Journal of Athletic Training最新文献

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.

Clinical Problem: Implementation and sustainability of a clinical electronic medical record (EMR) allowing for multiple billable encounters in an athletic medicine practice.Environment: Division-I collegiate athletics clinic.Variables: For ATs to complete billable documentation clinicians must: use an electronic health record (EHR), understand and appropriately use Current Procedural Terminology (CPT) and International Classification of Diseases version 10 (ICD-10) codes, understand patient encounter types, Relative Value Units (RVUs), and the role of a service provider related to incident-to capability.Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.Strategy: Proposed and implemented the use of a clinic based EMR which communicated within the entire medical system with all providers. Proposed and implemented structural changes within the athletic medicine clinic to support athletic trainer billing in a traditional clinical atmosphere. Implementation resulted in the ability to bill incident-to but posed a challenge in compliance of adopting a new documentation strategy.Findings: ATs were able to be reimbursed by some insurance companies. The use of the clinical EMR resulted in athletic trainers billing 13 CPT codes and insurance reimbursement as high as $38,000 per fiscal year in the 5 years since implementation.Outcome: Documentation in a clinical-based record has standardized communication between members of the athletic medicine team, generated revenue, and is used as a tool to measure productivity and demonstrate the fiscal value of the athletic trainer.Lessons Learned: ATs must buy-in to and understand the need to shift from an "athletic trainer specific EMR" to a clinical based EMR. Although the quantity of documentation does not change, the quality and structure of the notes must meet CMS guidelines. This significant change requires policy updates and demands that ATs in this system re-structure documentation practices. Creating a culture of growth is critical, allowing others to see that while this method is different, ATs can complete this level of documentation. (298 words).

Context:There is a 2-4x increased risk for musculoskeletal injury after concussion. A potential reason for the increased risk is aberrant biomechanics. The majority of prior research has focused on single-task biomechanics, but dual-task biomechanics may better represent athletic competition. Objective:To compare (1) jump landing and cutting biomechanics, (2) dual-task cost cognitive outcomes, and (3) perceived task difficulty/demands under single- and dual- task conditions (no-counting, serial 3s, serial 7s) between individuals with and without a concussion history. Design:Cross-sectional. Setting:Biomechanics laboratory. Participants:Twenty-three individuals with (age:20.2±1.9years, BMI:22.9±2.7kg/m2, 60.9% female, 44.7 months [95% confidence interval=23.6, 65.7] post-concussion) and 23 individuals without (age: 20.7±1.7years, BMI: 22.4±2.3kg/m2, 60.9% female) a concussion history participated. Main Outcome Measures:Jump landing and cutting trunk lower extremity kinematics and kinetics under single- and dual-task conditions. Cognitive accuracy and response rate during dual-tasking. NASA Task Load Index questionnaire. Results:During the jump landing, all participants exhibited a significantly faster reaction time during no counting versus serial 3s (p<0.001, Hedge's g=1.187) and serial 7s (p<0.001, Hedge's g=1.526). During the cutting, all participants exhibited a significantly faster reaction time during no counting versus serial 3s (p<0.001, Hedge's g=0.910) and serial 7s (p<0.001, Hedge's g=1.261), and serial 3s versus serial 7s (p=0.002, Hedge's g=0.319). All participants reported lower task demands during jump landing and cutting for no counting versus serial 3s (p<0.001) and serial 7s (p<0.001), and serial 3s versus serial 7s (p<0.001). Conclusion:Concussion history did not affect any of our outcomes, possibly because lingering biomechanical deficits may have resolved in our sample. Task demands did increase with increasing cognitive load, which may be beneficial for progressively manipulating the dual-task cognitive component during rehabilitation.

Context: Screening programs to identify negative ulnar nerve adaptations in throwing athletes can help minimize injury risk and individualize treatment programs prior to the onset of symptoms. However, it is currently unclear how the ulnar nerve structurally adapts chronically in professional baseball pitchers. Objective: To compare ulnar nerve ultrasound structural characteristics between the throwing (dominant) and non-throwing control (non-dominant) elbows in professional pitchers, with a secondary purpose of comparing ultrasound structural characteristics between subluxating and non-subluxating ulnar nerves. Design: Cross-sectional study. Setting: The beginning of the 2022 Minor League Baseball spring training of a single professional baseball organization. Participants: All asymptomatic professional baseball pitchers from a single organization. Main Outcome Measures: Bilateral elbow ultrasound examinations by a musculoskeletal radiologist for subsequent image quantification of ulnar nerve properties (echogenicity, area, circularity), as well as to identify ulnar nerve subluxation. Results: Overall, 67 male professional baseball pitchers were enrolled. No significant bilateral differences in ulnar nerve cross-sectional area (dominant: 0.2 cm2 vs. non-dominant: 0.2 cm2, p=0.4), echogenicity (137 pixel intensity vs. 128 pixel intensity, p=0.07), or circularity (0.67 vs. 0.69, p=0.4) were observed. Ulnar nerve echogenicity was significantly lower in subluxating dominant ulnar nerves compared to non-subluxating dominant ulnar nerves (127 pixel intensity vs. 143 pixel intensity, p=0.006), while no significant differences in ulnar nerve area (0.2 mm2 vs. 0.2 mm2, p=0.1) or circularity (0.68 vs. 0.66, p=0.4) were observed between groups. Conclusions: The ulnar nerve of the throwing elbow had similar cross-sectional area, echogenicity, and circularity compared to the non-dominant ulnar nerve. Nerve echogenicity was significantly decreased in subluxating ulnar nerves, however further research is necessary to determine why this difference exists and the potential direction of causality.

Objectives: To compare strength parameters and pain ratings across three different positions forisometric hip abduction and adduction strength testing. Design: Cross-sectional study. Setting: Two elite European football academies. Participants: Male football players (n=188, mean age 15.5 ± 1.6) from the U14-U19 teams. Methods: Isometric hip abduction and adduction were tested in 3 different positions on the ForceFrame: bent-leg with knees on pads, straight-leg with ankles on pads, and straight-leg with knees on pads. The order was randomised. The outcome measures were maximum isometric hip adduction and abduction strength (Fmax), limb symmetry index (LSI), hip adduction-to-abduction strength ratio and hip/groin pain numeric rating scale (NRS). Results: Correlation was moderate to high for Fmax in hip adduction (r = 0.64 to 0.73) and abduction (r = 0.78 to 0.84), but low for LSI and strength ratios (r = 0.06 to 0.48). Pain was reported by 19% and 13% of players during adduction and abduction respectively, with the majority (11% and 10%) only reporting pain in one of the three positions. Conclusions: The findings suggest that maximal strength values from the three test positions can be compared (i.e. using a conversion factor). The interchangeability of test positions is otherwise limited, due to inconsistent pain ratings and low correlation for LSI and strength ratios.

Context: Baseball is a popular sport in the United States, with widespread play among secondary school student-athletes. Baseball-related injuries may vary based on community-level socioeconomic status of schools. Objective: To describe the injuries sustained by secondary school baseball players from schools categorized by community-level socioeconomic status. Design: Cross-sectional study design. Setting: Data (2014/15-2018/19 academic years) were obtained from the National Athletic Treatment, Injury, and Outcomes Network (NATION-SP) Participants: Secondary school baseball athletes. Main Outcome Measures: Frequencies and percentages of injuries, injury rates, and competition/practice injury rate ratios (IRR) were reported by the community-level socioeconomic status (ie, affluent, average wealth, disadvantaged) where each school is located. Results: NATION-SP captured 320 baseball injuries across 140,619 total athlete exposures (AEs), for an overall injury rate of 2.4/1,000 AEs. Of those, 52% occurred among athletes in 24 schools situated in affluent communities, 15.6% occurred in 12 schools from average wealth communities, and 32.5% occurred in 12 schools located in disadvantaged communities. The largest injury rate was schools located in disadvantaged communities (3.3/1000 AE), followed by affluent (2.3/1000 AE) and average wealth (1.4/1000 AE) communities. On average, schools from affluent and disadvantaged communities had higher injury rates during competition than during practice (affluent: IRR=1.5, 95% CI=1.11, 2.05; disadvantaged: IRR=1.6, 95% CI=1.12, 2.41). Frequencies of many injury characteristics were consistent in schools across community-level socioeconomic status with contact, sprain/strain, and non-timeloss ranking highest in terms of injury mechanism, diagnosis, and time loss, respectively. Shoulder/clavicle was most frequent body part injured in schools in average and disadvantaged wealth communities, and ankle was most frequent in schools in affluent communities. Conclusions: Baseball athletes playing in schools located in disadvantaged wealth communities had the largest overall injury rate, followed by schools in affluent, and average wealth communities. Across most injury characteristics, a consistent trend emerged regardless of community-level disadvantage, with the highest baseball injury rates resulting from contact mechanisms, diagnosed as sprains or strains, and classified as non-time- loss injuries. While many injury patterns are consistent across socioeconomic communities, examining injuries through the lens of community-levels of disadvantage provides insight into subtle differences that could information targeted prevention strategies or resource needs.