Journal of Athletic Training最新文献

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.

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.