Journal of Athletic Training最新文献

Context: Although the landing phases of the single-leg hop for distance (SLHD) are commonly assessed, limited work reflects how the take-off phase influences hop performance in patients with anterior cruciate ligament reconstruction (ACLR).

Objective: To compare trunk and lower extremity biomechanics between individuals with ACLR and matched uninjured controls during take-off of the SLHD.

Design: Cross-sectional study design.

Setting: Laboratory setting.

Patients or other participants: Sixteen individuals with ACLR and 18 uninjured controls.

Main outcome measure(s): Normalized quadriceps isokinetic torque, hop distance, and respective limb symmetry indices were collected for each participant. Sagittal and frontal kinematics and kinetics of the trunk, hip, knee, and ankle as well as vertical and horizontal ground reaction forces were recorded for loading and propulsion of the take-off phase of the SLHD.

Results: Those with ACLR had weaker quadriceps peak torque in the involved limb (P = .001) and greater strength asymmetry (P < .001) than control individuals. Normalized hop distance was not statistically different between limbs or between groups (P > .05), and hop distance symmetry was not different between groups (P > .05). During loading, the involved limb demonstrated lesser knee flexion angles (P = .030) and knee power (P = .007) than the uninvolved limb and lesser knee extension moments than the uninvolved limb (P = .001) and controls (P = .005). During propulsion, the involved limb demonstrated lesser knee extension moment (P = .027), knee power (P = .010), knee (P = .032) and ankle work (P = .032), and anterior-posterior ground reaction forces (P = .047) and greater knee (P = .016) abduction excursions than the uninvolved limb.

Conclusions: Between-limb differences in SLHD take-off suggest a knee underloading strategy in the involved limb. These results provide further evidence that distance covered during SLHD assessment can overestimate function and fail to identify compensatory biomechanical strategies.

Context: Underreporting of concussion symptoms in college athletics presents a challenge for sports medicine clinicians in evaluating and diagnosing such injuries. Some athletes do not report concussion symptoms because they do not recognize that they have a brain injury; however, many athletes intentionally withhold symptoms to avoid removal from sport participation.

Objective: To examine individual factors that influence college athletes' intentions to report concussion symptoms.

Design: Cross-sectional study.

Setting: Collegiate athletics.

Patients or other participants: Participants were 2649 student-athletes from 23 sports, across 22 colleges and universities.

Main outcome measure(s): The primary outcome was intention to report concussion symptoms. Predictor variables included demographics (age, race/ethnicity, sex, sport type, number of years in sport, number of previous concussions, and perceived concussion symptom knowledge), athletic identity, attitudes toward symptom reporting, perceived social pressure (injunctive and descriptive norms), and perceived behavioral control (capacity and autonomy).

Results: Hierarchical ordinary least-squares regression revealed positive effects of attitude (b = 0.063, P = .005), descriptive norms (b = 0.131, P < .001), injunctive norms (b = 0.107, P < .001), and capacity (b = 0.196, P < .001) on intention to report symptoms. Athletic identity and participation in collision sports had small negative indirect effects on intention, and perceived concussion knowledge had a small positive indirect effect. The full regression model explained 14.24% of the variance in concussion-reporting intention.

Conclusions: These findings may help clinicians develop more focused interventions that address key social and individual determinants of underreporting, including attitude, injunctive and descriptive norms, and capacity to report. Athletic identity, sport type, and perceived understanding of concussion symptoms also influence reporting intention to a lesser extent. Previous research in this area has often failed to address a diverse population of college-age athletes from different sports and National Collegiate Athletic Association divisions.

Context: The best practice for cleaning wrestling mats is using a residual disinfectant with continued antibacterial action. Recently available wash-in silver additives claim to confer a residual effect to fabric.

Objective: To test the efficacy of laundering with a wash-in silver additive in reducing athletes' exposure to potentially infectious microbes on apparel.

Design: A 4-part controlled laboratory study/parallel group comparison study. (1) To test whether fabrics in athletic clothing would be affected differently, we applied bacteria to control fabrics washed in detergent alone and test counterparts washed in detergent plus wash-in silver additive. Bacteria were applied to fabrics, extracted, plated, incubated, and counted. (2) To see if wash-in silver affected various bacteria differently, we washed cotton t-shirts with detergent alone or with detergent plus wash-in silver. We applied 4 bacterial species commonly found in the wrestling environment. Bacteria were extracted, plated, incubated, and counted. (3) To see if wash-in silver was effective in reducing bacterial contamination during practice, 32 collegiate wrestlers paired off with one wearing a test silver-treated t-shirt and their partner wearing a control shirt. Wrestler rotations exposed shirts to 2, 4, or 8 wrestlers. Identical swatches of fabric were cut from the t-shirts. Bacteria were extracted, plated, incubated, and counted. (4) We simulated prolonged/repeated bacterial exposure as occurs during tournaments by applying bacteria directly to silver-treated and untreated singlet material repeatedly over time. Test samples were taken at regular intervals to see if bacterial growth was inhibited by the presence of the silver nanoparticles. Bacteria were extracted, plated, incubated, and counted.

Setting: Laboratory and practice.

Participants: Collegiate Division III wrestling team.

Main outcome measure(s): Wash-in silver would be considered effective if a statistically significant reduction in bacterial count was observed at 95% confidence.

Results: Wash-in silver reduced bacterial growth at low levels of contamination but did not significantly reduce bacterial growth at levels seen during contact sport competitions. This was true for all bacterial species and all fabrics tested.

Conclusions: The environmental and potential health risks in using a wash-in silver nanoparticle laundry additive in the wash cycle for clothing worn by wrestlers outweigh any potential infection control benefits to these athletes. We do not currently recommend adopting wash-in silver treatment as part of the laundering regimen for wrestling programs until further testing of alternate methods of silver impregnation into sports fabrics has been investigated.

Athletic trainers are increasingly used in nontraditional settings, such as in law enforcement, where they can contribute to healthcare management, including concussion management of law enforcement officers (LEOs). Despite the prevalence of concussions among LEOs, there is a notable gap in concussion management guidelines for this population. LEOs may lack the education and resources necessary for concussion recognition and proper management. Drawing on advancements in concussion management in athletes and military personnel, here, we present a comprehensive framework for concussion management in LEOs encompassing concussion education, a graduated return-to-duty protocol, and considerations for implementation and documentation specific to law enforcement. We also present several barriers and facilitators to implementation. Due to job requirements, it is critical for law enforcement organizations and their medical providers to adopt a concussion management strategy. Without proper concussion management, LEOs may risk subsequent injury and/or suffer from prolonged recovery and adverse long-term outcomes.

Context: Repeated ankle sprains can lead to injuries, including those of the anterior talofibular ligament (ATFL); however, the extent to which these ligament injuries are associated with symptoms of chronic ankle instability (CAI) remains unclear.

Objective: To examine the influence of ATFL injury and ankle anterior displacement on symptoms of CAI.

Design: Case-control study.

Setting: University laboratory.

Patients or other participants: A total of 122 of 426 college students who completed a questionnaire on the history of ankle sprain were enrolled in healthy (n = 34; 24 men, 10 women; age = 20.6 ± 0.5 years), coper (n = 49; 38 men, 11 women; age = 20.2 ± 1.2 years), and CAI groups (n = 39; 24 men, 15 women; age = 20.1 ± 1.1 years).

Main outcome measure(s): One examiner measured the ATFL delineation using ultrasound and anterior ankle displacement using a capacitance-type sensor device. The Cumberland Ankle Instability Tool was applied to assess pain and perceived instability.

Results: The ATFL was normal more frequently in the healthy group and abnormal more frequently in the CAI group (χ2 = 18.45, P < .001). Anterior ankle displacement was greater in the coper and CAI groups than in the healthy group (both, P < .001), but no difference was observed between the coper and CAI groups (P = .16). We observed no correlation between the anterior ankle displacement and Cumberland Ankle Instability Tool scores (r = -0.004, P = .71) in participants with previous ankle sprains.

Conclusions: Observation of an abnormal ATFL on ultrasonography was associated with anterior displacement of the ankle joint. However, the influence of anterior ankle displacement due to damage to the ATFL on the pain and perceived instability in CAI was assumed to be small.

Context: Patients with lateral ankle sprains (LASs) often have deficient patient-reported outcomes (PROs) at return to activity (RTA), potentially increasing risk for recurrent LAS and ankle pain. Additionally, applied care strategies are known to correct impairments, but their ability to mitigate risk for long-term consequences remains unknown.

Objective: To determine if applied care strategies and PRO scores at RTA and 6 months after RTA predict recurrent LAS and ankle pain 12 months after an acute LAS.

Design: Prospective cohort study.

Setting: Online survey.

Patients or other participants: We enrolled 63 individuals within 1 week of sustaining an acute LAS.

Main outcome measure(s): Participants completed online surveys about their health history and recent LAS. At RTA and 6 months after RTA, participants completed online surveys regarding demographics, applied care strategies, and PROs, including the Foot and Ankle Disability Index (FADI), Identification of Functional Ankle Instability, Godin Leisure-Time Exercise Questionnaire, and Short Form-8 (SF8). At 12 months post-RTA, we asked participants if they sustained recurrent LASs. Chi-square analyses determined if recurrent LAS and ankle pain at 12 months were related to applied care strategies or ankle pain at RTA. Independent t tests compared demographics and PROs at RTA and 6 months between participants with and without a recurrent LAS or ankle pain at 12 months. Logistic regression and area under the receiver operating characteristic analyses determined if demographics, applied care strategies, ankle pain at RTA, and PRO scores at RTA and 6 months predicted recurrent LAS and ankle pain at 12 months.

Results: Participants with a recurrent LAS had a lower walking boot use (P = .05) and were taller than those without (P = .03). Increased height and lack of walking boot use were predictive of recurrent LAS (P < .01, R2 = 0.33, area under the receiver operating characteristic = 0.81 [0.68, 0.95]).

Conclusions: Individuals with LAS who are taller and do not use a walking boot might have greater risk for a recurrent LAS withing 12 months of RTA.

Context: People with patellofemoral pain (PFP) may have lower performance during the forward step-down and single-leg hop with their painful (unilateral complaints) or most painful (bilateral complaints) limb when compared with pain-free controls. However, no authors have investigated the appropriateness of using the pain-free or less painful limb as a reference standard in clinical practice or whether deficits might be present depending on the laterality of pain.

Objective: To compare performance scores and proportion of side-to-side limb symmetry during the forward step-down and single-leg hop tests among people with unilateral and bilateral PFP and pain-free controls.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Fifty-two young adults (18-35 years old) with unilateral PFP, 72 with bilateral PFP, and 76 controls.

Main outcome measure(s): Group × limb interactions on performance during the step-down (repetitions) and single-leg hop (distance [cm] normalized by the limb length) tests were investigated using a repeated-measures analysis of covariance controlling for sex. Pairwise comparisons were interpreted using effect sizes. A χ2 test was used to compare the proportion of symmetry/asymmetry (cutoff point of ≥90% for symmetry indices) across groups and tests.

Results: Main effects for groups (small to medium effects) but not limbs indicated lower performance of both limbs of individuals with unilateral and bilateral PFP than controls during forward step-down and single-leg hop tests. No significant differences for the proportion of symmetry/asymmetry were identified across groups (P ≥.05), which further suggests an impaired physical performance of the contralateral limb.

Conclusions: Our results indicate bilateral deficits in the physical performance of people with unilateral and bilateral PFP when compared with pain-free controls during the forward step-down and single-leg hop tests. Limb symmetry indices greater than 90% should be interpreted with caution, as they may overstate physical performance by not assuming bilateral deficits.

Context: California is the only state that does not regulate the athletic training profession, allowing unqualified personnel to be hired and call themselves athletic trainers (ATs). The benefits of employing a certified AT in the secondary school setting are numerous, but efforts to push regulation legislation continue to fail in California.

Objective: To describe the availability of certified ATs in California secondary schools and explore factors influencing AT employment.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: Participants from 1538 California secondary schools.

Main outcome measure(s): Officials from member schools completed the 2022-2023 California Interscholastic Federation Participation Census. Participants provided information specific to enrollment, sport participation, access to automated external defibrillators, and whether the school had ATs on staff. The AT's certification status was independently verified. Enrollment data specific to ethnicity, race, and percentage of students eligible for free meals were obtained through the California Department of Education Statistics.

Results: More than half (51.6%) of California secondary schools did not employ a certified AT, and 8.3% employed unqualified personnel as ATs. Nearly half (43%) of student-athlete participants were enrolled at schools with no certified AT. Schools that employed certified ATs had a lower proportion of students eligible to receive free and reduced-price meals. The average percentage of Hispanic or Latino students was greater in schools with no certified AT and schools that employed unqualified personnel as ATs than schools that employed certified ATs.

Conclusions: Data indicate that, in a 5-year period, access to athletic training services in California secondary schools has not improved. Large gaps in access to athletic training services and clear socioeconomic and racial and ethnic disparities exist. Efforts to educate stakeholders on the importance of athletic training regulation in California should continue.

Context: Researchers have shown that patients with chronic ankle instability (CAI) have deficits in memory and attention allocation. This functional deficit affects lower extremity performance. Motor-cognitive dual-task training may improve lower limb dysfunction caused by central nervous system injury. Further study is needed to determine whether dual-task training is more favorable than single-task training for improving neuromuscular control in patients with CAI.

Objective: To compare the effects of balance-cognition dual-task training and balance single-task training on lower limb function and electroencephalography changes during static postural control in patients with CAI.

Design: Randomized clinical trial (Chinese Clinical Trial Registry: ChiCTR2300073875).

Setting: Rehabilitation training room.

Patients or other participants: A total of 24 patients with CAI (age = 22.33 ± 2.43 years, height = 175.62 ± 7.7 cm, mass = 70.63 ± 14.59 kg) were block randomized into 2 groups.

Intervention(s): Protocols were performed 3 times per week for 6 weeks. The single-task group underwent 1-legged static balance training with eyes open and closed and hopping balance training. The dual-task group underwent balance and cognitive training (backward-counting task).

Main outcome measure(s): Cortical activity, proprioception, muscle onset time (difference between the muscle activation time and touchdown time), and dynamic balance were assessed before and after the interventions. We performed multivariate analyses of variance to identify main effects and interactions across groups and time. A post hoc Bonferroni test was performed for pairwise comparisons when interactions were present.

Results: All participants successfully completed the 6-week interventions. Proprioception, peroneus longus (PL) muscle onset time, and dynamic postural control improved after the interventions in both groups (P < .05). Dual-task training was superior to single-task training in improving joint position sense in plantar flexion, shortening PL muscle onset time, and altering cortical activity (P < .05).

Conclusions: A 6-week program of balance training or balance combined with cognitive training could improve the functional deficits associated with CAI. The dual-task training could also improve joint position sense in plantar flexion, PL muscle onset time, and cortical activity.

Context: Chronic ankle instability (CAI) patients exhibit altered movement patterns during jump landing/cutting movements. Persistent pain is one of the residual symptoms that may affect movements. Calculating joint energetics affected by chronic pain offers a novel method to understand how chronic pain influences energetics of lower extremity joints in CAI patients.

Objective: To identify the effects of chronic pain on lower extremity energy dissipation and generation during jump landing and cutting in CAI patients.

Design: Cross-sectional Study.

Setting: Laboratory.

Patients or other participants: Fifteen CAI patients with higher pain (6 males, 9 females; age=22.1±2.1year; height=1.74±0.09m; mass=71.3±10.6kg, pain=66.9±9.4), 15 CAI patients with lower pain (6 males, 9 females; age=22.3±2.1year; height=1.74±0.08m; mass=70.1±10.7kg, pain=89.3±2.6), and 15 healthy controls (6 males, 9 females; age=21.3±1.7year; height=1.73±0.08m; mass=70±10.3kg, pain=100±0).

Main outcome measures: Ground reaction force data were collected during 5 trials of maximal jump landing/cutting tasks. Joint power was defined as the product of angular velocity and joint moment. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve.

Results: CAI patients with higher pain displayed less ankle energy dissipation (p=.013 and p=.018) and generation in the ankle (p=.002 and p=.028) than CAI patients with lower pain and healthy controls during the jump landing/cutting phase. CAI patients with higher pain showed more hip energy generation than CAI patients with lower pain (P=.038) and healthy controls (P=.013) during the cutting phase.

Conclusions: CAI patients with higher pain changed both energy dissipation and generation in the lower extremities, reducing the burden of the ankle joint during jump landing/cutting and having a hip dominant compensatory strategy during the cutting phase. Our results suggest that chronic pain could be one of the factors that affect motor strategies in the CAI population.