteers with patellofemoral pain met the following criteria: knee pain greater than or equal to 3 cm on a 10-cm visual analog scale, insidious onset of symptoms not related to trauma, pain with palpation of the patellar facets, and knee pain during 2 of the following activities: stair climbing, jumping or running, squatting, kneeling, or prolonged sitting. Control participants were excluded if they had a prior history of patellofemoral pain, knee surgery in the past 2 years, or current lower extremity injury that limited participation in physical activity.

Intervention(s):

Concentric and eccentric torque of the hip musculature was measured on an isokinetic dynamometer. All volunteers performed 5 repetitions of each strength test. Separate multivariate analyses of variance were performed to compare concentric and eccentric torque of the hip extensors, abductors, and external rotators between groups.

Main Outcome Measure(s):

Average and peak concentric and eccentric torque of the hip extensors, abductors, and external rotators. Torque measures were normalized to the participant's body weight multiplied by height.

Results:

The patellofemoral pain group was weaker than the control group for peak eccentric hip abduction torque (F1,38  =  6.630, P  =  .014), and average concentric (F1,38  =  4.156, P  =  .048) and eccentric (F1,38  =  4.963, P  =  .032) hip external rotation torque.

Conclusions:

The patellofemoral pain group displayed weakness in eccentric hip abduction and hip external rotation, which may allow for increased hip adduction and internal rotation during functional movements.
Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report
Authors: Snead Dale , Marberry Kevin M. , Rowdon Greg
Published: December 2009

Objective:

To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment.

Background:

An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening.

Differential Diagnosis:

Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis.

Treatment:

Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions.

Uniqueness:

Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms.

Conclusions:

Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.
Comparisons of Cubed Ice, Crushed Ice, and Wetted Ice on Intramuscular and Surface Temperature Changes
Authors: Dykstra Joseph H. , Hill Holly M. , Miller Michael G. , Cheatham Christopher C. , Michael Timothy J. , Baker Robert J.
Published: December 2009

Context:

Many researchers have investigated the effectiveness of different types of cold application, including cold whirlpools, ice packs, and chemical packs. However, few have investigated the effectiveness of different types of ice used in ice packs, even though ice is one of the most common forms of cold application.

Objective:

To evaluate and compare the cooling effectiveness of ice packs made with cubed, crushed, and wetted ice on intramuscular and skin surface temperatures.

Design:

Repeated-measures counterbalanced design.

Setting:

Human performance research laboratory.

Patients or Other Participants:

Twelve healthy participants (6 men, 6 women) with no history of musculoskeletal disease and no known preexisting inflammatory conditions or recent orthopaedic injuries to the lower extremities.

Intervention(s):

Ice packs made with cubed, crushed, or wetted ice were applied to a standardized area on the posterior aspect of the right gastrocnemius for 20 minutes. Each participant was given separate ice pack treatments, with at least 4 days between treatment sessions.

Main Outcome Measure(s):

Cutaneous and intramuscular (2 cm plus one-half skinfold measurement) temperatures of the right gastrocnemius were measured every 30 seconds during a 20-minute baseline period, a 20-minute treatment period, and a 120-minute recovery period.

Results:

Differences were observed among all treatments. Compared with the crushed-ice treatment, the cubed-ice and wetted-ice treatments produced lower surface and intramuscular temperatures. Wetted ice produced the greatest overall temperature change during treatment and recovery, and crushed ice produced the smallest change.

Conclusions:

As administered in our protocol, wetted ice was superior to cubed or crushed ice at reducing surface temperatures, whereas both cubed ice and wetted ice were superior to crushed ice at reducing intramuscular temperatures.
A Clinical Method for Identifying Scapular Dyskinesis, Part 1: Reliability
Authors: McClure Philip , Tate Angela R. , Kareha Stephen , Irwin Dominic , Zlupko Erica
Published: December 2009

Context:

Shoulder injuries are common in athletes involved in overhead sports, and scapular dyskinesis is believed to be one causative factor in these injuries. Many authors assert that abnormal scapular motion, so-called dyskinesis, is related to shoulder injury, but evidence from 3-dimensional measurement studies regarding this relationship is mixed. Reliable and valid clinical methods for detecting scapular dyskinesis are lacking.

Objective:

To determine the interrater reliability of a new test designed to detect abnormal scapular motion.

Design:

Correlation design using ratings from multiple pairs of testers.

Setting:

University athletic training facilities.

Patients or Other Participants:

A sample of 142 athletes (from National Collegiate Athletic Association Divisions I and III) participating in sports requiring intense overhead arm use.

Intervention(s):

Participants were videotaped from the posterior aspect while performing 5 repetitions of bilateral, weighted (1.4-kg [3-lb] or 2.3-kg [5-lb]) shoulder flexion and frontal-plane abduction. Videotapes from randomly chosen participants were subsequently viewed and independently rated for the presence of scapular dyskinesis by 6 raters (3 pairs), with each pair rating 30 different participants. Raters were trained to detect scapular dyskinesis using a self-instructional format with standardized operational definitions and videotaped examples of normal and abnormal motion.

Main Outcome Measure(s):

Scapular dyskinesis was defined as the presence of either winging or dysrhythmia. Right and left sides were rated independently as normal, subtle, or obvious dyskinesis. We calculated percentage of agreement and weighted kappa (κw) coefficients to determine reliability.

Results:

Percentage of agreement was between 75% and 82%, and κw ranged from 0.48 to 0.61.

Conclusions:

The test for scapular dyskinesis showed satisfactory reliability for clinical use in a sample of overhead athletes known to be at increased risk for shoulder symptoms.
A Clinical Method for Identifying Scapular Dyskinesis, Part 2: Validity
Authors: Tate Angela R. , McClure Philip , Kareha Stephen , Irwin Dominic , Barbe Mary F.
Published: December 2009

Context:

Although clinical methods for detecting scapular dyskinesis have been described, evidence supporting the validity of these methods is lacking.

Objective:

To determine the validity of the scapular dyskinesis test, a visually based method of identifying abnormal scapular motion. A secondary purpose was to explore the relationship between scapular dyskinesis and shoulder symptoms.

Design:

Validation study comparing 3-dimensional measures of scapular motion among participants clinically judged as having either normal motion or scapular dyskinesis.

Setting:

University athletic training facilities.

Patients or Other Participants:

A sample of 142 collegiate athletes (National Collegiate Athletic Association Division I and Division III) participating in sports requiring overhead use of the arm was rated, and 66 of these underwent 3-dimensional testing.

Intervention(s):

Volunteers were viewed by 2 raters while performing weighted shoulder flexion and abduction. The right and left sides were rated independently as normal, subtle dyskinesis, or obvious dyskinesis using the scapular dyskinesis test. Symptoms were assessed using the Penn Shoulder Score.

Main Outcome Measure(s):

Athletes judged as having either normal motion or obvious dyskinesis underwent 3-dimensional electromagnetic kinematic testing while performing the same movements. The kinematic data from both groups were compared via multifactor analysis of variance with post hoc testing using the least significant difference procedure. The relationship between symptoms and scapular dyskinesis was evaluated by odds ratios.

Results:

Differences were found between the normal and obvious dyskinesis groups. Participants with obvious dyskinesis showed less scapular upward rotation (P < .001), less clavicular elevation (P < .001), and greater clavicular protraction (P  =  .044). The presence of shoulder symptoms was not different between the normal and obvious dyskinesis volunteers (odds ratio  =  0.79, 95% confidence interval  =  0.33, 1.89).

Conclusions:

Shoulders visually judged as having dyskinesis showed distinct alterations in 3-dimensional scapular motion. However, the presence of scapular dyskinesis was not related to shoulder symptoms in athletes engaged in overhead sports.
Student Retention in Athletic Training Education Programs
Authors: Dodge Thomas M. , Mitchell Murray F. , Mensch James M.
Published: December 2009

Context:

The success of any academic program, including athletic training, depends upon attracting and keeping quality students. The nature of persistent students versus students who prematurely leave the athletic training major is not known. Understanding the profiles of athletic training students who persist or leave is important.

Objective:

To (1) explore the relationships among the following variables: anticipatory factors, academic integration, clinical integration, social integration, and motivation; (2) determine which of the aforementioned variables discriminate between senior athletic training students and major changers; and (3) identify which variable is the strongest predictor of persistence in athletic training education programs.

Design:

Descriptive study using a qualitative and quantitative mixed-methods approach.

Setting:

Thirteen athletic training education programs located in District 3 of the National Athletic Trainers' Association.

Patients or Other Participants:

Ninety-four senior-level athletic training students and 31 college students who changed majors from athletic training to another degree option.

Data Collection:

Data were collected with the Athletic Training Education Program Student Retention Questionnaire (ATEPSRQ).

Analysis:

Data from the ATEPSRQ were analyzed via Pearson correlations, multivariate analysis of variance, univariate analysis of variance, and a stepwise discriminant analysis. Open-ended questions were transcribed and analyzed using open, axial, and selective coding procedures. Member checks and peer debriefing techniques ensured trustworthiness of the study.

Results:

Pearson correlations identified moderate relationships among motivation and clinical integration (r  =  0.515, P < .01) and motivation and academic integration (r  =  0.509, P < .01). Univariate analyses of variance showed that academic integration (F1,122  =  8.483, P < .004), clinical integration (F1,119  =  30.214, P < .001), and motivation (F1,121  =  68.887, P < .001) discriminated between seniors and major changers. Discriminant analysis indicated that motivation was the strongest predictor of persistence in athletic training education, accounting for 37.2% of the variance between groups. The theoretic model accurately classified 95.7% of the seniors and 53.8% of the major changers. A common theme emerging from the qualitative data was the presence of a strong peer-support group that surrounded many of the senior-level students.

Conclusions:

Understanding student retention in athletic training is important for our profession. Results from this study suggest 3 key factors associated with student persistence in athletic training education programs: (1) student motivation, (2) clinical and academic integration, and (3) the presence of a peer-support system. Educators and program directors must create comprehensive recruitment and retention strategies that address factors influencing students' decisions to stay in the athletic training profession.
Muscle Activation and Movement Patterns During Prone Hip Extension Exercise in Women
Authors: Lewis Cara L. , Sahrmann Shirley A.
Published: December 2009

Context:

The consistency of muscle activation order during prone hip extension has been debated.

Objective:

To investigate whether women use a consistent and distinguishable muscle activation order when extending the hip while prone and to explore the effects of verbal cues on muscle activation and movement.

Design:

Single-session, repeated-measures design.

Setting:

University laboratory.

Patients or Other Participants:

Eleven healthy women (age  =  27.7 ± 6.2 years [range, 22–37 years]).

Intervention(s):

We tested the participants under 3 conditions: no cues, cues to contract the gluteal muscles, and cues to contract the hamstrings muscles.

Main Outcome Measure(s):

We measured hip and knee angle and electromyographic data from the gluteus maximus, medial hamstrings, and lateral hamstrings while participants performed prone hip extension from 30° of hip flexion to neutral.

Results:

When not given cues, participants used the consistent and distinguishable muscle activation order of medial hamstrings, followed by lateral hamstrings, then gluteus maximus (195.5 ± 74.9, 100.2 ± 70.3, and 11.5 ± 81.9 milliseconds preceding start of movement, respectively). Compared with the no-cues condition, the gluteal-cues condition resulted in nearly simultaneous onset of medial hamstrings, lateral hamstrings, and gluteus maximus (131.3 ± 84.0, 38.8 ± 96.9, and 45.1 ± 93.4 milliseconds, respectively) (P > .059); decreased activation of the medial hamstrings (P < .03) and lateral hamstrings (P < .024) around the initiation of movement; increased activation of gluteus maximus throughout the movement (P < .001); and decreased knee flexion (P  =  .002). Compared with the no-cues condition, the hamstrings-cues condition resulted in decreased activation of the medial hamstrings just after the initiation of movement (P  =  .028) and throughout the movement (P  =  .034) and resulted in decreased knee flexion (P  =  .003).

Conclusions:

Our results support the contention that the muscle activation order during prone hip extension is consistent in healthy women and demonstrates that muscle timing and activation amplitude and movement can be modified with verbal cues. This information is important for clinicians using prone hip extension as either an evaluation tool or a rehabilitation exercise.
Association of Quadriceps and Hamstrings Cocontraction Patterns With Knee Joint Loading
Authors: Palmieri-Smith Riann M. , McLean Scott G. , Ashton-Miller James A. , Wojtys Edward M.
Published: December 2009

Context:

Sex differences in neuromuscular control of the lower extremity have been identified as a potential cause for the greater incidence of anterior cruciate ligament (ACL) injuries in female athletes compared with male athletes. Women tend to land in greater knee valgus with higher abduction loads than men. Because knee abduction loads increase ACL strain, the inability to minimize these loads may lead to ACL failure.

Objective:

To investigate the activation patterns of the quadriceps and hamstrings muscles with respect to the peak knee abduction moment.

Design:

Cross-sectional study.

Setting:

Neuromuscular research laboratory.

Patients or Other Participants:

Twenty-one recreationally active adults (11 women, 10 men).

Main Outcome Measure(s):

Volunteers performed 3 trials of a 100-cm forward hop. During the hop task, we recorded surface electromyographic data from the medial and lateral hamstrings and quadriceps and recorded lower extremity kinematics and kinetics. Lateral and medial quadriceps-to-hamstrings (Q∶H) cocontraction indices, the ratio of medial-to-lateral Q∶H cocontraction, normalized root mean square electromyographic data for medial and lateral quadriceps and hamstrings, and peak knee abduction moment were calculated and used in data analyses.

Results:

Overall cocontraction was lower in women than in men, whereas activation was lower in the medial than in the lateral musculature in both sexes (P < .05). The medial Q∶H cocontraction index (R2  =  0.792) accounted for a significant portion of the variance in the peak knee abduction moment in women (P  =  .001). Women demonstrated less activation in the vastus medialis than in the vastus lateralis (P  =  .49) and less activation in the medial hamstrings than in the lateral hamstrings (P  =  .01).

Conclusions:

Medial-to-lateral Q∶H cocontraction appears to be unbalanced in women, which may limit their ability to resist abduction loads. Because higher abduction loads increase strain on the ACL, restoring medial-to-lateral Q∶H cocontraction balance in women may help reduce ACL injury risk.
The Use of a Tuning Fork and Stethoscope to Identify Fractures
Authors: Moore Michael Bryan
Published: December 2009

Context:

Nonradiographic tests to identify fractures rely on a patient's report of increased pain at the site of injury. These tests can be misleading and produce false-positive or false-negative results because of differences in pain tolerance. A painless technique using a tuning fork and stethoscope to detect fractures has undergone limited review in the athletic training literature.

Objective:

To determine if the use of a 128-Hz vibrating tuning fork and stethoscope were effective in identifying fractures.

Design:

Cross-sectional study.

Setting:

University athletic training room or local orthopaedic center when fractures were suspected.

Patients or Other Participants:

A total of 37 patients (19 males, 18 females) volunteered.

Main Outcome Measure(s):

A diminished or absent sound arising from the injured bone as compared with the uninjured bone represented a positive sign for a fracture. Radiographs interpreted by the attending orthopaedic physician provided the standard for comparison of diagnostic findings.

Results:

Sensitivity was 0.83 (10∶12), specificity was 0.80 (20∶25), positive likelihood ratio was 4.2, negative likelihood ratio was 0.21, and diagnostic accuracy was 81% (30∶37).

Conclusions:

The tuning fork and stethoscope technique was an effective screening method for a variety of fractures.
Reliability and Validity of a Novel Muscle Contusion Device
Authors: M. McBrier Nicole , Neuberger Thomas , Okita Nori , Webb Andrew , Sharkey Neil
Published: December 2009

Context:

Many models have been employed to replicate skeletal muscle injury associated with trauma; however, most are restricted to 1 level of severity.

Objective:

To create and validate an injury-producing device that could generate multiple levels of injury severity.

Design:

Validation study.

Patients or Other Participants:

Twenty-six male Wistar rats, 3 to 4 months old.

Intervention(s):

A contusion device was developed and its ability to deliver consistent impacts was validated alone and in the presence of an experimental animal. A free-falling mass (267 g) was adjusted to the desired height (40, 50, 60, or 70 cm) and then dropped.

Main Outcome Measure(s):

Peak load, peak displacement, impulse, energy, and velocity peak were measured. Injury severity was determined using magnetic resonance imaging.

Results:

Outcome measures observed from the device alone were different by height (F18,136  =  21.807, P < .001, 1−β  =  1.0). Outcomes using the experimental animals were also dependent on height (F14,102  =  68.679, P < .001, 1−β  =  1.0). Linear regression analyses indicated that height accounted for 17% to 89% of the variance.

Conclusions:

Mild to moderate and moderate to severe injuries can be replicated with this device, which will be useful in evaluating clinical treatments on acute muscle injury.
Athletic Trainers' Beliefs Toward Working With Special Olympics Athletes
Authors: Conatser Phillip , Naugle Keith , Tillman Mark , Stopka Christine
Published: December 2009

Context:

Certified athletic trainers (ATs) are often the first health care providers to treat injured athletes. However, few researchers have studied ATs' beliefs concerning working with Special Olympics athletes.

Objectives:

To examine ATs' beliefs toward working with Special Olympics athletes by using the theory of planned behavior model and to examine the influence of moderator variables.

Design:

Cross-sectional survey.

Setting:

Athletic Trainers' Beliefs Toward Special Olympics Athletes survey instruments were mailed to 147 directors of Commission on Accreditation of Allied Health Education Programs–accredited athletic training education programs (ATEPDs) in 43 states and 120 cities.

Patients or Other Participants:

One hundred twenty ATEPDs (44 women, 76 men).

Main Outcome Measure(s):

We used stepwise multiple regression analysis to determine whether attitude toward the behavior, subjective norm, and perceived behavioral control predicted intention and to determine which moderator variables predicted attitude toward the behavior, subjective norm, and perceived behavioral control. Pearson product moment correlations were used to determine ATEPDs' beliefs about how competent they felt working with Special Olympics athletes and whether they were currently working with these athletes.

Results:

We found that subjective norm, attitude toward the behavior, and perceived behavioral control predicted intention (R  =  0.697, R2  =  0.486, F3,112  =  35.3, P < .001) and that intention predicted ATEPDs' actual behaviors (R  =  0.503, R2  =  0.253, F1,118  =  39.995, P < .001). Moderator variables that predicted attitude toward the behavior included more years of experience working with Special Olympics athletes, completion of 1 or more courses in adapted physical activity, ATEPDs' competence, completion of 1 or more special education courses, and sex (R  =  0.589, R2  =  0.347, F5,111  =  11.780, P < .001). Moderator variables that predicted subjective norm included more experience working with Special Olympics athletes and more Special Olympics certifications (R  =  0.472, R2  =  0.222, F2,112  =  16.009, P < .001). Moderator variables that predicted perceived behavioral control included ATEPDs' competence, more years of experience working with Special Olympics athletes, and a higher educational degree (R  =  0.642, R2  =  0.412, F4,113  =  19.793, P < .001).

Conclusions:

Certified athletic trainers had favorable attitudes about the behavior beliefs toward working with Special Olympics athletes; however, their subjective norm, perceived behavioral control, and intention beliefs were unfavorable. The ATEPDs reported they did not feel competent to work with Special Olympics athletes.
Clinical Instructors' and Athletic Training Students' Perceptions of Teachable Moments in an Athletic Training Clinical Education Setting
Authors: Rich Valerie J.
Published: December 2009

Context:

For some time, educators have advised clinical instructors (CIs) to capture the elusive teachable moment in clinical education. However, a universal definition of a teachable moment does not exist. Without a clear understanding of this concept, CIs and athletic training students (ATSs) may have difficulty facilitating the teachable moment.

Objective:

To recognize and define a teachable moment as it relates to the athletic training clinical education setting and to identify potential barriers to creating the teachable moment.

Design:

Mixed-methods design employing grounded theory and quantitative analysis.

Setting:

Collegiate sports medicine clinic affiliated with a Commission on Accreditation of Allied Health Education Programs–accredited athletic training education program.

Patients or Other Participants:

11 CIs (6 men, 5 women) and 11 ATSs (3 men, 8 women).

Data Collection and Analysis:

Participants completed a teachable moment questionnaire to define and identify teachable moments. Follow-up semistructured interviews were conducted after data collection. A qualitative analysis was conducted on responses using open, axial, and selective coding. Member checking was conducted to establish trustworthiness. Qualitative data were quantified to descriptively report the findings.

Results:

Engaged clinical experiences were the overarching theme. Three major themes that defined a teachable moment emerged: (1) professional discourse about skills, techniques, research, and special cases; (2) authentic experience or actual hands-on experience; and (3) skill development or time for skill instruction, practice, role playing, and simulations. Participants reported 158 teachable moments (CIs  =  75, ATSs  =  83). Lack of time and other duties were examples of barriers hindering the teachable moment.

Conclusions:

The teachable moment occurs when a CI and an ATS actively participate and interact with each other to enhance learning and foster intellectual curiosity in the clinical education environment. An underlying barrier to the teachable moment is perceived to be the CI's day-to-day responsibilities.
Head Impacts During High School Football: A Biomechanical Assessment
Authors: Broglio Steven P. , Sosnoff Jacob J. , Shin SungHoon , He Xuming , Alcaraz Christopher , Zimmerman Jerrad
Published: December 2009

Little is known about the impact biomechanics sustained by players during interscholastic football.Context:

To characterize the location and magnitude of impacts sustained by players during an interscholastic football season.Objective:

Observational design.Design:

On the field.Setting:

High school varsity football team (n  =  35; age  =  16.85 ± 0.75 years, height  =  183.49 ± 5.31 cm, mass  =  89.42 ± 12.88 kg).Patients or Other Participants:

Biomechanical variables (linear acceleration, rotational acceleration, jerk, force, impulse, and impact duration) related to head impacts were categorized by session type, player position, and helmet impact location.Main Outcome Measure(s):

Differences in grouping variables were found for each impact descriptor. Impacts occurred more frequently and with greater intensity during games. Linear acceleration was greatest in defensive linemen and offensive skill players and when the impact occurred at the top of the helmet. The largest rotational acceleration occurred in defensive linemen and with impacts to the front of the helmet. Impacts with the highest-magnitude jerk, force, and impulse and shortest duration occurred in the offensive skill, defensive line, offensive line, and defensive skill players, respectively. Top-of-the-helmet impacts yielded the greatest magnitude for the same variables.Results:

We are the first to provide a biomechanical characterization of head impacts in an interscholastic football team across a season of play. The intensity of game play manifested with more frequent and intense impacts. The highest-magnitude variables were distributed across all player groups, but impacts to the top of the helmet yielded the highest values. These high school football athletes appeared to sustain greater accelerations after impact than their older counterparts did. How this finding relates to concussion occurrence has yet to be elucidated.Conclusions:
Generalized Joint Laxity Associated With Increased Medial Foot Loading in Female Athletes
Authors: Barber Foss Kim D. , Ford Kevin R. , Myer Gregory D. , Hewett Timothy E.
Published: December 2009

The relationship between generalized joint laxity and plantar pressure distribution of the foot and the potential implications for lower extremity injury have not been studied.Context:

To determine the relationship between generalized joint laxity and dynamic plantar pressure distribution. We hypothesized that individuals with greater generalized joint laxity, or hypermobility, would have greater dynamic medial midfoot pressure and loading during walking than nonhypermobile individuals.Objective:

Case control.Design:

Institutional biomechanics laboratory.Setting:

Participants included 112 female soccer players between 11 and 21 years of age.Patients or Other Participants:

Each participant was tested for generalized joint laxity using the Beighton and Horan Joint Mobility Index (BHJMI; range, 0–9) and was categorized as having either high (BHJMI score ≥4) or low (BHJMI score <4) generalized joint laxity. Peak pressure and maximum force were calculated from a dynamic, barefoot plantar pressure distribution system.Main Outcome Measure(s):

Peak pressure and maximum force were greater in the 27 participants categorized as having high generalized joint laxity than in the 85 participants categorized as having low generalized joint laxity. The midfoot region exhibited greater loading in participants with high generalized joint laxity than in the other participants. We found an effect of BHJMI classification in the medial midfoot; peak pressure in the dominant (F1,109  =  11.262, P  =  .001) and nondominant (F1,109  =  14.32, P < .001) sides and maximum force in the dominant (F1,109  =  7.88, P  =  .006) and nondominant (F1,109  =  9.18, P  =  .003) sides were greater in the high generalized joint laxity group than in the low generalized joint laxity group.Results:

Athletes classified as having high generalized joint laxity demonstrated increased midfoot loading. Delineation of risk factors for medial collapse of the foot, which include hypermobility in athletes, may help clinicians evaluate and prevent lower extremity injury with treatments, such as orthoses.Conclusions:
Low Burnout and High Engagement Levels in Athletic Trainers: Results of a Nationwide Random Sample
Authors: Giacobbi Peter R.
Published: December 2009

To assess the prevalence of occupational burnout, engagement, and somatic health complaints and the associations among these constructs experienced by certified athletic trainers (ATs). A secondary objective was to examine differences between men and women, those with more versus less postcertification experience, and ATs who worked in different occupational settings.Objective:

Survey-based, stratified, proportionate random sample of full-time ATs.Design:

Data were collected online from ATs employed full time in the college or university, secondary school or youth, and industrial or clinical settings.Setting:

Of 3998 invited ATs, 934 replied, for a response rate of 24%. The mean age of the participants was 33.84 ± 8.29 years, and each AT worked with an average of 90 clients.Patients or Other Participants:

The dependent variables were perceived stress, occupational burnout, engagement, and somatic health complaints.Main Outcome Measure(s):

Although 17.2% of participants were in the most advanced stages of burnout, low levels of burnout and high degrees of occupational engagement were observed. Women ATs and those working in the college or university settings scored higher for burnout, whereas men and those in the clinical or industrial settings scored higher for engagement. Women also reported significantly more somatic health complaints than men did.Results:

The overall prevalence of burnout in ATs was relatively small, but sex and occupational-setting differences were observed and deserve greater scrutiny.Conclusions:
Curricular Satisfaction Levels of National Athletic Trainers' Association–Accredited Postprofessional Athletic Training Graduates
Authors: Henry Kevin J. , Van Lunen Bonnie L. , Udermann Brian , Oñate James A.
Published: December 2009

Academic programs rely on outcomes assessments to determine if changes in the curriculum are necessary.Context:

To examine the overall satisfaction levels of graduates (2005–2006) of National Athletic Trainers' Association–accredited postprofessional athletic training education programs as related to the 2002 Standards and Guidelines for Development and Implementation of NATA-Accredited Post-Professional Graduate Athletic Training Education Programs.Objective:

Original survey instrument and demographic questionnaire.Design:

Online survey instrument.Setting:

Of 211 survey recipients, 123 returned surveys (58.29% response rate).Patients or Other Participants:

Demographic information and satisfaction levels in 10 standard areas (depth of learning, breadth of learning, critical thinking, instructor availability, theoretic basis, writing skills, scholarly growth, community return, leadership, and overall program satisfaction) were obtained. Satisfaction scores were categorized into 10 percentage brackets (eg, 80%–89%) for each standard area.Main Outcome Measure(s):

No differences were noted in relation to any of the standard satisfaction areas for evaluation of time off from school. However, graduates who required more than the allotted amount of time to complete their degree were less satisfied in the areas of depth of learning (P  =  .027), breadth of learning (P  =  .001), instructor availability (P  =  .005), writing (P  =  .022), and overall program satisfaction (P  =  .016).Results:

Graduates were generally satisfied across all areas of their didactic curriculum. However, satisfaction levels were affected if graduates required more than the allotted amount of time to complete their degrees.Conclusions:
Current Sport-Related Concussion Teaching and Clinical Practices of Sports Medicine Professionals
Authors: Covassin Tracey , Elbin Robert , Stiller-Ostrowski Jennifer L.
Published: December 2009

Various consensus and position statements recommend a multifaceted approach when diagnosing a possible concussion. The effectiveness of these materials depends largely on their content being disseminated to educators and to those in the clinical setting.Context:

To identify the concussion management methods and guidelines currently taught in the athletic training classroom and clinical settings and to track the dissemination of the Vienna guidelines throughout the educational curriculum.Objective:

A 17-question Internet survey.Design:

A Web link was e-mailed to the program directors and certified athletic trainers holding educational positions in athletic training at 300 accredited programs in the United States.Setting:

513 program directors and athletic trainers.Patients or Other Participants:

Survey questions addressed education level, years of certification, employment setting, concussion assessment and return-to-play guidelines used in the clinical setting and the classroom, and clinical and teaching preferences for existing position statements and concussion grading systems. The Vienna guidelines' “simple” and “complex” definitions of concussions were provided with the return-to-play stepwise approach.Main Outcome Measure(s):

The National Athletic Trainers' Association position statement was the most widely used method of assessing, managing (61%), and making return-to-play decisions (47%) among participants. More than half of participants (66%) had never heard of the Vienna guidelines. After reading the Vienna guidelines' definitions and return-to-play criteria, nearly three-fourths of participants agreed with them. In addition, 68% said that they would use them, and 84% reported that they would teach them to students.Results:

The majority of program directors and certified athletic trainers used a multidimensional approach to assess and manage a concussion. The National Athletic Trainers' Association position statement and Vienna guidelines were underused in both the classroom and clinical settings.Conclusions:
Longitudinal Evaluation of Journal of Athletic Training Author Credentials: Implications for Future Research Engagement in Athletic Training
Authors: Myer Gregory D. , Kreiswirth Ethan M. , Kahanov Leamor , Martin Malissa
Published: December 2009

To employ retrospective trend analysis in an attempt to provide a layered description of the relative contribution (per credential) of clinical athletic trainers (those without terminal degrees) to authoring scientific literature in the Journal of Athletic Training (JAT). From these data, our secondary purpose was to evaluate trends relative to changes in journal policy and increased educational rigor or professional limitations over the past decade, discussing how they may affect the potential for clinical athletic trainers to contribute to JAT.Purpose:

Exploratory study design with trend analysis.Design:

Data collection and analysis included a trend evaluation of the credentials of clinical athletic trainer authors in JAT and the teams (by credential) of authorship to determine the credentials of authors who published in JAT.Participants:

Longitudinal tabulation of JAT author credentials from 1995 through 2007.Measurements:

We noted increases in the absolute number of research articles per volume and the number of authors per article and a decrease in the relative percentage of authors who were athletic trainers. The results also suggested that the bachelor of science degree (BS-ATC, representative of clinical athletic trainers without advanced degrees) and Doctor of Medicine (MD) credential may be underrepresented in JAT authorship.Results:

Postgraduate research training may facilitate scientific article contribution by athletic trainers. Continued evolution in the athletic training evidence-based medicine movement should foster research-based mentorship during education. Cultivating collaborations between clinical athletic trainers and research teams may also promote outcomes assessment trials, which will benefit athletic training practices.Conclusions:
Electrolyte and Plasma Changes After Ingestion of Pickle Juice, Water, and a Common Carbohydrate-Electrolyte Solution
Authors: Miller Kevin C. , Mack Gary , Knight Kenneth L.
Published: December 2009

Context:

Health care professionals advocate that athletes who are susceptible to exercise-associated muscle cramps (EAMCs) should moderately increase their fluid and electrolyte intake by drinking sport drinks. Some clinicians have also claimed drinking small volumes of pickle juice effectively relieves acute EAMCs, often alleviating them within 35 seconds. Others fear ingesting pickle juice will enhance dehydration-induced hypertonicity, thereby prolonging dehydration.

Objective:

To determine if ingesting small quantities of pickle juice, a carbohydrate-electrolyte (CHO-e) drink, or water increases plasma electrolytes or other selected plasma variables.

Design:

Crossover study.

Setting:

Exercise physiology laboratory.

Patients or Other Participants:

Nine euhydrated, healthy men (age  =  25 ± 2 years, height  =  179.4 ± 7.2 cm, mass  =  86.3 ± 15.9 kg) completed the study.

Intervention(s):

Resting blood samples were collected preingestion (−0.5 minutes); immediately postingestion (0 minutes); and at 1, 5, 10, 15, 20, 25, 30, 45, and 60 minutes postingestion of 1 mL/kg body mass of pickle juice, CHO-e drink, or tap water.

Main Outcome Measure(s):

Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume were analyzed. Urine specific gravity, osmolality, and volume were also measured to characterize hydration status.

Results:

Mean fluid intake was 86.3 ± 16.7 mL. Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma osmolality, and plasma volume did not change during the 60 minutes after ingestion of each fluid (P ≥ .05). Water ingestion slightly decreased plasma potassium concentration at 60 minutes (0.21 ± 0.14 mg/dL [0.21 ± 0.14 mmol/L]; P ≤ .05).

Conclusions:

At these volumes, ingestion of pickle juice and CHO-e drink did not cause substantial changes in plasma electrolyte concentrations, plasma osmolality, or plasma volume in rested, euhydrated men. Concern that ingesting these volumes of pickle juice might exacerbate an athlete's risk of dehydration-induced hypertonicity may be unwarranted. If EAMCs are caused by large electrolyte loss due to sweating, these volumes of pickle juice or CHO-e drink are unlikely to restore any deficit incurred by exercise.
Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue
Authors: Hart Joseph M. , Kerrigan D. Casey , Fritz Julie M. , Ingersoll Christopher D.
Published: December 2009

Context:

Isolated lumbar paraspinal muscle fatigue causes lower extremity and postural control deficits.

Objective:

To describe the change in body position during gait after fatiguing lumbar extension exercises in persons with recurrent episodes of low back pain compared with healthy controls.

Design:

Case-control study.

Setting:

Motion analysis laboratory.

Patients or Other Participants:

Twenty-five recreationally active participants with a history of recurrent episodes of low back pain, matched by sex, height, and mass with 25 healthy controls.

Intervention(s):

We measured 3-dimensional lower extremity and trunk kinematics before and after fatiguing isometric lumbar paraspinal exercise.

Main Outcome Measure(s):

Measurements were taken while participants jogged on a custom-built treadmill surrounded by a 10-camera motion analysis system.

Results:

Group-by-time interactions were observed for lumbar lordosis and trunk angles (P < .05). A reduced lumbar spine extension angle was noted, reflecting a loss of lordosis and an increase in trunk flexion angle, indicating increased forward trunk lean, in healthy controls after fatiguing lumbar extension exercise. In contrast, persons with a history of recurrent low back pain exhibited a slight increase in spine extension, indicating a slightly more lordotic position of the lumbar spine, and a decrease in trunk flexion angles after fatiguing exercise. Regardless of group, participants experienced, on average, greater peak hip extension after lumbar paraspinal fatigue.

Conclusions:

Small differences in response may represent a necessary adaptation used by persons with recurrent low back pain to preserve gait function by stabilizing the spine and preventing inappropriate trunk and lumbar spine positioning.
Generalizability Theory Analysis of Balance Error Scoring System Reliability in Healthy Young Adults
Authors: Broglio Steven P. , Zhu Weimo , Sopiarz Kay , Park Youngsik
Published: December 2009

Context:

An assessment of postural control is commonly included in the clinical concussion evaluation. Previous investigators have demonstrated learning effects that may mask concussion-induced balance decrements.

Objective:

To establish the test-retest reliability of the Balance Error Scoring System (BESS) and to provide recommendations that account for known learning effects.

Design:

Test-retest generalizability study.

Setting:

Balance research laboratory.

Patients or Other Participants:

Young adults (n  =  48) free from injuries and illnesses known to affect balance.

Intervention(s):

Each participant completed 5 BESS trials on each of the assessment dates, which were separated by 50 days.

Main Outcome Measure(s):

Total score of the BESS was used in a generalizability theory analysis to estimate the overall reliability of the BESS and that of each facet. A decision study was completed to estimate the number of days and trials needed to establish clinical reliability.

Results:

The overall reliability of the BESS was G  =  0.64. The test-retest reliability was improved when male (0.92) and female (0.91) participants were examined independently. Clinically acceptable reliability (greater than 0.80) was established when 3 BESS trials were administered in a single day or 2 trials were administered at different time points.

Conclusions:

Learning effects have been noted in individuals with no previous exposure to the BESS. Our findings indicate that clinicians should consider interpreting the mean score from 3 BESS administrations on a given occasion for both normative data comparison and pretest and posttest design. The multiple assessment technique yields clinically reliable scores and provides the sports medicine practitioner with accurate data for clinical decision making.
Clinical Assessment of Scapular Positioning in Musicians: An Intertester Reliability Study
Authors: Struyf Filip , Nijs Jo , De Coninck Kris , Giunta Marco , Mottram Sarah , Meeusen Romain
Published: December 2009

Context:

The reliability of the measurement of the distance between the posterior border of the acromion and the wall and the reliability of the modified lateral scapular slide test have not been studied. Overall, the reliability of the clinical tools used to assess scapular positioning has not been studied in musicians.

Objective:

To examine the intertester reliability of scapular observation and 2 clinical tests for the assessment of scapular positioning in musicians.

Design:

Intertester reliability study.

Setting:

University research laboratory.

Patients or Other Participants:

Thirty healthy student musicians at a single university.

Main Outcome Measure(s):

Two assessors performed a standardized observation protocol, the measurement of the distance between the posterior border of the acromion and the wall, and the modified lateral scapular slide test. Each assessor was blinded to the other's findings.

Results:

The intertester reliability coefficients (κ) for the observation in relaxed position, during unloaded movement, and during loaded movement were 0.41, 0.63, and 0.36, respectively. The κ values for the observation of tilting and winging at rest were 0.48 and 0.42, respectively; during unloaded movement, the κ values were 0.52 and 0.78, respectively; and with a 1-kg load, the κ values were 0.24 and 0.50, respectively. The intraclass correlation coefficient (ICC) of the measurement of the acromial distance was 0.72 in relaxed position and 0.75 with the participant actively retracting both shoulders. The ICCs for the modified lateral scapular slide test varied between 0.63 and 0.58.

Conclusions:

Our results demonstrated that the modified lateral scapular slide test was not a reliable tool to assess scapular positioning in these participants. Our data indicated that scapular observation in the relaxed position and during unloaded abduction in the frontal plane was a reliable assessment tool. The reliability of the measurement of the distance between the posterior border of the acromion and the wall in healthy musicians was moderate.