Journal of Athletic Training最新文献

Context: On average, individuals in early recovery after anterior cruciate ligament reconstruction (ACLr) improve limb loading symmetry (LLS) with instruction to equalize weight distribution between limbs during squats. However, the extent to which these instructions improve knee extensor loading symmetry (KLS) or reduce intralimb compensations is not known.

Objectives: Determine how limb loading instructions influence knee and intralimb loading in individuals 3-4 months post-ACLr and to explore variations in responses across individuals.

Design: Controlled laboratory study.

Setting: Research laboratory.

Patients or other participants: Individuals 109.4 days (18.2 days) post-ACLr (n = 20) and healthy matched controls (CTRL; n = 19).

Intervention: Participants performed double-limb squats in natural (no instruction) and instructed (instruction to evenly distribute weight between limbs) conditions.

Main outcome measure(s): Between-limbs and KLS were calculated as the ratio of vertical ground reaction force and knee extensor moment impulse, between surgical (Sx) : matched and nonsurgical (NSx) : matched limbs (ACLr : CTRL), respectively. Intralimb hip/knee (H/K) extensor loading distribution was calculated in Sx : matched limbs.

Results: Limb loading symmetry (natural = 0.86; instructed = 0.93, P < .001; effect size = 0.83) and KLS (natural = 0.54; instructed = 0.62, P = .007; effect size = 0.67) improved with instruction in the ACLr group with no change in the CTRL group. Hip/knee ratio did not change for either group. Here, k-means clustering, considering natural and change (natural-instructed) in LLS, KLS, and H/K ratio, described the response to instruction across 3 clusters: (1) ACLr: n = 3; CTRL: n = 9, were symmetrical in both conditions; (2) ACLr: n = 14, showed some improvement in symmetry, and (3) ACLr: n = 3, only improved LLS.

Conclusions: Average data suggest that weightbearing instruction improved LLS to within 7%, but a 38% knee loading deficit remained, and intralimb compensation did not improve. Data-driven clusters indicate that 3 ACLr participants were similar to CTRLs; 14 improved LLS, KLS, and H/K distribution; and 3 only improved LLS with worsening KLS and H/K.

A 26-year-old male international soccer player suffered a West Point Ankle Grade III syndesmosis injury leading up to the 2022 Fédération Internationale de Football Association (FIFA) World Cup. After surgical stabilization, the player completed an 11-phase return-to-performance pathway designed to ensure rapid and safe return to play. The pathway employs distinct phases that incorporate clinical, psychological, and sports-specific criteria to inform decision-making throughout the process. In this case report, we outline the phases and criteria used in conjunction with shared decision-making by the interdisciplinary team to ensure a successful return to play at the highest level. The effectiveness of this pathway was demonstrated by the player competing at the 2022 FIFA World Cup.

Context: Patellar tendinopathy (PT) is a highly prevalent overuse injury in volleyball. However, little is known if and how the risk for developing PT is increased through fatigue-induced alterations during repetitive jump-landing activities in volleyball.

Objective: The purpose of this study was to explore fatigue-induced risk factors for PT during a spike jump-landing task in volleyball.

Design: Prospective cohort study.

Setting: 3D biomechanical laboratory screening.

Patients or other participants: Seventy-nine adult, male volleyball players.

Main outcome measure(s): At baseline (pre-season), 3D full-body kinematics and kinetics were collected while performing a spike jump before and after a volleyball-specific fatigue protocol. Throughout the season, players were followed for the occurrence of PT and survival analysis with competing risks was performed to identify significant predictors for the development of PT (p < 0.05).

Results: During follow-up, 10 of the 79 players developed PT (13%). Players with significantly less hip flexion during the horizontal landing/push-off phase of the spike jump after fatigue were at higher risk for developing PT (HR = 0.898; 95% CI 0.826 to 0.977; p = 0.023) as well as players with a significantly more elongated rectus femoris muscle-tendon unit (HR = 3.258; 95% CI 1.136 to 9.343; p = 0.032).

Conclusions: Despite the low (injured) sample size of this study, preliminary research findings indicate less hip flexion and more elongated rectus femoris muscle-tendon units during landing after fatigue as potential risk factors for developing PT. Future prevention programs for PT may wish to focus on hip-specific exercises and technique modifications (e.g., more hip flexion during landing) under fatigued circumstances.

Context: As an essential core competency for high-quality healthcare, health information technology (HIT) leverages the use of technology, such as electronic record systems, to collect and use patient care information to make informed clinical decisions. There is a dearth of information regarding professional athletic training students' (ATSs') use of HIT professional behaviors during clinical experiences.

Objective: To assess HIT professional behaviors ATSs engage with during clinical experience patient encounters (PEs).

Design: Multisite panel design.

Setting: 12 professional athletic training programs.

Participants: 363 ATSs enrolled across the participating professional athletic training programs entered patient encounter information within E*Value during their scheduled clinical experiences.

Data collection and analysis: Characteristics of PEs (length of encounter, student role, clinical site type) were tracked in E*Value by students over three semesters. We used generalized estimating equation models to analyze the likelihood that students included HIT professional behaviors during 30,518 PEs.

Results: Clinical site type (p=0.04), length of encounter (p<0.001), and student role (p<0.001) had the greatest influence on students' documentation of PEs in electronic records systems; PEs occurring at the college/university setting, longer PEs, and full student autonomy increased the likely of this professional behavior. Length of encounter (p<0.001) and clinical site type (p<0.001) influenced students' use of information documented in electronic records systems to assist with clinical decision-making; PEs longer than 60 minutes and PEs in the clinic setting increased this professional behavior likelihood.

Conclusions: Since HIT is integral to providing high-quality patient care, and its use is developed and improved upon across the continuum of the professional career, program administrators and preceptors must seek out opportunities for students to engage in HIT behaviors during clinical experiences. Secondary school clinical sites, sites that typically have shorter patient encounters, and preceptors that offer less autonomy are most in need of intentional efforts toward HIT inclusion.

Context: The Open Landing Error Scoring System (OpenLESS) is a novel tool for automating the LESS to assess lower extremity movement quality during a jump-landing task. With the growing use of clinical measures to monitor outcomes and limited time during clinical visits, there is a need for automated systems. OpenLESS is an open-source tool that uses a markerless motion capture system to automate the LESS using 3D kinematics.

Objective: To describe the development of OpenLESS, examine its validity against expert rater LESS scores in healthy and clinical cohorts, and assess its intersession reliability in an athlete cohort.

Design: Cross-Sectional.

Participants: 92 total adult participants from three distinct cohorts: a healthy university student cohort (12 males, 14 females; age=23.0±3.8 years; height=171.9±8.3 cm; mass=75.4±18.9 kg), a post-anterior cruciate ligament reconstruction (ACLR) cohort (8 males, 19 females; age=21.4±5.7 years, height=173.5±12.5 cm; mass=73.9±13.1 kg; median 33 months post surgery), and a field-based athlete cohort (39 females; age=25.0±4.7 years, height=165.0±7.1cm; mass=63.5±8.6kg).

Main outcome measures(s): The OpenLESS software interprets movement quality from kinematics captured by markerless motion capture. Validity and reliability were assessed using intraclass correlation coefficients (ICC), standard error of measure (SEM), and minimal detectable change (MDC).

Results: OpenLESS agreed well with expert rater LESS scores for healthy (ICC2,k=0.79) and clinically relevant, post-ACLR cohorts (ICC2,k=0.88). The automated OpenLESS system reduced scoring time, processing all 353 trials in under 25 minutes compared to the 35 hours (~6 minutes per trial) required for expert rater scoring. When tested outside laboratory conditions, OpenLESS showed excellent reliability across repeated sessions (ICC2,k>0.89), with a SEM of 0.98 errors and MDC of 2.72 errors.

Conclusions: OpenLESS is a promising, efficient tool for automated jump-landing assessment, demonstrating good validity in healthy and post-ACLR populations, and excellent field reliability, addressing the need for objective movement analysis.

Context: Individuals after anterior cruciate ligament reconstruction (ACLR) participate in less physical activity compared to uninjured peers. Physical activity in this population is important for both short and long-term health, particularly to reduce the risk of chronic conditions (eg, obesity, osteoarthritis).

Objective: The purpose of this study was to assess the feasibility and acceptability of implementing a walking program early after ACLR.

Design: Explanatory Mixed Methods Study.

Setting: Telehealth.

Patients or other participants: Ten individuals (60% female, mean age 20.2 ± 3.9 years old, mean BMI 22.6 ± 2.9 kg/m2 ) within 8 weeks of a unilateral ACLR.

Intervention: A 12-week personalized progressive walking program to increase daily steps utilizing weekly virtual visits with a physical therapist.

Main outcome measures: Quantitative data included rates of appointment attendance, activity monitor wear compliance, adverse events, and achievement of daily step goals. Qualitative analysis of field notebooks collected throughout the intervention and semi-structured post intervention interviews were performed to explain the quantitative feasibility metrics using a case study approach.

Results: Participants wore their activity monitor 92.3% of days, attended 94.2% of appointments, met their recommended physical activity goal 54.8% of days, and 50% of individuals reached their physical activity target at least 50% of weeks. No adverse events related to the walking program were reported. Program-level and participant-level themes that promoted successful physical activity goal achievement were identified.

Conclusions: This study demonstrated mixed feasibility and acceptability of a progressive walking program early after ACLR. Participants demonstrated high adherence to wearing an activity monitor and completing weekly virtual physical activity program sessions. However, daily physical activity goals were only met approximately half of the time. Clinicians and researchers can use the themes identified from the qualitative analysis in future program designs to promote physical activity after ACLR.

Objective: Growing evidence has suggested clinical efficacy for the use of anodal transcranial direct current stimulation (atDCS) when combined with motor interventions in patients with chronic ankle instability (CAI). However, no studies have compared multiple approaches for improving motor function with atDCS in patients with CAI. We therefore aimed to determine the efficacy of atDCS over the motor or frontal cortex when combined with a four-week motor planning intervention on neural function, performance, and patient-reported outcomes in patients with CAI.

Design: Double-blind, sham-controlled, parallel randomized control trial.

Methods: Participants (n=44, 15 males, 29 females, 23.6±6.1 yrs) were assessed for outcome measures of cortical and reflexive excitability; performance measures of dynamic balance, muscle activation, reaction times, and cognitive performance on a dual-task balance test; and patient-reported outcome measures at baseline, mid-training (week 2), post-training (week 4), and retention (week 6). After baseline testing, participants were randomized to receive atDCS over the motor cortex, frontal cortex, or a sham current during rehabilitation exercises over four weeks. Participants reported for eight training sessions where they were instrumented for atDCS while performing obstacle walking, dual-task balance, and agility exercises. Analyses between groups and time points were performed with mixed linear models (α=0.05).

Results: Forty-six individuals were recruited & randomized with 37 completing the investigation (motor=14, frontal=11, sham=12). No differences across groups or times were observed in neural excitability or muscle activation variables (P>0.05). Significant improvements in dynamic postural stability indices were observed from baseline across all groups (P<0.05). Improvements were observed for foot & ankle function, perceived disablement, and the Global Rating of Change at post-training and retention (p<0.001).

Conclusions: Improvements in patient function were observed across all groups, suggesting the motor planning intervention improved function, regardless of atDCS application. Observing benefits from atDCS may be dependent on proper pairing of rehabilitation exercise with electrode location.

Context: Although the relationship between workload and injury incidence has recently gained attention, data on the acute-to-chronic workload ratio (ACWR) and injury incidence in Taekwondo remain unavailable.

Objective: To report the injury incidence related to the categorized ACWR, calculated using the rolling average (RA) and exponentially weighted moving average (EWMA) methods, for musculoskeletal injuries in Taekwondo.

Design: Descriptive epidemiologic study.

Setting: Data were prospectively collected through Taekwondo training facilities and competition venues.

Patients or other participants: A total of 110 collegiate Taekwondo players (58 females; 54 males) were studied over three consecutive seasons in 2020, 2021, and 2022.

Main outcome measures(s): The traumatic and gradual onset of musculoskeletal injury (rate, body location, type, mechanism, and severity) and workloads (duration of training and competitions) were recorded. ACWRs for each injury were calculated using the RA and EWMA and categorized as either high (> 1.5), relatively high (1.3 - 1.5), moderate (0.8 - 1.3), or low (<0.8).

Results: Of the 841 injuries (training: 16 per 1,000 hours; competition: 548 per 1,000 hours), the ankle (n=86/501, 17% in traumatic) and thigh (n=106/340, 31% in gradual onset) were the most predominantly injured body locations. Contusion (n=201/501, 40% in traumatic) and muscle cramps/spasm (n=201/501, 75% in gradual onset) were the most frequent injury types. Although the most predominant mechanism was overuse (n=331/841, 40%), 32% of the injuries (n=230/721) took > 28 days to recover from injury. The greatest number of traumatic (RA: n=224/501, 45%; EWMA: n=259/501; 52%) and gradual onset (RA: n=118/340, 35%; EWMA: n=165/340; 49%) injuries were recorded under the moderate ACWR.

Conclusions: The moderate ACWR range (0.8 - 1.3), which was considered as the "sweet spot" in team sports, was calculated to be the "danger zone" in Taekwondo. The high injury risk related workload could be used for planning training schedules.

Context: Track and 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 the likelihood of experiencing a lower extremity injury during the subsequent track and field or cross country season.

Design: Prospective cohort study.

Setting: University.

Patients or other participants: One hundred thirteen National Collegiate Athletic Association Division III track and field athletes in running, jumping, and vaulting events and cross country runners (50 women and 63 men, age = 19.9 ± 1.3 years [mean ± SD]).

Main outcome measure(s): Athletes were assessed on RRS tasks (double-leg hopping, plank, step-ups, single-leg squats, and wall sit) at the start of their season and were then observed by team athletic trainers during the season for occurrence of lower extremity injuries that resulted in missing 1 or more practices or meets. Adjusted odds ratios and 95% confidence intervals 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 5 times more likely to experience a lower extremity injury (adjusted odds ratios = 4.8; 95% confidence interval: 2.1, 11.3) than athletes scoring ≥4. Athletes who failed the double-leg hop or wall sit task were more likely to experience a lower extremity injury (P < .05).

Conclusions: Track and 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: Athletic trainers (ATs) are in a unique position to mitigate the negative influences of social determinants of health (SDH) in their patients. In the secondary school setting, understanding common SDH may inform strategies that reduce these influences. However, little is known about the types of SDH that ATs observe in patients in this setting.

Objective: To investigate SDH observed by ATs at the point of care in the secondary school setting.

Design: Descriptive, observational card study.

Setting: Secondary schools.

Patients or other participants: Twenty-seven ATs (average age = 29.9 ± 5.6 years, 23 [85.2%] female).

Main outcome measure(s): Athletic trainers recorded SDH on a standardized observation card during patient interactions. Cards provided instructions for completion and had a 4-column table with a list of 19 predetermined SDH, a checkbox for observed SDH, a checkbox for perceived negative influence of observed SDH on patient health, and an open box to write in actions taken to address the observed SDH.

Results: Overall, 676 cards with 748 observed SDH were collected from 27 secondary schools. Of those, 46.9% (351/748) were perceived to have a negative influence on patient health. The top 3 observed SDH were academic stressors (14.2%, 106/748), access to social media (12.6%, 94/748), and lack of health literacy (11.4%, 85/748). The ATs reported acting on 37.7% of negatively perceived SDH through counseling and education (48.6%, 137/282), additional resources (20.6%, 58/282), referral to others (17.4%, 49/282), and communication with others (13.5%, 38/282).

Conclusions: Our results indicated ATs in the secondary school setting were observing and acting to mitigate the negative influence of SDH. However, these ATs should be prepared to provide resources for patients negatively influenced by academic stressors, social media, and lack of health literacy. Resources, referrals, and additional education for patients may support a healthier community and positively influence athlete health and well-being.