Journal of Athletic Training最新文献

A 13-year-old male competitive club soccer player with a history of bilateral Osgood-Schlatter disease over the past 6 months reported unusually high fatigue and right heel pain after a match. Over the next 4 days, fever developed and persisted despite antipyretics. Right heel pain, warmth, and redness increased until weight-bearing was not tolerated. Subsequent imaging and blood work eventually lead to a calcaneal osteomyelitis diagnosis. A bone biopsy procedure and a 6-week course of antibiotics were completed. The rehabilitation and conditioning plan, which was successful, was based on assessment findings and targeted a return to sport 12 weeks postsurgery. Interprofessional collaboration was key for the diagnosis and effective medical treatment. Rehabilitation and conditioning protocol development was challenging as (1) no postsurgical rehabilitation protocol for a patient with calcaneal osteomyelitis wishing to return to sport has been described and (2) the impact of postinjury rehabilitation on training load is poorly documented.

Context: Individuals who undergo anterior cruciate ligament reconstruction (ACLR) have altered sensorimotor brain activity that can persist for years. Directing an individual's focus of attention (FoA) using instructional cues during rehabilitation and motor control training can impact movement performance, but the direct effects on sensorimotor brain activity and network-level relationships in an ACLR population are less understood. This can have important implications for understanding the neural underpinnings of automatic control processes for direct application to motor learning.

Objective: Determine differences in brain activity and patterns of activity when ACLR knee movement is cued using an internal FoA (iFoA) compared with an external FoA (eFoA).

Design: Cross-sectional study.

Setting: Research laboratory.

Patients or other participants: We recruited 12 participants (7 female, 6.9 ± 1.0 weeks post-ACLR) after primary, unilateral ACLR. Participants performed repeated isometric quadriceps contractions under iFoA and eFoA conditions during functional magnetic resonance imaging scans.

Main outcome measures: Brain activity (blood oxygen level-dependent response) from anatomic regions of interest were extracted from move-rest contrasts in each FoA condition, and paired t tests determined differences in activity across conditions. Intranetwork and internetwork connectivity analyses were performed using Multivariate Exploratory Linear Optimized Decomposition into Independent Components Independent Component Analysis. Dual regression and fsl randomise were used to determine differences in network connectivity between iFoA and eFoA conditions.

Results: The eFoA condition elicited greater activity in the precuneus compared with the iFoA condition. The default mode network (DMN) demonstrated greater intranetwork connectivity in the eFoA condition compared with the iFoA condition in the precuneus and lateral occipital cortex.

Conclusions: Increased precuneus activity may be a favorable adaptation for motor performance, and greater within-DMN connectivity could indicate more optimal network organization to improve motor efficiency and support automation. This suggests that automatic control processes may be facilitated neurologically by an eFoA, reducing the attentional demand to perform basic knee movement after ACLR.

Context: Postconcussion driving assessment has been limited to driving simulators, which are not clinically feasible. There is a need to equip clinicians with tools that can assist in making recommendations on return to driving.

Objective: To determine the association between clinical measures and driving simulator performance in college students within a week of a concussion.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Forty-three college students with concussion and 46 controls.

Main outcome measures: Clinical outcomes included total symptom score, dual-task tandem gait completion time, dual-task cost (the percentage decline in performance under dual task versus single task), Complex Figure performance, Useful Field of View performance, and Vestibular/Ocular Motor Screening (VOMS) symptom provocation score. Driving simulator outcomes included the number of collisions, speed exceedances, stop signs missed, centerline crossings, and road-edge excursions. Within each of the drive segments, we collected standard deviation of speed (SDS) and lane position (SDLP). Separate models for each clinical assessment and driving outcome with negative binomial and linear regression models were used.

Results: Greater dual-task cost was associated with increased road-edge excursions (P = .018) and SDS (P = .009). Higher VOMS symptom provocation was associated with less SDS (all P < .050). A higher Complex Figure copy score was associated with decreased centerline crossings (P = .001), road-edge excursions (P < .001), SDS (P < .001), and SDLP (all P < .050). A slower Complex Figure copy completion time was associated with lower SDS (P = .010). A higher Complex Figure delayed score was associated with fewer road-edge excursions and lower SDLP (all P < .050). Longer Complex Figure delayed completion time was associated with greater SDS (P = .03).

Conclusions: Dual-task and Complex Figure tests might be useful when assessing postconcussion driving ability. Higher VOMS symptom provocation was associated with better driving performance, possibly indicating that individuals experiencing vestibular-oculomotor symptoms may adopt more cautious strategies.

Context: Individuals with acute lateral ankle sprain (ALAS) demonstrate balance deficits and altered neural excitability associated with acute injury symptoms. However, it is unknown whether corticospinal excitability is altered during standing after ALAS and which factors are associated with neural change.

Objective: To investigate corticospinal excitability during single-legged standing and its relationship with postural control and acute injury symptoms after ALAS.

Design: Case-control study.

Setting: Research laboratory.

Patients or other participants: A total of 14 individuals with ALAS (age = 19.8 ± 2.0 years, height = 171.9 ± 8.2 cm, mass = 69.7 ± 8.2 kg) and 14 uninjured matched controls (age = 20.7 ± 2.3 years, 174.2 ± 8.8 cm, mass = 69.5 ± 14.9 kg) participated.

Main outcome measures: We measured the normalized motor-evoked potential (MEP) in the fibularis longus using transcranial magnetic stimulation at 100%, 120%, and 140% of the active motor threshold (AMT) while participants maintained a single-legged stance. Postural control was assessed using a 10-second single-legged stance immediately before transcranial magnetic stimulation testing. Center-of-pressure (COP) variables were recorded and analyzed.

Results: Individuals with ALAS demonstrated a trend toward facilitated corticospinal excitability of the fibularis longus during single-legged balance, with 64% (n = 9) of patients with ALAS exceeding the 95% CI upper limit for MEP at 100% of the AMT of the control group. Of the 4 patients with grade II ankle sprains, 75% (n = 3) exceeded this boundary for MEP at 100% of the AMT of the control group, and 100% (n = 4) exceeded the boundaries for all COP measures. Furthermore, correlation analyses revealed that a higher normalized MEP was associated with greater total COP velocity (r _s = 0.543, P = .048).

Conclusions: After ALAS, corticospinal excitability in the fibularis longus may have been facilitated during a single-legged stance, and the level of excitability tended to be associated with an increased rate of postural sway. The severity of ALAS appeared to influence both outcomes. These findings suggested a potential compensatory supraspinal mechanism for impaired postural control after ALAS.

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.