Journal of Athletic Training最新文献

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.

Context: Structural evidence for corticospinal tract (CST) abnormality in patients with anterior cruciate ligament reconstruction (ACLR) compared with healthy controls and the relationships between CST structure and clinical features of the patients (eg, objective sensorimotor outcomes and postoperative duration) are lacking.

Objective: To investigate whether the structural features of the CST differ between patients with ACLR and healthy controls and are associated with clinical features in patients after ACLR.

Design: Cross-sectional study.

Setting: Sports medicine laboratory.

Patients or other participants: A total of 26 patients who had undergone ACLR (age = 36.35 ± 6.39 years, height = 173.88 ± 5.97 cm, mass = 74.80 ± 10.61 kg) and 26 healthy controls (age = 32.85 ± 9.20 years, height = 173.35 ± 7.19 cm, mass = 72.88 ± 11.06 kg) participated.

Main outcome measure(s): Using the CST as the region of interest, we performed diffusion tensor imaging to measure the microstructure of white matter tracts. Between-groups comparisons and correlation analyses with clinical features in patients with ACLR were performed.

Results: Patients with ACLR had moderately lower fractional anisotropy (Cohen d = -0.666; 95% CI = -1.221, -0.104; P = .01), lower axial diffusivity (Cohen d = -0.526; 95% CI = -1.077, 0.030; P = .03), higher radial diffusivity (RD; Cohen d = 0.514; 95% CI = -0.042, 1.064; P = .04), and smaller Y-Balance Test anterior-reach distance (Cohen d = -0.743; 95% CI = -1.302, -0.177; P = .005) compared with healthy controls. The RD values were correlated with the postoperative duration (r = 0.623, P < .001) after controlling for age, sex, and body mass index in patients with ACLR.

Conclusions: Patients with ACLR had impaired integrity (lower fractional anisotropy values and higher RD values) in the CST contralateral to the ACLR injured limb in comparison with healthy controls. Decreased integrity (higher RD) of the CST in patients was associated with longer postoperative duration, which hinted that impaired structural integrity of the CST may be a maladaptive process of neuroplasticity in ACLR.

A female National Collegiate Athletic Association Division I track athlete experienced nonlocalized shin pain midway through her first season, which was diagnosed as medial tibial stress syndrome. Treatments included strengthening and range of motion exercises, reduced training volume, and pain control modalities, but symptoms worsened. It was revealed she had been suffering from severe sleep deprivation (<3 hours/night) contributing to bilateral tibial and fibular stress reactions. Months of trial and error eventually resulted in the implementation of sleep interventions which improved her total body bone mineral density and bilateral stress reactions. Two years after successful sleep interventions, this athlete has remained injury-free and continues to set personal bests in her events. Our standard injury screening protocols did not include questioning sleep quality and quantity early in the process, and in this case, we highlight the need for these measures to be considered initially and throughout the treatment and recovery phases of sports-related injuries.

Context: The anterior cruciate ligament (ACL) is well researched since injuries typically result in lengthy recoveries and rehabilitation periods until athletes can return to full activity. Although a large body of literature on the early and late stages of rehabilitation after ACL reconstructive (ACLR) surgery exists, less is known regarding the mid-phase of ACL rehabilitation and healthy versus injured limb differences in functional testing during this stage.

Objective: The purpose of this study is to determine if Y-Balance Test (YBT) scores obtained during the mid-phase of ACLR rehabilitation change over months 4, 5, and 6.

Design: Case series.

Setting: Research laboratory.

Patients or other participants: A total of 27 participants (17 females; 18.96 ± 3.02 years [range, 15-24]; 173.63 ± 10.29 cm; 72.55 ± 17.83 kg) who sustained a unilateral ACL injury, experienced no episodes of instability or knee giving away, had not suffered a previous ACL injury, and expressed a desire to return to sport at the end of rehabilitation came in once a month after ACLR to participate in a battery of tests.

Main outcome measure(s): Y-Balance Test scores in the anterior, posterolateral (PL), and posteromedial (PM) directions in the healthy and reconstructed limbs.

Results: A main effect for limb was observed for the anterior (healthy: month 4: 78.8 ± 5.8 cm, month 5: 79.5 ± 5.2 cm, and month 6: 79.4 ± 5.8 cm; reconstructed: month 4: 77.2 ± 5.9 cm, month 5: 78.5 ± 5.1 cm, and month 6: 78.1 ± 6.4 cm; P = .023) and PM (healthy: month 4: 80.0 ± 8.7 cm, month 5: 81.0 ± 9.1 cm, and month 6: 82.9 ± 8.9 cm; reconstructed: month 4: 79.3 ± 6.8 cm, month 5: 79.4 ± 8.2 cm, and month 6: 81.1 ± 8.5 cm; P = .013) directions, indicating that the reconstructed limb performed worse than the healthy limb. A main effect for time was observed for the PL direction (healthy: month 4: 74.5 ± 8.1 cm, month 5: 75.8 ± 7.4 cm, and month 6: 77.6 ± 8.2 cm; reconstructed: month 4: 74.1 ± 8.6 cm, month 5: 74.6 ± 7.7 cm, and month 6: 76.8 ± 9.8 cm; P = .023).

Conclusions: The YBT measured improvement in the PL direction across time in the reconstructed limb. In the PM and anterior directions, the YBT did not measure these same improvements across this period.

Context: Social determinants of health are known to affect overall access to youth sports; however, it is not fully understood how multiple social determinants of health may affect access to school-based athletic training services.

Objective: To determine the relationship between Social Vulnerability Index (SVI) scores on access to high school-based athletic trainers (ATs) in California.

Design: Retrospective, cross-sectional study.

Setting: Online survey.

Patients or other participants: California Interscholastic Federation (CIF) high school respondents of the 2022-2023 Participation Census.

Main outcome measure(s): Association between SVI scores and access to school-based AT services. In this study, we used data from CIF high school respondents of the 2022-2023 Participation Census. School addresses were used to extract SVI scores from the US Census Bureau. Separate multivariable logistic regressions and generalized linear mixed effects models assessed the relationships between access to school-based athletic training services and SVI scores at the census and county levels.

Results: Of the 1598 respondent schools (65% public, 24% private, and 11% charter), 49% reported having an AT, of which 41% were certified. Adjusted analyses revealed that increased vulnerability in household characteristics was associated with lower odds of access to ATs and certified ATs at both county (odds ratio [OR] = 0.89 [95% confidence interval (CI) = 0.80, 0.99]; P = .04) and census tract levels (OR = 0.93 [95% CI = 0.89, 0.97]; P = .002). Increased vulnerability in socioeconomic status was associated with lower odds of having a certified AT at the census tract level (OR = 0.94 [95% CI = 0.89, 0.98]; P = .006) but not the county level (P = .16).

Conclusions: Increased vulnerability in household characteristics is associated with decreased odds of access to high school-based athletic training services.

Context: Postoperative muscle weakness contributes to the development of aberrant gait biomechanics that persist after traditional anterior cruciate ligament reconstruction (ACLR). However, it is unknown if quadriceps weakness impedes the ability of ACLR patients to modify gait biomechanics using a real-time gait biofeedback (RTGBF) intervention.

Objective: The purpose was to determine if quadriceps strength is associated with the ability to modify vertical ground reaction force (vGRF) during a RTGBF intervention.

Design: Cross-sectional study.

Setting: Research laboratory.

Patients or other participants: Thirty-five individuals with unilateral ACLR (time since ACLR = 32 ± 16 months; 22 females, 13 males).

Main outcome measure(s): Peak vGRF (pvGRF) was evaluated during a baseline walking trial and three 250-step randomized RTGBF walking trials, by 5%, 10%, or 15% body weight (BW). The ability to modify gait was reported as changes in pvGRF (ΔpvGRF; body weight [BW]) and root mean square error (RMSE) of the peak vGRF relative to the feedback target (pvGRF RMSE; BW). We also calculated quadriceps strength.

Results: No significant associations were found between strength (mean = 2.56 ± 0.75 Nm/kg; range, 0.84-4.6 Nm/kg) and ΔpvGRF (5% ΔpvGRF: 0.04 ± 0.03 BW, 10% ΔpvGRF: 0.10 ± 0.03 BW, 15% ΔpvGRF: 0.15 ± 0.04 BW) nor strength and RMSE (5% RMSE: 0.04 ± 0.02 BW, 10% RMSE: 0.05 ± 0.02 BW, 15% RMSE: 0.08 ± 0.04 BW) for any of the 3 RTGBF trials (R2 = 0.003-0.025; P = .37-.77).

Conclusions: The magnitude of quadriceps strength did not influence the ability to modify gait using RTGBF. These data suggest that it may be unnecessary to wait for quadriceps full strength recovery to capitalize on the benefits of RTGBF after ACLR.