Journal of Athletic Training最新文献

Context: Chronic ankle instability (CAI) is prevalent among individuals who sustain a lateral ankle sprain (LAS) injury. The persistence of the characteristic long-standing clinical symptoms of CAI may be attributable to the lack of adoption by physiotherapists of evidence-informed clinical guidelines.

Objective: To investigate the extent to which French-speaking physiotherapists implement the International Ankle Consortium rehabilitation-oriented assessment (ROAST) framework when providing clinical care for individuals with an acute LAS injury.

Design: Cross-sectional study.

Setting: Online survey informed by a Delphi process of foot-ankle experts.

Patients or other participants: A total of 426 French-speaking physiotherapists completed the online survey.

Main outcome measure(s): The survey was disseminated to French-speaking physiotherapists in France; Switzerland; Quebec, Canada; Luxembourg; and Belgium. It comprised closed and open-ended questions organized in 5 sections: (1) participant demographics, (2) participant self-assessment of expertise, (3) clinical diagnostic assessment of the ankle (bones and ligaments), (4) clinical evaluation after an acute LAS injury (ROAST framework), and (5) CAI. The qualitative data from the open-ended questions were analyzed using best-practice thematic-analysis guidelines.

Results: Only 6.3% (n = 27) of the respondents could name all Ottawa Ankle Rules criteria. Only 25.6% (n = 109) of the respondents cited or described criterion standard tests from the literature to assess the integrity of the lateral ankle ligaments. Less than 25% (n = 71) of the respondents reported using clinical evaluation outcome metrics (ROAST) recommended by the International Ankle Consortium to inform their clinical care for individuals with an acute LAS injury. In general, the respondents had a greater knowledge of the functional than the mechanical insufficiencies associated with CAI.

Conclusion: A minority of French-speaking physiotherapist survey respondents use the International Ankle Consortium ROAST to inform their clinical care for individuals with an acute LAS injury. This highlights the responsibility of the scientific community to better disseminate evidence-informed research to clinicians.

Context: A quadriceps setting exercise is commonly used following knee injury, but there is great variation in cues that clinicians provide to patients when performing the exercise.

Objectives: To determine if internal, external, or visual cues result in the greatest quadriceps electromyographical (EMG) activity during a quadriceps setting exercise in healthy individuals.

Design: Descriptive laboratory study.

Setting: University research laboratory.

Patients or other participants: Thirty healthy individuals volunteered for this study. Participants were given 1 of 5 cues in a randomized order: internal cue "tighten your thigh muscles," internal cue "push your knee down," external cue "push into the bolster," external cue "push into the strap," or visual biofeedback using the cue "raise the value on the screen as high as you can."

Main outcome measure(s): Normalized vastus lateralis electromyographical activity.

Results: Both visual biofeedback (83.2% ± 24.9%) and the press into the strap condition (76.8% ± 24.4%) produced significantly greater (P < .001) electromyographical activity than the push knee down (53.2% ± 27.0%), tighten thigh (52.7% ± 27.3%), or push into the bolster (50.8% ± 26.3%) conditions. There was no significant difference (P = .10) between the visual biofeedback and press into the strap conditions as well as no significant difference (P > .38) between the push knee down, tighten thigh, or push into the bolster conditions.

Conclusion: If the clinical aim during a quadriceps setting exercise is to obtain the greatest volitional muscle recruitment, the use of visual biofeedback or pressing into a strap is recommended.

Context: Gait biomechanics and daily steps are important aspects of knee-joint loading that change after anterior cruciate ligament reconstruction (ACLR). Understanding their relationship during the first 6 months post-ACLR could help clinicians develop comprehensive rehabilitation interventions that promote optimal joint loading after injury, thereby improving long-term knee-joint health.

Objectives: To compare biomechanical gait waveforms throughout stance at early time points post-ACLR in individuals with different daily step behaviors at 6 months post-ACLR and to examine how these gait waveforms compare with those of uninjured controls.

Design: Case-control study.

Setting: Laboratory.

Patients or other participants: A total of 32 individuals with primary ACLR assigned to the low-step group (LSG; n = 13) or the high-step group (HSG; n = 19) based on their average daily steps at 6 months post-ACLR and 32 uninjured matched controls.

Main outcome measure(s): Gait biomechanics were collected at 2, 4, and 6 months post-ACLR for the ACLR groups and at a single session for the control group. Knee-adduction moment, knee-extension moment (KEM), and knee-flexion angle (KFA) waveforms were calculated during gait stance and then compared via functional waveform analyses. Mean differences and corresponding 95% CIs between groups were reported.

Results: Primary results demonstrated less KFA (1%-45% versus 79%-92% of stance) and greater KEM (65%-93% of stance) at 2 months and greater knee-adduction moment (14%-20% versus 68%-92% of stance) at 4 months post-ACLR for the HSG compared with the LSG. Knee-adduction moment, KEM, and KFA waveforms differed across various proportions of stance at all time points between the step and control groups.

Conclusions: Differences in gait biomechanics were present at 2 and 4 months post-ACLR between step groups, with the LSG demonstrating an overall more flexed knee and more profound stepwise underloading throughout stance than the HSG. The results indicate a relation between early gait biomechanics and later daily step behaviors post-ACLR.

Context: Collegiate female distance runners may be at risk for low energy availability (LEA) due to increased exercise energy expenditure with or without decreased energy intake. Furthermore, this population has an increased risk of disordered eating (DE), which can lead to LEA and negative health consequences, such as menstrual dysfunction (MD).

Objective: To (1) investigate risk of LEA, DE, and MD; (2) compare DE, training volume, and weight dissatisfaction between female collegiate runners at risk and those not at risk for LEA; and (3) compare the risk for LEA between National Collegiate Athletic Association Division I, II, and III female collegiate runners.

Design: Cross-sectional study.

Setting: Free-living conditions.

Patients or other participants: A total of 287 female runners who competed on a National Collegiate Athletic Association Division I, II, or III cross-country team, track team, or both.

Main outcome measure(s): Participants completed a 45-item questionnaire that included the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Disordered Eating Screen for Athletes (DESA-6).

Results: We observed that 54.4% (n = 156) of runners were at risk for LEA (LEAF-Q score ≥ 8), 40.8% (n = 117) were at risk for DE (DESA-6 score ≥ 3), and 56.5% (n = 162) reported MD (LEAF-Q menstrual function subsection score ≥ 4). Athletes at risk for LEA had higher DESA-6 scores than athletes not at risk for LEA (P < .001). Athletes at risk for LEA had greater weight dissatisfaction than those not at risk for LEA ( = 15.92, P = .001). Higher weekly training volume was not associated with risk for LEA ( = 4.20, P = .11).

Conclusions: A substantial percentage of collegiate female runners were found to be at risk for LEA and DE and to report MD. These findings demonstrate that the risks for DE, MD, and weight dissatisfaction are associated with risk for LEA.

Context: Quadriceps strength is a key outcome for guiding rehabilitation and return to sport-specific activities after anterior cruciate ligament reconstruction (ACLR) surgery.

Objective: (1) Describe the quadriceps-strength-testing practices and barriers college athletic trainers (ATs) are using and experiencing when returning patients to sport-specific activities after ACLR. (2) Compare testing methods between college ATs working in the National Collegiate Athletic Association (NCAA) Division I setting and other college settings.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: Two hundred forty-three full-time collegiate ATs who had primarily overseen/directed an ACLR rehabilitation in the past 5 years (age = 34.8 ± 10.7 years, length of AT practice = 11.7 ± 9.3 years, NCAA Division I setting = 56%).

Main outcome measure(s): Our survey included 4 sections: demographics, general ACLR rehabilitation practices, quadriceps-strength-testing methods and criteria, and quadriceps-strength-testing barriers.

Results: Knee-muscle strength was the most common (98%) outcome collegiate ATs used when determining whether an ACLR patient is ready to progress to sport-specific activities. Manual muscle testing was the most used testing method (57%), followed by isokinetic dynamometry (IKD) (48%), repetition maximum testing (35%) and handheld dynamometry (22%). Most ATs (63%-64%) used greater than 90% side-to-side symmetry as their return to sport-specific activities criterion. Lack of equipment needed (83%), lack of financial means (28%), and lack of training/education (20%) were the barriers that most limited ATs use of IKD testing, the gold standard testing method. Compared with ATs in other settings, a greater proportion of ATs working in the NCAA Division I setting used IKD testing (65% vs 28%) and a smaller proportion used manual muscle testing (47% vs 70%).

Conclusions: Although almost all college ATs considered knee-muscle strength an important outcome to assess when returning patients to sport-specific activities after ACLR, quadriceps-strength-testing practices were highly variable among ATs and may be affected by access to necessary resources.

Context: During a baseball pitch, energy is transferred from the lower extremities through the lumbopelvic junction to the upper extremity. Reduced lumbopelvic stability has been associated with elbow injuries, but the mechanisms are unclear.

Objective: To characterize the predictive ability of lumbopelvic stability on elbow-varus torque during a baseball pitch.

Design: Cross-sectional study.

Setting: Facilities at National Collegiate Athletic Association Division I universities.

Patients or other participants: A total of 44 National Collegiate Athletic Association Division I baseball players (age = 19.6 ± 1.3 years, height = 190 ± 10 cm, mass = 90.1 ± 6.3 kg).

Main outcome measure(s): Pitchers completed a warm-up and then threw 10 fastballs from a mound to a catcher. During the pitches, elbow-varus torque was recorded using an inertial measurement unit, and ball velocity was recorded using a radar gun. Participants also completed a single-legged step-down (SLSD) task with and without a cognitive Stroop, and triplanar pelvic and trunk kinematics were recorded using inertial measurement units. Statistical analysis consisted of a cluster analysis, principal components analysis, and a multivariate logistic regression model.

Results: Cluster analysis identified 2 clusters: low torque-high velocity and high torque-low velocity. The principal components analysis identified 4 patterns of variability (principal components) during the SLSD: (1) sagittal plane, (2) transverse plane, (3) frontal-plane trail leg, and (4) frontal-plane lead leg. Logistic regression models indicated increased transverse-plane trunk (odds ratio = 2.9; 95% CI = 1.1, 8.0; P = .04) and increased pelvis motion (odds ratio = 2.5; 95% CI = 1.1, 6.0; P = .03) predicted higher odds of belonging to the high torque-low velocity cluster.

Conclusions: Lumbopelvic movement assessed during the SLSD can identify deficits that relate to high elbow torque-low ball velocity during the baseball pitch. Specifically, higher transverse-plane pelvis and trunk motion were independently associated with pitchers in the high torque-low velocity cluster. Our assessment of trunk and pelvis motion during an SLSD provides a method for coaches and clinicians to identify a potential risk factor related to increased elbow-varus torque and decreased ball velocity.

Context: Track & field and cross country athletes experience high rates of lower extremity injuries. The Running Readiness Scale (RRS) may help determine which athletes have a higher likelihood of lower extremity injury.

Objective: To determine if RRS performance at the start of the season was related to likelihood of experiencing a lower extremity injury during the subsequent track & field or cross country season.

Design: Prospective cohort study.

Setting: University.

Patients or other participants: 113 NCAA Division III track & field athletes in running, jumping and vaulting events and cross country runners (50 female, 63 male, mean±SD age 19.9±1.3 years).

Main outcome measure(s): Athletes were assessed on RRS tasks: double-leg hops, plank, step ups, single-leg squats, and wall sit at the start of their season and then were observed by team athletic trainers during the season for occurrence of lower extremity injuries that resulted in missing one or more practices or meets. Adjusted Odds Ratios (AOR) and 95% confidence intervals (CIs) were used to assess the likelihood of lower extremity injury.

Results: Thirty-seven athletes (32.7%) experienced a lower extremity injury. Athletes scoring ≤3 on the RRS were almost five times more likely to experience lower extremity injury (AOR=4.8; 95%CI: 2.1-11.3) than athletes scoring ≥ 4. Athletes failing double-leg hops or wall sit tasks were more likely to experience lower extremity injury (p<0.05).

Conclusions: Track & field and cross country athletes with RRS scores of ≤3 had a higher likelihood of lower extremity injury than those with scores of ≥4.

Context: Tendon abnormalities on imaging are commonly observed in individuals with Achilles tendinopathy. Those abnormalities can also be present in asymptomatic individuals, which is an important risk factor for developing tendon symptoms. Ballet dancers are particularly vulnerable due to the high loads placed on their Achilles tendons. Understanding the relationship between clinical measures and tendon abnormality is essential for this population.

Objective: To investigate the predictive value of clinical measures for identifying Achilles tendon abnormality in asymptomatic ballet dancers using a non-linear statistical analysis.

Design: Cross-sectional study.

Setting: Dance company facility and research laboratory.

Patients: Thirty-five asymptomatic professional and amateur ballet dancers enrolled (23 female/12 male).

Main outcome measures: Presence of Achilles tendon abnormality were investigated using grey-scale ultrasound. Tendons were classified as having abnormality if presenting fusiform shape and/or hypoechoic areas. Clinical measures assessed were foot pronation, ankle dorsiflexion angle, hip, knee, and ankle isometric torque, and standing calf endurance. CART analysis was used to explore nonlinear interactions among clinical measures and their role in identifying tendon abnormality.

Results: 68 tendons were included in analysis. Structural change was common in asymptomatic dancers, with 80% presenting tendon abnormality. Hip isometric torque, ankle dorsiflexion range of motion, and calf endurance were measures related to tendon abnormality. Interactions between hip torque and ankle dorsiflexion range of motion were statistically associated with presence of tendon abnormality. Increased hip abductor torque was linked to a 59% reduction in the probability of tendon abnormality. 26 The CART model reached proper accuracy (total classification percentage of 83.8%).

Conclusions: Hip torque was an important clinical measure related to tendon structure. Assessment of dancers should include the whole lower limb as combination of hip torque and ankle dorsiflexion range of motion accurately identified presence of tendon abnormality.

Context: Immediate athletic trainer (AT) availability for acute injuries is essential as worse long-term outcomes are associated with delays in receiving medical care. Several factors have been found to influence AT availability between secondary schools, but few studies have evaluated how medical coverage varies between athlete groups.

Objective: The purpose of this project was to identify factors that impact the time to AT evaluation following acute sport-related injury in a secondary school setting.

Design: Cross-sectional study.

Setting: Retrospective analysis of deidentified patient records via the Athletic Training Practice-Based Research Network.

Patients or other participants: High school athletes diagnosed with an acute sport-related injury during in-season play from 2010 to 2023.

Main outcome measure(s): Time to AT evaluation was measured as the number of days between injury onset, reported by the patient, and AT evaluation.

Results: This report consists of 17 354 patient cases representing 20 different sports. Overall, 46.9% (n = 8138) of patients who sustained an injury during in-season play were evaluated by an AT the same day (range, 0-14 days). Significant group differences were reported for sex (P < .001), setting (P < .001), and sport level (P < .01), with female athletes and in-game injuries associated with longer times to AT evaluation. Freshmen were evaluated sooner than junior varsity (P < .01) and varsity (P < .001) athletes. No difference was observed between junior varsity and varsity athletes (P = .34).

Conclusions: Almost half of patients received medical care within 24 hours following an acute injury during in-season play, highlighting how qualified health care is accessible for many student-athletes through ATs in the secondary school setting. Differences in time to AT evaluation may be attributable to sex discrepancies in immediate medical coverage between sports and injury reporting patterns among athletes.