Journal of Athletic Training最新文献

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.

Context: Recurrent trauma and altered biomechanics in those with chronic ankle instability (CAI) have been linked to altered joint loading. Previous studies revealed that patients with CAI exhibit altered joint contact force (JCF) profiles relative to uninjured individuals during walking and landing. Identifying more easily obtainable outcomes that are associated with ankle JCF in those with CAI would reduce the knowledge gap between loading profiles at the ankle joint and outcomes related to CAI.

Objective: To quantify how ankle JCF, structural measures, postural control, and walking biomechanics interrelate in patients with CAI and how CAI variables predict ankle JCF.

Design: Cross-sectional study.

Setting: Research laboratory.

Patients or other participants: A total of 21 patients with CAI (7 men, 15 women; age = 23 ± 4 years, height = 171.6 ± 8.3 cm, mass = 71.7 ± 12.1 kg).

Main outcome measures: Triaxial peaks, impulses, and loading rates of ankle JCF were captured. Rearfoot alignment, Star Excursion Balance Test reach distances, weight-bearing lunge test score, and peak ankle angles and moments during the stance phase of walking were also recorded. Partial Pearson r correlations and forward stepwise regressions were used to examine the relationships among the ankle JCF variables and traditional CAI-related impairments.

Results: Less compressive JCF variables were associated with more rearfoot varus alignment (r = -0.53, P = .02) and greater peak inversion moment while walking (r = -0.46, P = .041). Greater posterior JCF was associated with greater peak eversion (r = 0.55, P = .01) and dorsiflexion moments while walking (r = -0.48, P = .03) as well as less rearfoot varus alignment (r = 0.51, P = .02). Similarly, greater lateral JCF variables were associated with greater dorsiflexion moment while walking (r = 0.49, P = .03) as well as less rearfoot varus alignment (r = -0.52, P = .02). Multivariate regression models partially explained ankle JCF while walking in those with CAI.

Conclusions: Although our results suggest potential associations between gait biomechanics, structural measures, and postural control with ankle JCF, further research is needed to determine if targeting these factors during therapeutic interventions would modify mechanical loading at the ankle joint during walking.

Context: Football and basketball are high risk sports for anterior cruciate ligament (ACL) injuries and lateral ankle sprains (LAS). These injuries have a high recurrence rate and long-term consequences in terms of early-onset osteoarthritis, as well as lack of return to preinjury level.

Objective: To (1) prospectively record the socio-economic costs associated with non-contact ACL injuries LAS in amateur football and basketball, and (2) to determine the association between costsand the degree of implementing preventive neuromuscular training (NMT).

Design: Prospective cohort study Setting: Amateur football and basketball teams were followed-up during one season.

Participants: Cohort of 3221 amateur football and basketball players.

Main outcome measures: All direct and indirect costs of sustained non-contact ACL injuries and LAS were registered until return to play and was described on a player-level. The degree of implementing NMT was documented twice per season. The degree of implementing NMT duringpre-season and mid-season was documented.

Results: The incidence proportion of ACL injuries and LAS was estimated at 0.01 and 0.03 injuries per player season, respectively. Thirty percent of the ACL injuries and 65% of the LAS represented a recurrent injury. The mean total cost per ACL injury and LAS was €6340.7 and €731.6, respectively. Over 90% of the injured players did not implement preventive NMT or implemented it inadequately.

Conclusions: The high costs of ACL injuries and LAS and the observation that preventive NMT is scarcely implemented in amateur football and basketball emphasizes an urgent need for policy makersto focus on injury prevention.

Context: Limited real-world data demonstrate healthcare provided by collegiate sports medicine teams, across a variety of sports and injury categories that could inform appropriate staffing and workload.

Objective: To describe athletic training (AT) services and physician encounters (PE) for acute and overuse injuries, stratified by gender and time-loss (TL) status.

Design: Descriptive epidemiology.

Setting: Sports medicine facilities at 12 institutions participating in the PAC-12 Health Analytics Program.

Patients or other participants: Division I collegiate student-athletes.

Main outcome measures: Injury counts were associated with AT services and PE. Percentages of cases which received either none or ≥1 AT service and PE were calculated. Descriptive data were provided with confidence intervals, with rates calculated per-injury and per-team-season.

Results: From 27,575 injuries, 266,910 AT services were provided, with 11,988 PE associated across 31 different sports (M 15; W 16) completing 947 team-seasons (M 416; W 531). Almost half of AT services (47.2%) and PE (48.4%) were dedicated to acute-NTL and overuse-TL and -NTL injuries. Percentages of cases receiving any AT services varied by injury category of acute-TL and -NTL and overuse-TL and -NTL (63.9% to 80.1%), while PE ranged from 33% to 59%. When ranking AT services per-injury and per-team-season, the sports with the highest rates were more frequently categorized as low to moderate risk in the Appropriate Medical Coverage of Intercollegiate Athletics, rather than increased risk.

Conclusions: Lower or moderate risk sports demonstrated substantial healthcare utilization in AT service rates per-injury and per-team-season. Additionally, those services were frequently directed at overuse and NTL injuries, rather than predominantly acute-TL. Our findings suggest a potential mismatch between provider workload and historic risk categorization calculated by injury risk and treatments per-injury. These data should inform and update considerations for appropriate staffing levels, differential workload assignments, and alignment with clinical best practices.

Objective: Determine differences in running biomechanics in female endurance runners between days when they did and did not report menstrual cycle-related symptoms.

Methods: Observational study. Subjects were provided RunScribe sensors to attach to their shoes to collect biomechanical data when running. Daily during the study period, subjects were sent a text message to complete a survey asking about their wellness, menstrual status, and training status. Descriptive measures (mean ± SD) were generated for whether runners reported being asymptomatic or symptomatic during runs and run workout details. Paired sample t-tests were executed to identify differences in impact Gs, braking Gs, pronation excursion, maximum pronation velocity, foot strike type, and gait speed between runs on days participants reported having menstrual-related symptoms (symptomatic) or not (asymptomatic). Participants needed to have recorded runs spanning the entire data collection window to be included for comparative analyses.

Results: Twenty-seven university club runners (age 20.5 ± 1.5) participated in the study. All runners (n = 27) experienced at least one menstrual cycle-related symptom during data collection. The average number of asymptomatic runs was 22.3 ± 17.1 and symptomatic runs was 9.1 ± 7.5. Daily mileage averaged 4.3 ± 1.9 miles and total mileage was 154.2 ± 115.4 miles. Fourteen runners had run data viable for pairwise sampling. There was no significant difference in biomechanical measures between symptomatic or asymptomatic days (p > .05).

Conclusion: This study prospectively monitored distance runners' activity while simultaneously recording symptoms related to the menstrual cycle. While runners reported fewer days running when symptomatic, we did not identify a difference in objective biomechanical measures between asymptomatic or symptomatic runs. Perceived symptom burden was present in this sport population and may warrant further exploration of perceived expectations of the menstrual cycle to athletic performance.