Journal of Athletic Training最新文献

Context: While bone health remains a critical concern for women of all ages, there exists limited research on the comprehensive incidence of fractures among female collegiate athletes.

Objective: To describe the epidemiology of sport-related fractures across women's National Collegiate Athletic Association (NCAA) sports.

Design: Descriptive epidemiology study.

Setting: Injury surveillance in collegiate women's sports.

Patients or other participants: Women competing in NCAA sports during 2009/10-2018/19.

Main outcome measure(s): We examined fracture frequencies and distributions by sport, mechanism of injury, the injured body part, and injury history. We used a Bayesian framework to estimate fracture rates (per 10,000 AEs) by sport and event type.

Results: The NCAA ISP recorded 944 fractures across all women's sports during the study period, and fractures were most frequently reported among lower extremity body parts. Fractures were most commonly reported as non-contact/overuse injuries (39.0%), although equipment/apparatus contact mechanisms accounted for > 60% of fractures reported in field hockey and ice hockey. Fracture recurrence was most prevalently noted in track and field (17.8%) and gymnastics (17.6%). The posterior mean overall injury rate was 2.16 per 10,000 AEs (95% Credible Interval: [1.39, 3.44]), and the highest overall rate was estimated in gymnastics (Posterior mean= 6.29; 95% Credible Interval: [3.70, 10.31]).

Conclusions: Our findings indicate that fractures in women's gymnastics, lower leg fractures and fractures attributed to non-contact/overuse mechanisms, particularly among long-distance runners, warrant further attention in this population. Our results can inform targeted research efforts aimed at better understanding and improving bone health outcomes for female athletes.

Objective: To evaluate the longitudinal changes in knee sagittal kinematics pre- and post-anterior cruciate ligament reconstruction (ACLR) during varying walking speeds in non-laboratory environments. A secondary objective describing the hip and ankle joint kinematics.

Design: Longitudinal observational study.

Setting: Hospital.

Patients or other participants: Forty ACLR patients and 17 healthy matched controls were recruited.

Main outcome measure(s): Knee joint sagittal kinematics measured using seven inertial measurement units at pre-surgery, three-, and five-months post-surgery while walking at slow, normal, and fast speeds.

Results: At pre-surgery, compared to the contralateral limb, the injured knee exhibited greater minimum flexion during normal and fast walking (p≤.008) and exhibited less knee flexion at the first peak (p=.006). SPM revealed significant differences throughout the gait cycle at all speeds (p≤.033). Compared to controls, the injured knee had greater minimum flexion during normal and slow walking (p≤.025). At three months, compared to the contralateral limb, the injured knee showed increased minimum flexion across all speeds (p≤.005) and exhibited less knee flexion at the first peak during fast walking (p<.001). SPM indicated significant differences throughout the gait cycle at all speeds (p≤.028). Compared to controls, the injured knee remained more flexed at the minimum angle across all speeds (p<.001) and exhibited less knee flexion at the first peak during slow walking (p=.031). At five months, differences between limbs were reduced, with significant differences in minimum flexion at all speeds (p≤.027). SPM differences were limited to specific gait cycle portions during normal and fast walking (p≤.011). Compared to controls, the injured knee remained more flexed at the minimum angle during slow and normal walking (p≤.005). Lastly, hip adaptations resolved while ankle asymmetries persisted during terminal stance.

Conclusions: ACLR patients demonstrated progressive improvements in knee sagittal kinematics, indicating a recovery trend. However, the recovery was non-linear across different walking speeds.

Context: Sleep has been suggested to be a modifier of recovery following a concussion and is associated with greater symptomatology and number of days until symptom resolution. However, the physiological mechanism for why sleep disturbances occur remains poorly understood. Alterations in time spent in stages of a sleep cycle following a concussion may contribute to recovery.

Objective: The purpose of our study was to use a non-invasive, sensor-derived measure of sleep stages to determine differences between collegiate athletes with or without a concussion, acutely following injury (<72 hours).

Design: Case-control.

Setting: Division 1 collegiate athletics.

Participants: Division 1 Collegiate athletes diagnosed with a concussion were compared to healthy-matched controls based on health history, demographics and sport.

Interventions: Individuals in both groups were provided with and instructed to wear an OURA ring actigraphy device, nightly, within 72 hours of their concussion.

Main outcome measures: Differences in sensor-derived time spent in Light, Deep, rapid eye- movement (REM) sleep, time awake, and total sleep time between groups.

Results: A total of 18 athletes were included in our analyses (9 concussed, 9 controls) with an average age of 19.3+ 1.3 years. Individuals with a concussion spent less time in deep sleep (113.1±33.1 vs 134.4±51.1 minutes, p=0.03), and more time awake (90.22±30.0 vs 49.28±11.5 minutes, p=0.02) compared to individuals without a concussion. No significant differences were found for time spent in total sleep time, Light or REM sleep.

Conclusion: Acutely following concussion, individuals may demonstrate changes in sleep stages. Our results suggest that time spent in different stages of sleep may be a potential mechanism underlying recovery from concussion. Our results provide an important step in using wearable sensors to better understand sleep disturbances following concussion to help mitigate risk of a prolonged recovery.

Context: Anterior cruciate ligament (ACL) injuries are prevalent in active populations, posing significant health risks. Despite advancements in surgery and rehabilitation, effectively preventing long-term health complications remains a significant challenge, underscoring the critical importance of developing effective ACL injury prevention strategies. Existing research into the risk of ACL injuries, in relation to lower extremity strength and demographic factors, often presents conflicting findings. These studies are frequently limited by small sample sizes or a narrow focus on specific muscle groups.

Objective: To explore the association between lower extremity strength, as measured by maximum voluntary isometric contraction (MVIC), demographic factors, and the risk of ACL injuries in a large sample of military cadets.

Design: Prospective Cohort Study.

Setting: Military service academies.

Patients or other participants: A total of 2,187 female and 3,432 male military cadets were recruited from three US military service academies.

Intervention(s): Cadets underwent baseline testing in the summer prior to their freshman year. Testing included demographics and MVICs for six muscle groups including the quadriceps, hamstrings, gluteus maximus, gluteus medius, and hip internal and external rotators. Cadets were prospectively followed for primary ACL injury incidence, from date of enrollment to graduation from service academy.

Main outcome measure(s): Multivariable logistic regression analyses were conducted to examine the association between MVIC values and primary ACL injury risk while controlling for demographic factors.

Results: There were 101 (38 females, 63 males) cadets that went on to sustain a primary ACL injury within their time at the academy. The results of this study found that greater gluteus maximus strength (OR = 0.32; P = 0.007) was associated with a decreased risk of ACL injury in military cadets. Cadets matriculating with higher BMI (OR = 1.09, P = 0.01) was associated with an increased risk of primary ACL injury in military cadets. All other factors were not statistically significant for predicting primary ACL injury risk.

Conclusion: This study suggests that greater gluteus maximus strength may have a protective effect against prospective ACL injury. Conversely, higher BMI appears to be a risk factor for prospective ACL injury. These findings may have important implications for the identification of at-risk individuals for targeted ACL injury prevention programs in military cadet populations.

Context: Diverse representation in athletic training leadership is essential for fostering inclusion and innovation in the profession. Despite efforts to enhance leadership diversity, disparities persist, underscoring the need to explore barriers to leadership and the effectiveness of leadership in meeting the needs of athletic trainers (ATs).

Objective: To examine racial and ethnic differences in ATs' desire, pursuit, and attainment of leadership positions in the profession in addition to perceptions of current leadership effectiveness.

Design: Cross-sectional, web-based survey.

Participants: A purposeful sample of 1,173 racially and ethnically diverse ATs from an organized professional network followed by a random sample of 6,000 members of the National Athletic Trainers' Association (NATA). A total of 488 participants completed the survey for a 14.7% response rate.

Data collection and analysis: Data were collected via a web-based survey, including 7 demographic items, 4 Likert-scale items, and 5 open-ended questions. Independent samples Kruskal-Wallis tests, chi-square tests, and ANOVA tests were used to compare differences between subgroups, with pairwise testing conducted using the Bonferroni correction.

Results: Irrespective of race and ethnicity, most ATs expressed desire for and pursuit of leadership positions in the profession. 56.5% of ATs reported attaining such roles, primarily at departmental or institutional levels. African American ATs perceived greater barriers to attaining leadership positions due to their race and ethnicity and felt their needs were less met by current leadership as compared to white counterparts.

Conclusions: Systemic biases and in-group favoritism may impede attainment of leadership positions in athletic training organizations and influence perceptions of leadership effectiveness for racial and ethnic minority ATs. Consequently, there is a pressing need for intentional efforts to diversify leadership within athletic training and foster more inclusive leadership. Implementing strategies, such as diversifying selection processes and promoting allyship, are critical to ensuring equitable opportunities and advancing diversity within leadership.

Context: Psychosocial factors are important to consider throughout concussion recovery. Coping skills may play a role post-injury by influencing the stress response and health-promoting behaviors (e.g., rehabilitation adherence). However, limited evidence exists examining coping skills throughout concussion recovery in college-aged individuals.

Objective: To compare (1) changes in coping skills between acute and full medical clearance (FMC) visits in college-aged individuals diagnosed with concussion and healthy controls, and (2) determine the association between coping skills and recovery outcomes following concussion.

Design: Prospective cohort study.

Setting: University laboratory.

Patients or other participants: 96 college-aged individuals (concussion group: N=64, age=21.33±2.37 years; control group: N=32, age=21.54±2.54 years) were enrolled.

Main outcome measures: The Athletic Coping Skills Inventory (ACSI-28) was completed at acute (within 5 days of concussion) and FMC (within 3 days of clearance) visits. A 2 × 2 mixed ANOVA determined differences in total and subscale scores between groups (concussion vs. control) from acute to FMC visit. Multiple linear regressions determined the association between acute ACSI-28 scores and recovery for the concussion group, with statistical significance set a priori at p<0.05 for both tests.

Results: The concentration subscale was significantly lower for the concussion group at the initial visit (F(1,94)=7.28, p=0.01). The main effect of time showed both groups' ACSI-28 total score significantly increased from acute to FMC visit (F(1,94)=22.08, p<0.001). There were no significant differences in total scores between groups at either visit (p>0.05). Additionally, no associations were found between ACSI-28 scores and concussion recovery outcomes when controlling for sex, race, history of depression/anxiety, and acute visit symptom severity (symptom resolution: B=0.06, p=0.62; FMC: B=0.09, p=0.46).

Conclusions: Only coping-related concentration skills from the ACSI-28 are impaired during the acute stage of concussion recovery but improve by the FMC visit. Other coping skills associated with the ACSI-28 remain unaffected throughout concussion recovery in college-aged individuals.

Context: Mental health screenings are recommended during preparticipation physical examinations. The Mental Health-Related Survey (MHRS), a 9-item questionnaire adapted from the 18-item Mental Health Screening Form-III, is suggested in three consensus and/or position statements. However, there is no evidence on the effectiveness of the MHRS.

Objective: To assess the validity of the MHRS for mental health screening in collegiate student- athletes.

Design: Cross-sectional study.

Setting: University athletic program.

Patients: 515 NCAA Division II student-athletes (20±1 years old).

Main outcome measures: Participants completed the MHRS, PHQ-9 for depression, and GAD-7 for anxiety. A stratified sample underwent a neuropsychiatric interview (MINI). Descriptive statistics and Pearson correlations were performed. An area under the curve (AUC) analysis compared the MHRS to the MINI. Validity was determined using sensitivity, specificity, Youden's index, predictive values, and accuracy.

Results: 322 student-athletes (62.5%) indicated 'yes' to one or more items on the MHRS, suggesting they would require a mental health referral. Women indicated more 'yes' answers than men (p<0.001). Average scores were 2.21±3.06 on the PHQ-9 and 2.66±3.87 on the GAD-7. Using a cut score of 6, 68 individuals (13.2%) reported clinically relevant depression, and 76 (14.8%) reported anxiety. PHQ-9 and GAD-7 scores strongly correlated with MHRS scores (PHQ-9: r=0.713, p<0.001; GAD-7: r=0.745, p<0.001). The MHRS had a specificity of 24.6%, a sensitivity of 93.9%, and overall accuracy of 40.14%. The AUC score was 0.762. We identified a new cutoff score for the MHRS of ≥4; however, the sensitivity of 63.6% and specificity of 76.3% raise concerns regarding how well this tool can rule out and in clinically significant symptoms of mental health conditions.

Conclusion: Most student-athletes indicated 'yes' to at least one item on the MHRS, warranting a mental health referral. The MHRS showed high sensitivity but low specificity, indicating low clinical utility as a screening tool.

Context: Sport-related concussion is a common injury among National Collegiate Athletic Association football athletes. Beginning with the 2016 season, Ivy League Conference coaches voted to ban player- on-player tackling from all in-season practices. BLINDED have enforced a no-tackle approach in practices since 2010.

Objective: To examine the association between tackling technique and head contact risk, and compare base rates of techniques used in the 2016 season between an Ivy League team with a longstanding no- tackle practice policy vs. the rest of the league.

Design: Cross-sectional study.

Setting: Ivy League College Football Conference.

Patients or other participants: Two-hundred-thirty-seven Ivy League defensive football players that participated in the 2016 season.

Main outcome measure(s): Tackles (N=3,701) across 237 Ivy League defensive football players in the 2016 season were coded based on predetermined classifications, which were combined to create unique tackle combinations/techniques. Associations among tackling techniques, head impact risk, and team (BLINIDED vs. other Ivy League teams) were evaluated using logistic regression, yielding odds ratios (OR) for head contact.

Results: Low-risk tackle characteristics for head contact during a tackle were neutral neck position (OR=0.1), back contact area (OR=0.3), pursuing momentum (OR=0.5), and quarterback sack momentum (OR=0.3). Low-risk tackle techniques were high-back-neutral (OR=0.1), low-back-neutral (OR=0.2), and medium-back-neutral (OR=0.1). High-risk tackle characteristics were flexion (OR=14.2) and extension (OR=3.8) neck positioning, front contact (OR=2.2), blowup (OR=2.5), and cut (OR=3.0). High-risk tackle techniques included low-side-flexion (OR=4.9), low-front-flexion (OR=9.9), medium-side-flexion (OR=15.5), and medium-front-flexion (OR=11.4). Relative to BLINDED, other teams demonstrated higher odds of using high-risk techniques (low-side-flexion OR=3.5; low-front-flexion OR=3.9; medium- side-flexion OR=6.3; medium-front-flexion OR=2.3) and reduced odds of using low-risk tackle combinations (high-side-neutral OR=0.4; high-back-neutral OR=0.6; medium-side-neutral OR=0.8).

Conclusions: Tackling techniques are associated with head contact risk, and by extension, player safety. BLINDED, who have a longstanding policy of practicing without player-on-player tackling, showed reduced use of high-risk tackling techniques.

Context: Exertional heatstroke (EHS) is a leading cause of death in athletes and the warfighter. Polar Life Pod (PLP) and ice sheet cooling (ISC) are two of the more portable cooling techniques to treat EHS and show promise for treating patients when large volumes of water or immersion devices (e.g., tubs) are not available. "Ideal" cooling rates consistent with excellent EHS prognoses exceed 0.16°C/min while "acceptable" rates are between >0.08°C/min and 0.15°C/min. No research has compared the cooling effectiveness of the Polar Life Pod (PLP), a body bag-like device, to ISC following simulated military conditioning exercise.

Objective: Determine if PLP or ISC reduced rectal temperature (TREC) differently and at 'acceptable' or 'ideal' cooling rates.

Design: Randomized, counterbalanced, crossover study.

Setting: Laboratory.

Patients or other participants: Fourteen participants (10 men, 4 women; age: 22±3y; mass:73.8±17.8kg; ht:168.5±7.8cm).

Interventions: Participants donned a military uniform and rucksack and marched in the heat (temperature=∼37.5°C; relative humidity=∼40%) until TREC was 39.5°C. Then they undressed and were wrapped in bed sheets presoaked in ice water (≤0.89±0.33°C) or lay in PLP filled with water (151.4±3.8L; 4.22±0.95°C) until TREC was 38°C.

Main outcome measures: TREC and cooling durations; calculated TREC cooling rates.

Results: Participants exercised in similar clothing, environmental conditions, and durations (PLP=50.5±9.9min, ISC=48.9±10.9min, P=0.38). PLP cooling rates differed from ISC and were 'ideal' whilst ISC rates were 'acceptable' (PLP=0.22±0.08°C/min; ISC=0.11±0.05°C/min, P<0.001).

Conclusions: PLP lowered TREC twice as quickly as ISC and at rates consistent with favorable EHS outcomes. PLP's faster cooling rates were likely due to it utilizing conductive and convective cooling, treating a larger body surface area, and providing a larger heat sink than ISC. PLP and ISC can be utilized to treat EHS, but PLP is preferred because it reduced TREC faster, utilized less ice, and required the same number of personnel and coolers as ISC.