bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Intentions to Eat a Healthful Diet Among National Collegiate Athletic Association Division II Collegiate Athletes
Authors: Karpinski Christine A. , Milliner Kellianne
Published: September 2016

Context

Many athletes fail to obtain the optimal levels of energy and nutrients to support health and performance. The constructs underlying the Theory of Planned Behavior (TPB) may help identify barriers to healthful eating that can be addressed in nutrition-education programs.

Objective

To use the TPB to examine factors regarding collegiate male and female student-athletes' intentions of eating a healthful diet.

Design

Cross-sectional study.

Setting

Online survey tool.

Patients or Other Participants

The survey was taken by 244 male and female National Collegiate Athletic Association Division II athletes, and data from 201 were analyzed. Mean age of the athletes was 20 ± 1.31 years (range, 18–24 years); most were white (86.1%) and female (78.6%).

Main Outcome Measure(s)

We assessed predictive strength of attitude, subjective norms, and perceived behavioral control on behavioral intentions. Regression analysis evaluated how the variables of TPB were valued and how they predict behavioral intentions.

Results

The combination of attitude, subjective norms, and perceived behavioral controls accounted for 73.4% (R 2) of the variance in behavioral intention (F = 180.82, P < .001). Attitude had the greatest influence on behavioral intentions (β = .534, P < .001).

Conclusions

Understanding both the intentions of collegiate athletes to eat healthfully and how highly they value nutrition is crucial for the development of effective nutrition education and counseling programs.
Predicting Musculoskeletal Injury in National Collegiate Athletic Association Division II Athletes From Asymmetries and Individual-Test Versus Composite Functional Movement Screen Scores
Authors: Mokha Monique , Sprague Peter A. , Gatens Dustin R.
Published: September 2016

Functional Movement Screen (FMS) scores of ≤14 have been used to predict injury in athletic populations. Movement asymmetries and poor-quality movement patterns in other functional tests have been shown to predict musculoskeletal injury (MSI). Therefore, movement asymmetry or poor-quality movement patterns on the FMS may have more utility in predicting MSI than the composite score.Context:

To determine if an asymmetry or score of 1 on an individual FMS test would predict MSI in collegiate athletes.Objective:

Cohort study.Design:

National Collegiate Athletic Association Division II university athletic program.Setting:

A total of 84 Division II rowers, volleyball players, and soccer players (men: n = 20, age = 20.4 ± 1.3 years, height = 1.77 ± 0.04 m, mass = 73.5 ± 4.8 kg; women: n = 64, age = 19.1 ± 1.2 years, height = 1.69 ± 0.09 m, mass = 64.8 ± 9.4 kg).Patients or Other Participants:

The FMS was administered during preseason preparticipation examinations. Injury-incidence data were tracked for an academic year by each team's certified athletic trainer via computer software. An MSI was defined as physical damage to the body secondary to athletic activity or an event for which the athlete sought medical care, and resulted in modified training or required protective splitting or taping. Composite FMS scores were categorized as low (≤14) or high (>14). Pearson χ2 analyses were used to determine if MSI could be predicted by the composite FMS score or an asymmetry or score of 1 on an individual FMS test (P < .05).Main Outcome Measure(s):

Athletes with FMS scores of ≤14 were not more likely to sustain an injury than those with higher scores (relative risk = 0.68, 95% confidence interval = 0.39, 1.19; P = .15). However, athletes with an asymmetry or individual score of 1 were 2.73 times more likely to sustain an injury than those without (relative risk = 2.73, 95% confidence interval = 1.36, 5.4; P = .001).Results:

Asymmetry or a low FMS individual test score was a better predictor of MSI than the composite FMS score.Conclusions:
Implementing Health and Safety Policy Changes at the High School Level From a Leadership Perspective
Authors: Pagnotta Kelly D. , Mazerolle Stephanie M. , Pitney William A. , Burton Laura J. , Casa Douglas J.
Published: September 2016

Although consensus statements and recommendations from professional organizations aim to reduce the incidence of injury or sudden death in sport, nothing is mandated at the high school level. This allows states the freedom to create and implement individual policies. An example of a recommended policy is heat acclimatization. Despite its efficacy in reducing sudden death related to heat stroke, very few states follow the recommended guidelines.Context:

To retroactively examine why and how 3 states were able to facilitate the successful creation and adoption of heat-acclimatization guidelines.Objective:

Qualitative study.Design:

High school athletic associations in Arkansas, Georgia, and New Jersey.Setting:

Eight men and 3 women (n = 11; 6 athletic trainers; 2 members of high school athletic associations; 2 parents; 1 physician) participated. Participant recruitment ceased when data saturation was reached.Patients or Other Participants:

All phone interviews were digitally recorded and transcribed verbatim. A grounded-theory approach guided analysis and multiple analysts and peer review were used to establish credibility.Data Collection and Analysis:

Each state had a different catalyst to change (student-athlete death, empirical data, proactivity). Recommendations from national governing bodies guided the policy creation. Once the decision to implement change was made, the states displayed 2 similarities: shared leadership and open communication between medical professionals and members of the high school athletic association helped overcome barriers.Results:

The initiating factor that spurred the change varied, yet shared leadership and communication fundamentally allowed for successful adoption of the policy. Our participants were influenced by the recommendations from national governing bodies, which align with the institutional change theory. As more states begin to examine and improve their health and safety policies, this information could serve as a valuable resource for athletic trainers in other states and for future health and safety initiatives.Conclusions:
Athletic Trainers' Beliefs About and Implementation of Evidence-Based Practice
Authors: Keeley Kimberly , Walker Stacy E. , Hankemeier Dorice A. , Martin Malissa , Cappaert Thomas A.
Published: September 2016

Context

Understanding the beliefs about and use of evidence-based practice (EBP) among athletic trainers (ATs) will help to determine appropriate strategies to improve implementation.

Objective

To examine the ATs' beliefs about and use of EBP.

Design

Cross-sectional study.

Setting

Online survey instrument.

Patients or Other Participants

A total of 467 ATs responded to the survey request, a response rate of 11.67%. A total of 385 (9.6%) completed the EBP Beliefs Scale and 342 (8.5%) completed the EBP Implementation Scale.

Main Outcome Measure(s)

The EBP Beliefs Scale and EBP Implementation Scale were administered. The surveys collected demographic information in addition to information about participants' beliefs regarding EBP and implementation of EBP in clinical practice.

Results

The ATs demonstrated a level of neither agree nor disagree (56.00 ± 7.86) on the EBP Beliefs Scale. Belief scores were higher among those ATs required to document for third-party reimbursement (P = .001), those with access to current research through professional journals other than the Journal of Athletic Training (P = .02), and those with a doctoral degree (P = .01). A low level of implementation (9.00 ± 11.38), representing the implementation of EBP approximately 0 times in the previous 8 weeks, was found on the EBP Implementation Scale. Implementation scores were higher among preceptors (P = .01), those required to document for third-party reimbursement (P < .001), those with access to current research through professional journals (P = .002), and those with a doctoral degree (P = .01).

Conclusions

Participants had a positive attitude toward EBP; however, they were not implementing EBP concepts when providing patient care. This suggests that additional information and EBP resources are needed so ATs can better implement EBP in practice. To provide the best patient care and to promote EBP within the profession, clinicians should make EBP a priority and advocate for EBP implementation.
Certified Athletic Trainers' Knowledge and Perceptions of Posttraumatic Osteoarthritis After Knee Injury
Authors: Pietrosimone Brian , Blackburn J. Troy , Golightly Yvonne M. , Harkey Matthew S. , Luc Brittney A. , DeFreese J. D. , Padua Darin A. , Jordan Joanne M. , Bennell Kim L.
Published: September 2016

Context: 

Posttraumatic osteoarthritis (PTOA) is a specific phenotype of osteoarthritis (OA) that commonly develops after acute knee injury, such as anterior cruciate ligament (ACL) or meniscal injury (or both). Athletic trainers (ATs) are well positioned to educate patients and begin PTOA management during rehabilitation of the acute injury, yet it remains unknown if ATs currently prioritize long-term outcomes in patients with knee injury.

Objective: 

To investigate ATs' knowledge and perceptions of OA and its treatment after ACL injury, ACL reconstruction, or meniscal injury or surgery.

Design: 

Cross-sectional study.

Patients or Other Participants: 

An online survey was administered to 2000 randomly sampled certified ATs. We assessed participants' perceptions of knee OA, the risk of PTOA after ACL or meniscal injury or surgery, and therapeutic management of knee OA.

Results: 

Of the 437 ATs who responded (21.9%), the majority (84.7%) correctly identified the definition of OA, and 60.3% indicated that they were aware of PTOA. A high percentage of ATs selected full meniscectomy (98.9%), meniscal tear (95.4%), ACL injury (90.2%), and partial meniscectomy (90.1%) as injuries that would increase the risk of developing OA. Athletic trainers rated undertaking strategies to prevent OA development in patients after ACL injury or reconstruction (73.8%) or meniscal injury or surgery (74.7%) as extremely or somewhat important. Explaining the risk of OA to patients with an ACL or meniscal injury was considered appropriate by 98.8% and 96.8% of respondents, respectively; yet a lower percentage reported that they actually explained these risks to patients after an ACL (70.8%) or meniscal injury (80.6%).

Conclusions: 

Although 84.7% of ATs correctly identified the definition of OA, a lower percentage (60.3%) indicated awareness of PTOA. These results may reflect the need to guide ATs on how to educate patients regarding the long-term risks of ACL and meniscal injuries and how to implement strategies that may prevent PTOA.
High School Football Injury Rates and Services by Athletic Trainer Employment Status
Authors: Kerr Zachary Y. , Lynall Robert C. , Mauntel Timothy C. , Dompier Thomas P.
Published: September 2016

Context

Reported injury rates and services in sports injury surveillance may be influenced by the employment setting of the certified athletic trainers (ATs) reporting these data.

Objective

To determine whether injury rates and the average number of AT services per injury in high school football varied by AT employment status.

Design

Cross-sectional study.

Setting

We used data from the National Athletic Treatment, Injury and Outcomes Network and surveyed ATs about their employment setting.

Patients or Other Participants

Forty-four responding ATs (37.9% of all National Athletic Treatment, Injury and Outcomes Network participants) worked at high schools with football programs and were included in this study. Fourteen ATs were full-time employees of the high school, and 30 ATs were employed as outreach ATs (ie, full-time and part-time ATs from nearby clinics, hospitals, and graduate school programs).

Main Outcome Measure(s)

We calculated injury rates per 1000 athlete-exposures and average number of AT services per injury.

Results

Reported injury rates and services per injury were greater among full-time school employees compared with outreach ATs. However, injury rates did not differ when restricted to time-loss injuries only.

Conclusions

Our findings suggest that ATs who are full-time school employees may be able to identify and care for more patients with injuries.
Hydration: The New FIFA World Cup's Challenge for Referee Decision Making?
Authors: Houssein Mohamed , Lopes Philippe , Fagnoni Bruno , Ahmaidi Said , Yonis Soubère Mahamoud , Leprêtre Pierre-Marie
Published: September 2016

Various continental sporting events have exposed team sports referees to different environmental conditions. Several studies have focused on strategies to prevent athlete performance impairment induced by heat or warm (or both) conditions, but few authors have investigated the effect of heat on referees' performance. In a thermoneutral environment, referees' physical activity induced mild 2.0% dehydration, which was responsible for reductions in physical, psychomotor, and cognitive performances. Therefore, the hydration status of referees should be taken into account to reduce referees' errors and misjudgments in the heat.
Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial
Authors: Donovan Luke , Hart Joseph M. , Saliba Susan A. , Park Joseph , Feger Mark Anthony , Herb Christopher C. , Hertel Jay
Published: September 2016

Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.Context:

To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.Objective:

Randomized controlled clinical trial.Design:

Laboratory.Setting:

A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg).Patients or Other Participants:

Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.Intervention(s):

We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated.Main Outcome Measure(s):

We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.Results:

Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.Conclusions:
Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer
Authors: Kasamatsu Tricia , Cleary Michelle , Bennett Jason , Howard Keith , McLeod Tamara Valovich
Published: September 2016

Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools.Context:

 To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion.Objective:

 Cross-sectional study.Design:

 Web-based survey.Setting:

 A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]).Patients or Other Participants:

 School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables.Main Outcome Measure(s):

 Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles.Results:

 Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.Conclusions:
Age Differences in Recovery After Sport-Related Concussion: A Comparison of High School and Collegiate Athletes
Authors: Nelson Lindsay D. , Guskiewicz Kevin M. , Barr William B. , Hammeke Thomas A. , Randolph Christopher , Ahn Kwang Woo , Wang Yanzhi , McCrea Michael A.
Published: September 2016

Younger age has been hypothesized to be a risk factor for prolonged recovery after sport-related concussion, yet few studies have directly evaluated age differences in acute recovery.Context:

 To compare clinical recovery patterns for high school and collegiate athletes.Objective:

 Prospective cohort study.Design:

 Large, multicenter prospective sample collected from 1999–2003 in a sports medicine setting.Setting:

 Concussed athletes (n = 621; 545 males and 76 females) and uninjured controls (n = 150) participating in high school and collegiate contact and collision sports (79% in football, 15.7% in soccer, and the remainder in lacrosse or ice hockey).Subjects:

 Participants underwent evaluation of symptoms (Graded Symptom Checklist), cognition (Standardized Assessment of Concussion, paper-and-pencil neuropsychological tests), and postural stability (Balance Error Scoring System). Athletes were evaluated preinjury and followed serially at several time points after concussive injury: immediately, 3 hours postinjury, and at days 1, 2, 3, 5, 7, and 45 or 90 (with neuropsychological measures administered at baseline and 3 postinjury time points).Main Outcome Measure(s):

 Comparisons of concussed high school and collegiate athletes with uninjured controls suggested that high school athletes took 1 to 2 days longer to recover on a cognitive (Standardized Assessment of Concussion) measure. Comparisons with the control group on other measures (symptoms, balance) as well as direct comparisons between concussed high school and collegiate samples revealed no differences in the recovery courses between the high school and collegiate groups on any measure. Group-level recovery occurred at or before 7 days postinjury on all assessment metrics.Results:

 The findings suggest no clinically significant age differences exist in recovery after sport-related concussion, and therefore, separate injury-management protocols are not needed for high school and collegiate athletes.Conclusions:
The Ability of American Football Helmets to Manage Linear Acceleration With Repeated High-Energy Impacts
Authors: Cournoyer Janie , Post Andrew , Rousseau Philippe , Hoshizaki Blaine
Published: September 2016

Football players can receive up to 1400 head impacts per season, averaging 6.3 impacts per practice and 14.3 impacts per game. A decrease in the capacity of a helmet to manage linear acceleration with multiple impacts could increase the risk of traumatic brain injury.Context:

To investigate the ability of football helmets to manage linear acceleration with multiple high-energy impacts.Objective:

Descriptive laboratory study.Design:

Laboratory.Setting:

We collected linear-acceleration data for 100 impacts at 6 locations on 4 helmets of different models currently used in football. Impacts 11 to 20 were compared with impacts 91 to 100 for each of the 6 locations.Main Outcome Measure(s):

Linear acceleration was greater after multiple impacts (91−100) than after the first few impacts (11−20) for the front, front-boss, rear, and top locations. However, these differences are not clinically relevant as they do not affect the risk for head injury.Results:

American football helmet performance deteriorated with multiple impacts, but this is unlikely to be a factor in head-injury causation during a game or over a season.Conclusions:
Injuries and Associated Risk Factors Among Adolescent Elite Orienteerers: A 26-Week Prospective Registration Study
Authors: von Rosen Philip , Heijne Annette I.-L. M. , Frohm Anna
Published: September 2016

In orienteering, the number of injury-registration studies is limited. Most researchers have used a cross-sectional design during specific events and, therefore, have mainly identified acute injuries.Context:

To determine the prevalence of injuries by registering acute and overuse injuries in adolescent elite orienteerers over 26 weeks and to study the variation of injury prevalence over the season and the potential risk factors.Objective:

Cohort study.Design:

Two high schools in Sweden with national orienteering teams.Setting:

All athletes (33 adolescent girls, 31 adolescent boys; age = 17 ± 1 years) from 2 high schools with orienteering teams.Patients or Other Participants:

We used a weekly Web-based questionnaire to identify the incidence and prevalence of injuries and training variables. Risk factors for injury were calculated using multiple linear regression techniques.Main Outcome Measure(s):

The average weekly prevalence of overuse and acute injuries was 35.7% (95% confidence interval = 34.8%, 36.6%) and 1.7% (95% confidence interval = 1.3%, 2.1%), respectively; overuse injuries (78.0%, n = 85) accounted for the majority. The incidence of acute and overuse injuries was highest for the foot/lower leg (48.6%, n = 53), and 71.6% (n = 78) of all injuries affected the foot/lower leg and knee area. Time to the first reported injury was associated with training volume (β = 0.184, P = .001), competition time (β = −0.701, P = .009), running on asphalt roads (β = −0.348, P = .008), and running on forest surfaces and trails (β = −0.331, P = .007), with a model fit of r 2 = 0.50 (intercept = 2.196, P < .001). During the study, we observed a weekly increase (0.3%) in the prevalence of overuse injuries in the foot/lower leg (r 2 = 0.33, P = .001); the highest prevalence (26.9%) was at the beginning of the competitive season.Results:

Overuse injuries, predominately in the foot/lower leg area, were more common than acute injuries in adolescent elite orienteerers. These injuries had the highest prevalence at the beginning of the competitive season; therefore, this period can be seen as a possible risk factor for sustaining overuse injuries in the foot/lower leg.Conclusions:
Neural Excitability and Joint Laxity in Chronic Ankle Instability, Coper, and Control Groups
Authors: Bowker Samantha , Terada Masafumi , Thomas Abbey C. , Pietrosimone Brian G. , Hiller Claire E. , Gribble Phillip A.
Published: September 2016

Neuromuscular and mechanical deficiencies are commonly studied in participants with chronic ankle instability (CAI). Few investigators have attempted to comprehensively consider sensorimotor and mechanical differences among people with CAI, copers who did not present with prolonged dysfunctions after an initial ankle sprain, and a healthy control group.Context:

To determine if differences exist in spinal reflex excitability and ankle laxity among participants with CAI, copers, and healthy controls.Objective:

Case-control study.Design:

Research laboratory.Setting:

Thirty-seven participants with CAI, 30 participants categorized as copers, and 26 healthy control participants.Patients or Other Participants:

We assessed spinal reflex excitability of the soleus using the Hoffmann reflex protocol. Participants' ankle laxity was measured with an instrumented ankle arthrometer. The maximum Hoffmann reflex : maximal muscle response ratio was calculated. Ankle laxity was measured as the total displacement in the anterior-posterior directions (mm) and total rotation in the inversion and eversion directions (°).Main Outcome Measure(s):

Spinal reflex excitability was diminished in participants with CAI compared with copers and control participants (P = .01). No differences were observed among any of the groups for ankle laxity.Results:

Changes in the spinal reflex excitability of the soleus that likely affect ankle stability were seen only in the CAI group, yet no mechanical differences were noted across the groups. These findings support the importance of finding effective ways to increase spinal reflex excitability for the purpose of treating neural excitability dysfunction in patients with CAI.Conclusion:
Using Ankle Bracing and Taping to Decrease Range of Motion and Velocity During Inversion Perturbation While Walking
Authors: Hall Emily A. , Simon Janet E. , Docherty Carrie L.
Published: September 2016

Prophylactic ankle supports are commonly used. However, the effectiveness of external supports in preventing an inversion stress has been debated.Context:

To evaluate how ankle bracing and taping affect inversion range of motion, time to maximum inversion, inversion velocity, and perceived ankle stability compared with a control condition during a dynamic inversion perturbation while walking.Objective:

Crossover study.Design:

Research laboratory.Setting:

A total of 42 physically active participants (16 men, 26 women; age = 21.2 ± 3.3 years, height = 168.9 ± 8.9 cm, mass = 66.1 ± 11.4 kg) volunteered.Patients or Other Participants:

Participants walked on a custom-built walkway that suddenly inverted their ankles to 30° in 3 conditions: brace, tape, and control (no external support). We used an ASO ankle brace for the brace condition and a closed basketweave technique for the tape condition. Three trials were completed for each condition.Intervention(s):

Maximum inversion (degrees), time to maximum inversion (milliseconds), and inversion velocity (degrees per second) were measured using an electrogoniometer, and perceived stability (centimeters) was measured using a visual analog scale.Main Outcome Measure(s)

Maximum inversion decreased more in the brace condition (20.1°) than in the control (25.3°) or tape (22.3°) conditions (both P values = .001), and the tape condition restricted inversion more than the control condition (P = .001). Time to maximum inversion was greater in the brace condition (143.5 milliseconds) than in the control (123.7 milliseconds; P = .001) or tape (130.7 milliseconds; P = .009) conditions and greater in the tape than in the control condition (P = .02). Inversion velocity was slower in the brace condition (142.6°/s) than in the control (209.1°/s) or tape (174.3°/s) conditions (both P values = .001) and slower in the tape than in the control condition (P = .001). Both the brace and tape conditions provided more perceived stability (0.98 cm and 0.94 cm, respectively) than the control condition (2.38 cm; both P values = .001).Results:

Both prophylactic conditions affected inversion range of motion, time to maximum inversion, inversion velocity, and perceived ankle stability. However, bracing provided more restriction at a slower rate than taping.Conclusions:
Biochemical Response to a Moderate Running Bout in Participants With or Without a History of Acute Knee Injury
Authors: Cattano Nicole M. , Driban Jeffrey B. , Barbe Mary F. , Tierney Ryan T. , Amin Mamta , Sitler Michael R.
Published: September 2016

Context: 

Individuals with an acute knee-injury history are 4 times more likely to develop knee osteoarthritis than those without a prior knee injury, and it is unknown why. Individuals with an injury history may exhibit aberrant changes in tissue turnover after physical activity (eg, running), which could lead to osteoarthritis, but this has yet to be determined among young, physically active individuals.

Objective: 

To determine collagen degradation and synthesis and inflammatory biomarker concentration levels before exercise and changes in response to an acute running bout in injured participants compared with healthy control participants.

Design: 

Cohort study.

Setting: 

Research laboratory.

Patients or Other Participants: 

A total of 22 physically active individuals between 18 and 25 years of age were recruited for the study: 11 injured participants (knee injury within 4 years of the study) who were medically cleared for physical activity and 11 matched healthy control participants.

Main Outcome Measure(s): 

The independent variable was group (injured or control). Dependent variables were serum biomarker concentrations for cartilage oligomeric matrix protein, matrix metalloproteinase-13, proinflammatory marker interleukin-1β, c-terminal cross-linking telopeptide of type II collagen, and type II collagen synthesis marker. Each participant provided prerun and postrun blood samples for biomarker-concentration analysis.

Results: 

No group differences existed in serum biomarker concentrations before exercise or in serum biomarker changes from pre-exercise to postexercise.

Conclusions: 

After an acute bout of moderate-intensity running, young, active individuals in a high-risk postinjury population had similar biochemical responses as matched healthy controls. However, the external generalizability of these findings to other exercises and populations has yet to be determined.
Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity
Authors: Wang Hsin-Min , Shultz Sandra J. , Schmitz Randy J.
Published: September 2016

Context: Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry.

Objective: To determine the relationship of ACL width and femoral notch angle to AKL.

Design: Cross-sectional study.

Setting: Controlled laboratory.

Patients or Other Participants: Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg).

Main Outcome Measure(s): Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL.

Results: Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R2 = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model.

Conclusions: A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.
Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability
Authors: Conceição Josilene Souza , Schaefer de Araújo Felipe Gustavo , Santos Gilmar Moraes , Keighley John , dos Santos Marcio Jose
Published: September 2016

Context: Rehabilitation programs for patients with chronic ankle instability (CAI) generally involve balance-perturbation training (BPT). Anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are the primary strategies used to maintain equilibrium during body perturbations. Little is known, however, about how APAs and CPAs are modified to promote better postural control for individuals with CAI after BPT.

Objective: To investigate the effect of BPT that involves kicking a ball on postural-control strategies in individuals with CAI.

Design: Randomized controlled clinical trial.

Setting: Laboratory.

Patients or Other Participants: We randomly assigned 44 volunteers with CAI to either a training group (TG; 11 women, 11 men; age = 24 ± 4 years, height = 173.0 ± 9.8 cm, mass = 72.64 ± 11.98 kg) or control group (CG; 11 women, 11 men; age = 22 ± 3 years, height = 171.0 ± 9.7 cm, mass = 70.00 ± 11.03 kg).

Intervention(s): The TG performed a single 30-minute training session that involved kicking a ball while standing on 1 foot. The CG received no intervention.

Main Outcome Measure(s): The primary outcome was the sum of the integrated electromyographic activity (∑∫EMG) of the lower extremity muscles in the supporting limb that were calculated during typical intervals for APAs and CPAs. A secondary outcome was center-of-pressure displacement during similar intervals.

Results: In the TG after training, the ∑∫EMG decreased in both dorsal and ventral muscles during compensatory adjustment (ie, the time interval that followed lower limb movement). During this interval, muscle activity (∑∫EMG) was less in the TG than in the CG. Consequently, center-of-pressure displacement increased during the task after training.

Conclusions: A single session of ball-kicking BPT promoted changes in postural-control strategies in individuals with CAI. These results should stimulate new and more comprehensive studies to investigate the effect of this and other BPT techniques on postural control in patients with CAI.
A Comparison of 2 Practical Cooling Methods on Cycling Capacity in the Heat
Authors: Cuttell Saul A. , Kiri Victor , Tyler Christopher
Published: September 2016

Context: Cooling the torso and neck can improve exercise performance and capacity in a hot environment; however, the proposed mechanisms for the improvements often differ.

Objective: To directly compare the effects of cooling the neck and torso region using commercially available devices on exercise capacity in a hot environment (temperature = 35°C ± 0.1°C, relative humidity = 50.1% ± 0.7%).

Design: Crossover study.

Setting: Laboratory.

Patients or Other Participants: Eight recreationally active, nonheat-acclimated men (age = 24 ± 4 years, height = 1.82 ± 0.10 m, mass = 80.3 ± 9.7 kg, maximal power output = 240 ± 25 W).

Intervention(s): Three cycling capacity tests at 60% maximal power output to volitional exhaustion: 1 with no cooling (NC), 1 with vest cooling (VC), and 1 with a neck cooling collar (CC).

Main Outcome Measure(s): Time to volitional exhaustion, rectal temperature, mean skin temperature, torso and neck skin temperature, body mass, heart rate, rating of perceived exertion, thermal sensation, and feeling scale were measured.

Results: Participants cycled longer with VC (32.2 ± 9.5 minutes) than NC (27. 6 ± 7.6 minutes; P = .03; d = 0.54) or CC (30.0 ± 8.8 minutes; P = .02; d = 0.24). We observed no difference between NC and CC (P = .12; d = 0.31). Neck and torso temperature and perceived thermal sensation were reduced with the use of cooling modalities (P < .001), but no other variables were affected.

Conclusions: Cycling capacity in the heat improved when participants used a commercially available cooling vest, but we observed no benefit from wearing a commercially available CC. The vest and the collar did not alter the heart rate, rectal temperature, skin temperature, or sweat-loss responses to the cycling bout.
Use of Cold-Water Immersion to Reduce Muscle Damage and Delayed-Onset Muscle Soreness and Preserve Muscle Power in Jiu-Jitsu Athletes
Authors: Fonseca Líllian Beatriz , Brito Ciro J. , Silva Roberto Jerônimo S. , Silva-Grigoletto Marzo Edir , da Silva Walderi Monteiro , Franchini Emerson
Published: September 2016

Context: Cold-water immersion (CWI) has been applied widely as a recovery method, but little evidence is available to support its effectiveness.

Objective: To investigate the effects of CWI on muscle damage, perceived muscle soreness, and muscle power recovery of the upper and lower limbs after jiu-jitsu training.

Design: Crossover study.

Setting: Laboratory and field.

Patients or Other Participants: A total of 8 highly trained male athletes (age = 24.0 ± 3.6 years, mass = 78.4 ± 2.4 kg, percentage of body fat = 13.1% ± 3.6%) completed all study phases.

Intervention(s): We randomly selected half of the sample for recovery using CWI (6.0°C ± 0.5°C) for 19 minutes; the other participants were allocated to the control condition (passive recovery). Treatments were reversed in the second session (after 1 week).

Main Outcome Measure(s): We measured serum levels of creatine phosphokinase, lactate dehydrogenase (LDH), aspartate aminotransferase, and alanine aminotransferase enzymes; perceived muscle soreness; and recovery through visual analogue scales and muscle power of the upper and lower limbs at pretraining, postrecovery, 24 hours, and 48 hours.

Results: Athletes who underwent CWI showed better posttraining recovery measures because circulating LDH levels were lower at 24 hours postrecovery in the CWI condition (441.9 ± 81.4 IU/L) than in the control condition (493.6 ± 97.4 IU/L; P = .03). Estimated muscle power was higher in the CWI than in the control condition for both upper limbs (757.9 ± 125.1 W versus 695.9 ± 56.1 W) and lower limbs (53.7 ± 3.7 cm versus 35.5 ± 8.2 cm; both P values = .001). In addition, we observed less perceived muscle soreness (1.5 ± 1.1 arbitrary units [au] versus 3.1 ± 1.0 au; P = .004) and higher perceived recovery (8.8 ± 1.9 au versus 6.9 ± 1.7 au; P = .005) in the CWI than in the control condition at 24 hours postrecovery.

Conclusions: Use of CWI can be beneficial to jiu-jitsu athletes because it reduces circulating LDH levels, results in less perceived muscle soreness, and helps muscle power recovery at 24 hours postrecovery.
Localized Ankle Fatigue Development and Fatigue Perception in Adults With or Without Chronic Ankle Instability
Authors: Webster Courtney A. , Nussbaum Maury A.
Published: September 2016

Context: Fatigue could contribute to ankle-sprain injuries during sport, particularly for individuals with chronic ankle instability (CAI).

Objective: To examine whether adults with or without CAI develop fatigue at similar rates when performing ankle exercises at the same relative effort level and whether these groups differ in their subjective perceptions of fatigue.

Design: Controlled laboratory study.

Setting: Biomechanics research laboratory.

Patients or Other Participants: A total of 11 volunteers with CAI (1 man, 10 women; age = 23.5 ± 3.0 years, height = 168.0 ± 11.2 cm, mass = 64.3 ± 13.5 kg) were recruited for the unstable-ankle group, and 11 volunteers matched for age, height, mass, and sex (1 man, 10 women; age = 24.1 ± 2.1 years, height = 169.5 ± 9.7 cm, mass = 62.3 ± 9.7 kg) were recruited as control participants.

Intervention(s): Localized muscle fatigue (LMF) was induced in the ankle of the dominant limb using a custom fatigue protocol. Plantar-flexion and dorsiflexion exertions were completed at a rate of 12 cycles per minute at isotonic loads equal to 70% and 30%, respectively, of individual maximal voluntary isometric strength. Intermittent measures of maximal voluntary isometric strength and ratings of perceived exertion (RPEs) were obtained.

Main Outcome Measure(s): We compared isometric-strength measures and RPE scores at each observation time (prefatigue and at 4, 8, 12, and 16 minutes into the fatigue protocol) and the group correlations between changes in strength and changes in RPE scores.

Results: Based on ankle-strength measures, the 2 test groups developed LMF at similar rates when exercising at equivalent levels of relative effort. The 2 groups also reported similar levels of discomfort as fatigue progressed.

Conclusions: The rate of LMF development at the ankle and the associated perception of fatigue did not differ between adults with or without CAI.
Barriers to the Role of the Head Athletic Trainer for Women in National Collegiate Athletic Association Division II and III Settings
Authors: Mazerolle Stephanie M. , Eason Christianne M.
Published: September 2016

Context: Very few women assume the role of head athletic trainer (AT). Reasons for this disparity include discrimination, motherhood, and a lack of interest in the position. However, data suggest that more women seek the head AT position in National Collegiate Athletic Association Division II and III settings.

Objective: To examine the barriers female ATs face as they transition to the role of head AT.

Design: Qualitative study.

Setting: Divisions II and III.

Patients or Other Participants: In total, 77 female ATs participated in our study. Our participants (38 ± 9 years old) were employed as head ATs at the Division II or III level.

Data Collection and Analysis: We conducted online interviews with all participants. They journaled their reflections to a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was secured by peer review and researcher triangulation.

Results: Organizational and personal factors emerged as the 2 major themes that described challenges for women assuming the role of the head AT. Organizational barriers were defined by gender stereotyping and the “good old boys” network. Personal influences included a lack of leadership aspirations, motherhood and family, and a lack of mentors.

Conclusions: Female ATs working in Divisions II or III experienced similar barriers to assuming the role of the head AT as those working in the Division I setting. Stereotyping still exists within collegiate athletics, which limits the number of women in higher-ranking positions; however, a lack of desire to assume a higher position and the desire to balance work and home inhibit some women from moving up.
Characteristics of Athletic Training Students That Preceptors Find Desirable
Authors: Carr W. David , Thomas Spencer , Paulsen Jenica , Chiu Jennifer
Published: September 2016

Context: Athletic training students acquire clinical hours under the direct supervision of athletic training preceptors.

Objective: The purpose of this project was to explore what characteristics preceptors desire in their athletic training students.

Design and Setting: Online survey instrument.

Patients or Other Participants: A total of 286 certified athletic trainers (128 male, 158 female; average years experience 10.58 ± 8.48). Participants were required to be current preceptors and have 1 or more years of preceptor experience.

Main Outcome Measure(s): An instrument of 21 questions, including 7 demographics, 13 Likert-scale (1 = not important; 10 = strongly important), and 1 rank order item was developed. Validity of the instrument was established by a review of experts. An analysis of internal consistency revealed an α of .834. Data was analyzed with SPSS (version 20.0; IBM Inc, Chicago, IL). Basic descriptive statistics were calculated, and an analysis of variance was conducted to determine differences.

Results: Top 3 characteristics seen amongst all settings were initiative (mean = 9.091 ± 1.166), communication skills (mean = 8.769 ± 1.241), and intelligence (mean = 8.723 ± 1.247). Gender differences were observed in 4 of the 13 characteristics.

Conclusions: Findings demonstrated initiative, communication skills, and intelligence to be perceived as the most important athletic training student characteristics. These findings differ with previous literature and the preliminary focus group findings, where emotional intelligence and communication skills were reported to be of greater importance.
Validation of the Quantitative Diagnostic Thinking Inventory for Athletic Training: A Pilot Study
Authors: Kicklighter Taz , Barnum Mary , Geisler Paul R. , Martin Malissa
Published: September 2016

Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices using hypothetico-deductive reasoning and experts relying more on case pattern recognition. Although several methods exist for measuring facets of clinical reasoning in specific situations, none have been experimentally applied, as of yet, to the profession of athletic training. The Diagnostic Thinking Inventory (DTI) has been used with medical doctors and medical students to determine their level of clinical reasoning as it applies to diagnosis making.

Objective: To validate the DTI for Athletic Training (DTI-AT) and associated interview questions for use in the field of athletic training.

Design: Mixed methodology.

Setting: Online inventory and Skype-based interviews.

Patients or Other Participants: Convenience sample of 25 senior-level athletic training students.

Main Outcome Measure(s): Participants completed an online version of the DTI-AT which rated clinical reasoning tendencies on a 6-point Likert-type scale. Quantitative analysis consisted of determining means and ranges of scores along with reliability of total scores and subset scores. Randomly selected participants were interviewed online in order to provide validity of interview questions that were used to determine personal and professional activities that are either thought to enhance or hinder clinical reasoning. A secondary purpose was to solicit specific feedback that may enhance our understanding of the modified DTI.

Results: A strong reliability was found for total DTI (r(41) = 0.846) and an acceptable reliability for flexibility in thinking (r(21) = 0.731) and structure of memory (r(20) = 0.771).

Conclusions: The modifications of the DTI-AT demonstrated strong reliability and face validity. The DTI-AT may be an effective tool for determining clinical reasoning of athletic training students.