Journal of Athletic Training最新文献

Context: Low health literacy disproportionately affects individuals and communities that are socially disadvantaged or have geographical barriers to health care. For injuries such as concussion, preparticipation education is typically mandatory, but it is unclear if the reading level of these educational documents is suitable to meet the health literacy needs of adolescent athletes across urban and rural communities.

Objective: To assess differences in health literacy among adolescent athletes in urban and rural communities and compare scores with the state-mandated concussion education handout.

Design: Cross-sectional study.

Setting: High school athletics.

Patients or other participants: Participants included 270 adolescent athletes in total who attended urban (n = 157) and rural (n = 110) schools.

Main outcome measures: The Rapid Estimate of Adolescent Literacy in Medicine-Teen (REALM-Teen) was used to assess a participant's ability to read common medical words and lay terms for body parts and illnesses. The tool consists of 66 words divided into 3 lists, and scores can range from 0 to 66. Scores are tabulated into a health literacy score for each participant, equating to a grade-specific reading level.

Results: Urban adolescent athletes had a higher total REALM-Teen score than rural participants (t = 3.868, p < .001). Urban adolescents had higher mean scores than those from rural locations for each individual REALM-Teen list; score differences were statistically significant for lists 2 and 3 (t = 2.888, p = .004; t = 4.012, p < .001, respectively). Only 26% (n = 41) of urban and 12.7% (n = 14) of rural adolescent athletes scored at a reading level that aligns with the health literacy level necessary to read /comprehend the state-provided concussion education handout.

Conclusions: Urban adolescent athletes had better health literacy compared with their rural peers; however, irrespective of rurality, more than half of participants had low health literacy for their appropriate age/grade in high school (≤seventh grade). Ensuring that health information is provided at an appropriate reading level for the target audience is essential to increasing health literacy.

Context: Baseball pitching load is linked to injury in adolescent baseball athletes; however, it is unclear if pitch counts are a good indicator of total upper extremity load during baseball pitching.

Objectives: The purpose of this study is to determine (1) the recovery time-course of musculoskeletal variables after a single live pitching bout and (2) the association between pitch counts, rating of perceived exertion (RPE), and arm-specific session RPE on musculoskeletal changes after live game pitching in adolescent baseball athletes.

Design: Cross-sectional study.

Setting: Competitive baseball games.

Participants or other participants: Thirty-six adolescent baseball pitchers (16.1 ± 0.9 years, 178.2 ± 10.4 cm, 71.5 ± 10.2 kg).

Main outcome measures: Internal and external shoulder range of motion, internal and external shoulder rotation peak force, and infraspinatus cross-sectional area and echo intensity were collected before pitching, immediately after pitching, and on days 1, 3, and 5 after pitching. Pitch count and RPE were collected during the pitching bout, and an arm-specific session RPE score was calculated as the product of pitch count and RPE. Linear mixed models were used to determine the recovery time-course on both arms and to determine the association between the load variables (pitching count, RPE, arm-specific session RPE) and the change in the musculoskeletal variables on the dominant arm.

Results: Internal shoulder range of motion was highest on day 3 (mean difference: 3.31, t = 3.12, P = .019), and external shoulder rotation peak force decreased immediately after pitching (-11.53, t = 3.51, P = .005) and increased at day 5 (14.8, t = 4.52, P < .001). Internal shoulder rotation peak force was lowest immediately after pitching and highest at day 5 (19.14, t = 4.18, P < .001). No significant (P > .057) association was found between load variables and musculoskeletal variables.

Conclusions: Baseball-specific pitching load metrics did not predict musculoskeletal changes after live game pitching. Future researchers should investigate pitching load variables that better predict musculoskeletal changes.

Context: Incomplete neurological recovery following concussion has been linked to increased lower extremity musculoskeletal injury risk. Incorporating cognitive demands into jump-landing tasks may offer better insights into neurological recovery postconcussion and its connection to injury risk.

Objective: To compare unilateral knee biomechanics during jump-landing tasks across different levels of motor and cognitive demands between individuals with a recent concussion and matched controls.

Design: Cross-sectional study.

Setting: Biomechanics laboratory.

Patients or other participants: We recruited 26 college students with a recent concussion (22 women; age = 19.7 ± 1.2 years; Tegner scale = 7.0 ± 2.2; time since recent concussion = 5.4 ± 3.2 months) and 26 healthy reference participants without a concussion history (22 women; age = 19.9 ± 1.3 years; Tegner scale = 7.0 ± 2.0).

Main outcome measures: Unilateral and limb symmetry of knee biomechanics were assessed during initial ground contact and the landing phase of jump-landing tasks. Limb symmetry was determined by the absolute difference between limbs for knee flexion and abduction angle, internal knee extension and adduction moments, and vertical and posterior ground reaction force. Separate repeated-measure analyses of variance with mixed designs examined group, condition, and group-by-condition interaction, with α = .05.

Results: No group differences were observed in most outcome measures for either limb or limb symmetry across all jump-landing tasks except that the concussion history group had lower nondominant peak posterior ground reaction force compared with the healthy reference group (F_1,50 = 3.461, P = .016, η² = 0.111). Both groups demonstrated higher peak knee flexion, abduction angle, and peak knee adduction moments but lower peak knee extension moments and peak vertical ground reaction force on both limbs during double-leg versus single-leg conditions. No other significant findings were observed.

Conclusions: The concussion history group demonstrated similar knee biomechanical profiles to the healthy reference group during landing even with added cognitive demands in jump-landing tasks. Elevated lower extremity musculoskeletal injury risk postconcussion may not be detectable through jump-landing biomechanics.

Context: Women with patellofemoral pain (PFP) commonly have hip muscle weakness in comparison with women without PFP. One underlying mechanism for this muscle weakness is inhibition. Although the presence of muscle weakness is well documented in women with PFP, few authors have investigated gluteus medius inhibition in this population. Women are twice as likely to suffer from PFP when compared with men; therefore, we focused on the female population.

Objective: To compare voluntary activation of the gluteus medius between women with and without PFP.

Design: Case-control study.

Setting: Laboratory.

Patients or other participants: Twenty-eight female participants: 13 pain-free control participants (age = 21.6 ± 3.6 years, height = 1.66 ± 0.06 m, mass = 65.4 ± 11.3 kg) and 15 participants with PFP (age = 22.3 ± 3.2 years, height = 1.66 ± 0.07 m, mass = 75.3 ± 22.6 kg, duration of pain = 3.5-96 months).

Main outcome measures: Standing hip-abduction normalized strength (N·m/kg), superimposed-burst force, and gluteus medius central activation ratio (CAR). Linear modeling was used to compare forces and the CAR between groups while controlling for age, mass, and hip-abduction force.

Results: Women with PFP had lower gluteus medius CAR than controls. Overall, after controlling for participant age, mass, and gluteus medius maximal voluntary isometric contraction, the PFP group had an average gluteus medius CAR 2.5% lower than the pain-free control group (control = 98.4% ± 0.01%, PFP = 95.9% ± 0.65%, P = .004).

Conclusions: Women with PFP had reduced voluntary activation of the gluteus medius when assessed with a superimposed burst. Due to the wide range of CAR values found (74%-99%), inhibition was present in some of the participants. This provides evidence that assessment of gluteal voluntary activation could assist with targeted treatment programs for individuals presenting with PFP.

Objective: To assess whether combining electrotherapies with therapeutic exercise (TEx) for chronic ankle instability (CAI) is more effective than TEx alone.

Data sources: PubMed, MEDLINE, SPORTDiscus, and Web of Science were searched to ascertain studies relevant to this review published from inception until September 2024.

Study selection: Studies included were randomized control trials, including human participants with no restriction on sex, age, or setting, with an intervention of electrotherapy in combination with TEx compared with TEx alone for treating CAI.

Data extraction: Each article was reviewed to establish if a type of electrotherapy was used with TEx for rehabilitating CAI and compared with TEx alone.

Data synthesis: A total of 3118 articles was found for review, with 7 studies meeting the inclusion criteria. The 7 studies were then divided into 4 groups: stochastic resonance stimulation, transcutaneous electrical nerve stimulation, transcranial direct current stimulation, and neuromuscular electrical stimulation for comparison.

Conclusions: The findings from the studies included in this review suggested that combining electrotherapy with TEx has preferable functional outcome measures than TEx alone when rehabilitating CAI.

Context: Massage therapy is a common intervention for athletic recovery. However, its effects on fatigue, muscle stiffness, and intramuscular fluid content or the mechanism for pain reduction remain uncertain.

Objectives: To evaluate the immediate and subacute effects (24-72 hours) of massage on pain, fatigue, muscle stiffness, and intramuscular fluid content in university athletes after an induced fatigue protocol. Additionally, we investigated whether changes in muscle stiffness and intramuscular fluid content mediate the effects of massage on pain and fatigue.

Design: Randomized controlled clinical trial.

Setting: Laboratory.

Patients or other participants: Eighty-six university athletes, who completed a quadriceps fatigue protocol involving isokinetic concentric contractions.

Interventions: Participants received either 10-minute massage therapy targeting the quadriceps or a sham control intervention. They were applied immediately after the fatigue protocol and repeated 48 hours later.

Main outcome measures: Pain and fatigue were assessed using numeric rating scales. Muscle stiffness and intramuscular fluid content were evaluated using ultrasound elastography and echo intensity, respectively.

Results: Massage therapy reduced pain immediately after the intervention compared with the sham group by -1.4 points (95% confidence interval = -2.8, -0.1). No differences were observed for pain at subsequent time points or for fatigue, muscle stiffness, or intramuscular fluid content at any time. Mediation analysis did not reveal indirect effects of changes in muscle stiffness or intramuscular fluid content on changes in pain or fatigue.

Conclusions: Massage therapy provides immediate pain relief after induced fatigue but does not produce lasting effects on pain, fatigue, muscle stiffness, or intramuscular fluid content. The observed pain reduction was not mediated by changes in muscle stiffness or intramuscular fluid content.

Context: Access to athletic trainers (ATs) in high schools is crucial for student-athlete (SA) safety. Although most high schools in the United States have access to athletic training services (ATS), no authors have longitudinally compared ATS trends between public (PUB) and private (PVT) school sectors.

Objective: To compare ATS trends between PUB and PVT schools from the 2018-2019 through 2022-2023 academic years.

Design: Longitudinal cross-sectional study.

Setting: Online survey.

Main outcome measures: High school responses to the Athletic Training Locations and Services survey from all 50 US states and the District of Columbia were queried from the 2018-2019 to 2022-2023 academic years. Average numbers of SAs (SAs), sports (Sports), full-time ATs (FtATs), part-time ATs (PtATs), and the sum of full-time and part-time ATs (ATs), along with the average weekly contracted hours (CHrs) and actual hours (AHrs) per school, and ratios of SAs : ATs, Sports : ATs, CHrs : SAs, CHrs : Sports, AHrs : SAs, and AHrs : Sports were examined to track ATS trends over 5 years and compare PUB vs PVT schools.

Results: Public schools had higher SAs and Sports vs PVT schools (both P < .001). Private schools had higher ATs, CHrs, and AHrs than PUB schools (all P < .050). Ratios of SAs : ATs and Sports : ATs were higher in PUB schools, whereas CHrs : SAs, AHrs : SAs, CHrs : Sports, and AHrs : Sports were higher in PVT schools (all P < .050). From 2018-2019 to 2022-2023, PUB schools increased Sports and Sports : ATs; PVT schools increased SAs, Sports, ATs, and SAs : ATs (all P < .050). Over the years, PUB schools decreased CHrs : Sports and AHrs : Sports; PVT decreased CHrs : SAs, AHrs : SAs, CHrs : Sports, and AHrs : Sports. FtATs increased in both sectors, whereas PtATs decreased in only PVT schools.

Conclusions: Overall, ATS were more extensively provided in PVT schools, based on ATs and ATS hours. Both sectors increased FtATs, which is encouraging. However, as SAs and Sports increased, ATS provided per SA and sport declined.