Journal of Athletic Training最新文献

Context: The pitching cycle is a highly dynamic task, and the trunk and abdominal obliques are key contributors in efficient kinetic transfer.

Objective: To determine the relationship between abdominal oblique strength and pitching biomechanics in adolescent baseball pitchers.

Design: Cross-sectional study.

Setting: Biomechanics laboratory.

Patients or other participants: Nineteen healthy right-handed high school male baseball pitchers (age = 17.1 ± 1.1 years, height = 183.7 ± 6.5 cm, mass = 83.1 ± 10.1 kg).

Main outcome measures: The main outcome was full body biomechanics captured at key points during the pitching cycle. The main variable of interest was abdominal oblique strength (glove arm and throwing arm). Kinematics and kinetics were calculated using Visual 3D motion capture software. Descriptive statistics including means and standard deviations were calculated. Shapiro-Wilk test confirmed the data were normally distributed. Scatterplots determined linear associations, so a 2-tailed Pearson correlation with Fisher option was used to examine associations between obliques strength measurements and biomechanical metrics.

Results: Three kinematic measures were identified with p < 0.05 and r = 0.5 demonstrating strong correlations with abdominal oblique strength. Maximum pelvis rotation velocity was positively correlated with throwing arm oblique strength (r =0.52, p = 0.02). Glove arm oblique strength was positively correlated with both maximum pelvis rotation velocity and maximum torso rotation velocity (r = 0.69, p = 0.001, and r = 0.52, p = 0.02, respectively).

Conclusions: These data highlight the moderate to strong positive relationship abdominal oblique strength has on both maximal pelvic and torso rotational velocity. Training to improve the strength of the abdominal obliques may increase both maximal pelvic and trunk rotational velocity, while avoiding a significant increase upper extremity joint loading, which is important in optimizing performance and injury prevention.

Objective: To determine impairments on self-reported/performance-based function in individuals with patellofemoral pain (PFP) as well as physical and non-physical factors potentially related with these impairments.

Data sources: We searched MEDLINE, Embase, CINAHL, Web of Science, and SPORTDiscus databases from inception until January 2024.

Study selection: We included studies comparing self-reported/performance-based measures of function between individuals with PFP and their pain-free limbs or pain-free individuals.

Data extraction: Two independent researchers extracted the key information from each study.

Data synthesis: We performed meta-analyses for each self-reported/performance-based measure of function and meta-regressions to identify factors that might explain meta-analyses outcomes. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included 83 studies (2807 individuals with PFP and 2518 pain-free individuals). We identified very low to high certainty evidence that individuals with PFP have reduced self-reported (large effect sizes, standardized mean difference [SMD], -1.99; 95% confidence interval [CI]:-2.41,-1.57 to SMD, -4.87; 95% CI:-6.97,-2.77) and performance-based (small to large effect sizes: SMD, -.30; 95% CI:-.58, -.02 to SMD, -1.21; 95% CI:-2.71, -.29) measures of function compared to pain-free individuals, but there are no differences between limbs in individuals with unilateral PFP for the most of performance-based measures of function (small to moderate effect sizes, SMD, -.20; 95% CI:-.68, .27 to SMD, -.49; 95% CI:-1.02, .03). Age, body mass index, duration of symptoms and self-reported pain did not significantly explain self-reported function, whereas age did not significantly explain performance-based function (R2 25 <.01 to .02, p =.145 to .914).

Conclusion: Our results highlight the negative impact of PFP on self-reported and performance- based function, which seems to also affect the pain-free limb. Self-reported and performance- based measures of function should be considered when assessing individuals with PFP. None of the factors investigated explained impaired self-reported and performance-based function.

Context: Knee joint effusion and quadriceps strength and activation deficits are common consequences of anterior cruciate ligament (ACL) injury and reconstruction. The presence of an effusion may initiate or worsen the quadriceps dysfunction present after ACL trauma. In simulated effusion studies, evidence indicates an inverse relationship between effusion size and quadriceps dysfunction. While this relationship was not found in patients after ACL injury, prior research was limited by a subjective clinical assessment of effusion grade.

Objective: The purpose of this study was to determine if the size of the knee joint effusion, measured via ultrasound, after ACL injury and reconstruction influences quadriceps strength and activation.

Design: Descriptive Laboratory Study.

Setting: Research Laboratory.

Patients or other participants: 41 individuals (23 females, age=21.8±7.5years, height =171.7±7.9cm, 15 mass =72.3±14.2kg), with an ACL injury reported for 2 sessions [one before 16 reconstruction and one ∽16 weeks after ACL reconstruction].

Main outcome measure: Three ultrasound images of the suprapatellar pouch and three trials of quadriceps strength and activation using the interpolated twitch technique were gathered from the ACL knee. Effusion cross-sectional area was measured using ImageJ, averaged and inputted into linear regression models to predict muscle strength and interpolated twitch activation. Analyses were considered significant at p≤0.05.

Results: No relationship was found between effusion size and strength (R2 = 0.086) or activation (R2=0.056) after ACL injury (p>0.05). After reconstruction, however, there was a small negative relationship between effusion size 24 and activation (R2=0.122; Standardized β=-0.349; p=0.025), while no relationship was found for effusion size and strength (R2=0.000; p≤0.05).

Conclusions: The size of the effusion after ACL injury does not influence strength or activation. However, after ACL reconstruction, effusion size does have a small influence on quadriceps activation, with a larger effusion being related to lower activation. Prior research using simulated effusions appear to overestimate the effects of effusion on quadriceps function.

Objective: This research systematically assesses the effects of low-load blood flow restriction on the cross-education of muscle strength and volume, providing evidence-based guidance for clinicians and rehabilitation therapists.

Method: The literature search utilized databases such as PubMed, Web of Science, and Embase. Quality assessment employed the Cochrane Collaboration's RCT bias evaluation tool. Data synthesis, forest plot creation, and publication bias assessment were performed with Reman 5.4 software. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202440038.

Result: Six meta-analyses, encompassing 259 undergraduate students, were performed. Results indicated a markedly enhanced cross-education effect in muscle strength induction via blood flow restriction, surpassing that of traditional unilateral training and control groups. Nonetheless, the cross-education impact on muscle volume induction showed no notable variance among the groups.

Conclusion: Blood flow restriction has been shown to effectively induce cross-education in muscle strength. Nevertheless, additional research is required to determine its impact on muscle strength. Nevertheless, additional research is required to determine its impact on muscle volume cross-education. Reduced exercise intensity with blood flow restriction may augment neural activation, implying possible advantages in rehabilitative training for individuals with neurological conditionsmeriting additional investigation.

Context: On average, individuals in early recovery following anterior cruciate ligament reconstruction (ACLr) improve limb loading symmetry (LLS) with instruction to equalize weight distribution between limbs during squats. However, the extent to which these instructions improve knee extensor loading symmetry (KLS) or reduce intra-limb compensations is not known.

Objective: Determine how limb loading instructions influence knee and intra-limb loading in individuals 3-4 months post-ACLr and to explore variations in responses across individuals.

Design: Controlled Laboratory study.

Setting: Research Laboratory.

Patients: Individuals 109.4 days (18.2 days) post-ACLr (n=20) and healthy matched controls (CTRL; n=19).

Intervention: Participants performed double limb squats in natural (N; no instruction) and instructed (IN; instruction to evenly distribute weight between limbs) conditions.

Main outcome measures: Between limb and knee loading symmetry were calculated as the ratio of vertical ground reaction force and knee extensor moment impulse, between surgical(Sx):matched and non-surgical(NSx):matched limbs (ACLr:control), respectively. Intra- limb hip/knee (H/K) extensor loading distribution was calculated in Sx:matched limbs.

Results: LLS (N: 0.86; IN: 0.93, P < 0.001; ES:0.83) and KLS (N: 0.54; IN: 0.62, P=0.007; ES:0.67) improved with instruction in the ACLr group with no change in CTRL. H/K ratio did not change for either group. K-means clustering, considering natural and change (natural- instructed) in LLS, KLS, and H/K ratio, described response to instruction across three clusters: 1) ACLr: n=3; CTRL: n=9, were symmetrical in both conditions, 2) ACLr: n=14, showed some improvement in symmetry, 3) ACLr: n=3, only improved LLS.

Conclusions: Average data suggests that weightbearing instruction improved LLS to within 7%, but a 38% knee loading deficit remained, and intra-limb compensation did not improve. Data- driven clusters indicate that three ACLr subjects were similar to controls, fourteen improved LLS, KLS and H/K distribution, and three only improved LLS with worsening KLS and H/K.

A 26-year-old male international soccer player suffered a West Point Ankle Grade III syndesmosis injury leading up to the 2022 FIFA World Cup. Following surgical stabilization, the player completed an eleven-phase return-to-performance (RTPerf) pathway designed to ensure rapid and safe return to play. The pathway employs distinct phases that incorporate clinical, psychological, and sports-specific criteria to inform decision making throughout the process. This case report outlines the phases and criteria used in conjunction with shared decision-making by the interdisciplinary team (IDT) to ensure a successful return to play at the highest level. The effectiveness of this pathway was demonstrated by the player competing at the 2022 FIFA World Cup.

Context: Attention-Deficit/Hyperactivity Disorder (ADHD) has been speculated to prolong concussion recovery; however, the evidence regarding concussion recovery for individuals with ADHD is limited.

Objective: To examine the concussion recovery time based on ADHD status, sex, and age.

Design: Cross-Sectional Study.

Setting: High school.

Participants: 935 (female n=382, 40.1%) concussions including 78 (female n=13, 20.0%) self-identified ADHD data were analyzed.

Main outcome measures: A Poisson regression was utilized to estimate the Return- to-Learn (RTL) and Return-to-Sport (RTS) recovery outcomes with three predicting variables: ADHD status, sex, and age.

Results: The mean RTL days of the ADHD and non-ADHD groups were 12.86 ± 10.89 (Median 11.0; IQR=8; 7.0-15.25) and 1.43 ± 8.39 (Median 9.0; IQR=9.0; 6.0-14.0), respectively. The mean RTS days of the ADHD and non-ADHD groups were 20.82 ± 15.25 days (Median 17.0; IQR=9; 12.0-21.0) and 18.03 ± 11.42 days (Median 15.0; IQR=10.0; 11.0-21.0), respectively. For RTL, the ADHD status (RR=1.16, 95%CI:1.08, 1.24, p<.001) and female sex (RR=1.13, 95%CI: 1.08, 1.17, p<.001) were significant variables for longer recovery, while the age was not (RR=0.995, 95%CI: 0.98, 1.01, p=.056). For RTS, the ADHD status (RR=1.17, 95%CI:1.12,1.23, p<.001), female sex (RR=1.07, 95%CI:1.04, 1.11, p<.001), and younger age (RR=0.98, 95%CI:0.96, 0.99, p<.001) were all significant variables for longer recovery.

Conclusions: Healthcare providers must be aware of the elevated risk of prolonged concussion recovery among high school athletes with ADHD.

Context: Shoulder injuries comprise the largest proportion of swimming injuries and there is a large percentage of swimmers participating with pain. Therefore, it is assumed that shoulder pain decreases performance, but studies have not compared collegiate swimmers' performance with and without pain.

Objectives: 1) Determine if individual swimmer's shoulder pain and function are associated with a change in normalized swimming performance over a season.2) Determine if differences in normalized swimming performance exist among 3 collegiate teams. 3) Qualitatively describe and compare team's training regimes.

Design: Cross sectional study.

Setting: Swimmers completed pre-(T1) and post-season (T2) surveys including pain ratings and shoulder function using the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow questionnaire. Swimming times were obtained from published meet results. Coaches reported training programs through interviews and tracking logs.

Participants: 52 NCAA Division III swimmers from 3 teams.

Main outcome measures: Stepwise linear regression was used to determine if pain and function related to performance. Team demographics and normalized swimming performance (reduction in time per lap from season's beginning to end) were compared with ANOVAs with post-hoc tests.

Results: Initial KJOC scores, but not pain, related to individual swimming performance. Differences in team performance were found (p=0.006), with Team 3 having greatest reduction in time (1.01 sec/lap), lower percentage of females, a more experienced coach and a periodization schedule with large increases and decreases in yardage. There was a main effect (p=0.043) for baseline demographics with Team 3's swimmers being taller and having longer competitive experience.

Conclusions: The initial KJOC score predicting swimming performance improvement demonstrates the need for athletic trainers to prioritize enhancement of pre-season function. Endurance training induced hypoalgesia and motivation may explain the lack of effect of shoulder pain on performance. Further research is needed to elucidate optimal periodization and dryland training.

Context: The training stress of heat acclimatization optimizing exercise performance in a hot environment can be demanding.

Objectives: This study evaluated the efficiency of different single heating protocols to elevate core temperature.

Design: Not randomized controlled trial.

Setting: Passive heating (PAS), 30-min active heating using a high-intensity bike protocol (HIBP) in a hot environment with 30-min passive heating (EH-PAS), 60-min HIBP in a hot environment (EH), or 60-min HIBP at room temperature (EM).

Participants: Ten male participants (25±3 years) performed four different 60-min heating strategies at least one week apart.

Main outcome measures: Body core temperature and heart rate.

Results: The highest peak gastrointestinal temperature occurred in EH-PAS (39.1±0.4°C), followed by EH (38.9±0.3°C), EM (38.4±0.3°C), and PAS (38.1±0.5°C). The average HR, measured as a control for intensity, was not different between exercise strategies (EH-PAS: 142±12.3, EH: 146±9.7, and EM: 142±13.3, p>0.05), while different from PAS: 98±15.2 bpm, p<0.05.

Conclusions: Adding passive heating to a shorter exercise protocol can be just as effective in keeping core temperature elevated as exercise in the heat alone during a 60-minute session. Therefore, a single-bout combination of exercise and passive heating may result in a similar body temperature induction compared to exercise heat stress alone.

Context: Athletic trainers (ATs) can manage nonurgent, musculoskeletal emergency department (ED) visits. Little is known about what populations are most likely to use the ED for nonurgent, sports-related musculoskeletal injuries.

Objectives: Our object is to provide national-level evidence on whether high-school age population with public insurance or lower socioeconomic status were more likely to have ED visits for nonurgent injuries.

Design: Cross-sectional study.

Setting: Secondary data analysis of the 2017-2019 Nationwide Emergency Department Sample (NEDS).

Patients or other participants: ED visits for high school-age patients with a sports-related musculoskeletal injury.

Main outcome measure: We used a multi-step process and AT scope of care threshold to classify ED visits for musculoskeletal injuries as urgent and nonurgent. National estimates of the proportions of visit, patient, and hospital characteristics by urgent, nonurgent, and total injury ED visits were reported. Survey weighted logistic regression was used to calculate odds ratios of an ED visit being for a nonurgent injury based on a patient's insurance type and socioeconomic status.

Results: For ED visits for musculoskeletal injuries in a high school-age, sports exposed population, 52.93% (95% CI: 51.11, 54.73) were for nonurgent injuries. Patients with public insurance were more likely (OR = 1.39; 95% CI: 1.35, 1.44) to have an ED visit for a nonurgent injury compared to ED visits for patients with private insurance. Patients from the lowest estimated neighborhood income quartiles were more likely (OR = 1.10; 95% CI: 1.02, 1.20) to have an ED visit for a nonurgent injury compared to ED visits for patients in the highest estimated income quartile.

Conclusions: Our results suggest opportunities to reduce nonurgent ED use using AT services exist, especially in high school-age athletes from vulnerable populations.