Journal of Athletic Training最新文献

Context: Pregnant athletes cannot receive proper care if they choose to conceal their pregnancy. Unfortunately, many factors may lead an athlete to conceal. Whereas the extant qualitative literature suggests scholarship and sponsorship are prominent factors in the decision to disclose, this research is limited to elite athletes.

Objective: To quantitatively examine predictors of pregnancy disclosure beyond scholarship and sponsorship in National Collegiate Athletic Association Division III college athletes.

Design: Cross-sectional study.

Setting: Midwestern United States.

Participants or other participants: Athletes on Division III women's sports teams (N = 127).

Main outcome measure(s): Confidence in the athletic trainer (AT), perceived training and performance changes, athletic identity, and athletic identity during pregnancy. Two separate multiple regression analyses were conducted with the 4 predictors and 2 outcomes: likelihood to disclose and time to disclosure.

Results: Confidence in the AT and athletic identity during pregnancy were significant predictors in both models, whereas the variable of perceived training and performance changes was only significant in the likelihood to disclose model. Athletic identity was not a significant predictor in either model. Results suggest Division III athletes believe they would be more likely to disclose their pregnancy and may disclose sooner if they feel that their AT can properly manage their physical, emotional, and social wellness during the pregnancy. Additionally, disclosure is promoted if they believe they will still be viewed as athletes by themselves and the people around them.

Conclusions: These findings emphasize the importance of the role of the AT, with implications that formal education of ATs should include the holistic support of the pregnant athlete.

Background: The female athlete triad (Triad) and relative energy deficiency in sport (REDs) describe potential health and performance consequences of low energy availability.

Objective: We surveyed female cross-country athletes to assess differences in educational impact scores (EIS; knowledge score × confidence score factor) of Triad and REDs. Associations between EIS and participant characteristics (eg, mileage [current and peak], years of running experience, age, bone stress injury history, division level participation, academic area of study, Triad or REDs diagnoses, and Triad or REDs education) were explored.

Main outcome measure(s): An evidence-based online survey was developed and administered via Qualtrics to female collegiate cross-country athletes (n = 275; age = 20 ± 1 years).

Results: A weak correlation existed between peak career mileage and EIS (r = 0.195; P = .010). Educational impact scores significantly differed in athletes with a related academic area of study versus those without (21.91 ± 5.16 and 16.11 ± 5.54, respectively). Educational impact scores significantly differed in athletes with Triad and REDs diagnoses (21.69 ± 5.85 and 22.58 ± 6.82, respectively) versus those without (16.80 ± 6.54 and 17.20 ± 6.34, respectively). Educational impact scores were higher in those who had received Triad education versus those who had not (21.03 ± 6.86 and 18.12 ± 6.82, respectively). A significant interaction between peak career mileage and Triad diagnosis was found (P = .005).

Conclusions: Significant education-based and diagnosis differences suggest that Triad diagnoses correlate with peak career mileage. These findings support the facilitation of education to improve not only the treatment but also the prevention of Triad and REDs.

Objective: To assess the effectiveness of exercise-based injury-prevention programs in preventing sports injuries in team handball players.

Data sources: Scopus, PubMed, Web of Science, SPORTDiscus, and CINAHL from inception until April 2023.

Study selection: Studies were included if they were randomized controlled trials or prospective cohort studies, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injuries, and reported injury incidence rates specific to team handball players. Two researchers independently evaluated studies for inclusion and assessed their methodological quality.

Data extraction: Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by 2 independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: shoulder injuries, lower extremity injuries, knee injuries, anterior cruciate ligament injuries, and ankle injuries. Extracted data were analyzed using a random-effects model to compute the overall effect estimates of injury-prevention programs in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group.

Data synthesis: Meta-analyses were conducted independently for each injury classification. Results indicated that prevention programs reduced the risk of shoulder injuries (OR = 0.60; 95% CI = 0.42, 0.85; P = .004), lower extremity injuries (OR = 0.59; 95% CI = 0.37, 0.95; P = .03), knee injuries (OR = 0.53; 95% CI = 0.35, 0.78; P = .002), anterior cruciate ligament injuries (OR = 0.66; 95% CI = 0.45, 0.96; P = .03), and ankle injuries (OR = 0.57; 95% CI = 0.40, 0.81; P = .002) in team handball players.

Conclusions: In team handball players, injury-prevention programs appear to effectively reduce the risk of shoulder, lower extremity, knee, ankle, and anterior cruciate ligament injuries.

Nondisclosed sport-related concussion symptoms pose a significant risk to athletes' health and well-being. Many researchers have focused on understanding the factors affecting athletes' concussion disclosure behaviors. One of the most robust predictors of the likelihood that an athlete will disclose concussion symptoms to their coaches, athletic trainers, parents, or peers is what researchers term social norms. The extant literature regarding social norms influencing concussion disclosure behaviors is inconsistent on how the construct should be defined, conceptualized, or measured, often failing to distinguish between descriptive and injunctive social norms and their sources (direct and indirect). In this technical note, we provide an overview of these critical distinctions, their importance in assessments, and examples from the literature in which scholars have correctly operationalized these constructs in athletic populations. We conclude with a brief set of suggestions for researchers seeking to measure social norms in future research.

Context: A quadriceps setting (quad set) exercise is commonly utilized 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 results in the greatest quadriceps electromyographical (EMG) activity during a quadriceps setting exercise in healthy individuals.

Design: Descriptive laboratory study.

Setting: University research laboratory.

Participants: Thirty healthy individuals volunteered for this study. Participants were given one of five 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 measures: Normalized vastus lateralis EMG activity.

Results: Both visual biofeedback (83.2±24.9%) and "press into the strap" (76.8±24.4%) produced significantly greater (p< 0.001) EMG 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= 0.10) between the visual biofeedback and "press into the strap" conditions as well as no significant difference (p> 0.38) between the push knee down, tighten thigh, or push into the bolster conditions.

Conclusions: 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.

Background: The main cause for attrition of military training is musculoskeletal injuries to the knee, such as patellofemoral pain (PFP).

Objective: The purpose of this systematic review was to identify which factors increase the risk of occurrence of PFP in military personnel.

Study design: Systematic review with meta-analysis.

Data sources: Searches were performed in Medline/PubMed, CINAHL, Embase, SPORTDiscus, Web of Science, Scopus, and OpenGray.

Study selection: We included studies that were prospective cohorts including military personnel and had at least one variable assessing a risk factor for PFP.

Data extraction: Extraction was performed by the same two independent evaluators and the data was separated between the military personnel who developed PFP and those who did not.

Data synthesis: Meta-analyses were performed using standardized mean differences (SMD) and 95% confidence intervals (95%CI) and the levels of recommendation were determined.

Results: From 11 articles, this review grouped 7,518 military personnel, of which 572 developed PFP, characterizing a prevalence of 7.61%. We found moderate evidence that isokinetic knee extensor weakness predicts PFP in the military (SMD -0.69, 95%CI -1.02, -0.35). A higher frontal plane knee projection angle (FPKPA) during single-leg squat was also identified as a risk factor for PFP in this population (SMD 0.55, 95%CI 0.14, 0.97) with moderate level of evidence. We found moderate evidence that sex, body mass index, isometric knee extensors strength, and isokinetic knee flexors strength do not predict PFP in military personnel. Finally, there is strong evidence that age and body mass do not predict PFP in this population.

Conclusions: Deficits in isokinetic knee extensor strength and a greater FPKPA are risk factors for PFP in military personnel. Since these are modifiable factors, these aspects should be considered in injury prevention interventions in the military.

Context: Pain during movement screens is a risk factor for musculoskeletal injury (MSKI). Movement screens often require specialized/clinical expertise and large amounts of time to administer.

Objective: Evaluate if self-reported pain 1) with movement clearing screens is a risk factor for any MSKI, 2) with movement clearing screens is a risk factor for body region-specific MSKIs, and 3) with a greater number of movement clearing screens progressively increases MSKI risk.

Design: Retrospective cohort study.

Setting: Field-based.

Participants: Military Service members (n=4,222).

Main outcome measures: Active-duty Service members self-reported pain during movement clearing screens (Shoulder Clearing, Spinal Extension, Squat-Jump-Land). MSKI data were abstracted up to 180-days post-screening. A Traffic Light Model grouped Service members if they self-reported pain during 0 (Green), 1 (Amber), 2 (Red), or 3 (Black) movement clearing screens. Cox proportional hazards models adjusted for age, gender, body mass index, and prior MSKI determined the relationships between pain during movement clearing screens with any and body region-specific MSKIs.

Results: Service members self-reporting pain during the Shoulder Clearing (adjusted-Hazard Ratio and 95% confidence interval (HRadj [95%CI]) =1.58 [1.37, 1.82]), Spinal Extension (HRadj=1.48 [1.28, 1.87]), or Squat- Jump-Land (HRadj=2.04 [1.79, 2.32]) tests were more likely to experience any MSKI compared to Service members reporting no pain. Service members with pain during the Shoulder Clearing (HRadj=3.28 [2.57, 4.19]), Spinal Extension (HRadj=2.80 [2.26, 3.49]), or Squat-Jump-Land (HRadj=2.07 [1.76, 2.43]) tests were more likely to experience an upper extremity, spine, back, and torso, or lower extremity MSKI, respectively, compared to Service members reporting no pain. The Amber (HRadj=1.69 [1.48, 1.93]), Red (HRadj=2.07 [1.73, 2.48]), and Black (HRadj=2.31 [1.81, 2.95]) cohorts were more likely to experience an MSKI compared to the Green cohort.

Conclusions: Self-report movement clearing screens in combination with a Traffic Light Model provide clinician/non-clinician-friendly, expedient means to identify Service members at MSKI risk.

Context: Hamstring strain injury (HSI) is the most frequently sustained injury in Major League Baseball (MLB). However, the beliefs and practices of practitioners working in MLB regarding HSI risk factors and prevention strategies in baseball athletes have not been documented.

Objective: To document the current beliefs and practices of practitioners working in MLB regarding HSI prevention.

Design: Cross-sectional study.

Setting: Major League Baseball via an online survey.

Patients or other participants: Athletic trainers, physical therapists, and strength and conditioning coaches working in MLB during the 2021 season.

Data collection and analysis: An online survey was conducted, with participants completing the survey once. Questions pertained to risk factor identification, the use and perceived effectiveness of prevention strategies, and barriers to implementation. Descriptive statistics were calculated for each question.

Results: A total of 91 responses were received featuring respondents from 28 of 30 MLB organizations. The perceived most important intrinsic risk factors were tolerance to high-speed running for first-time HSI and previous HSI for recurrent injury. The perceived most important extrinsic risk factor for both first-time and recurrent HSI was internal communication between staff. The perceived most effective prevention strategies were managing overall workload, regular exposure to high-speed running, and periodization. The most used prevention strategies were core or lumbopelvic strengthening, traditional resistance-training exercises, and managing overall workload. Approximately half (53%) of respondents reported barriers to effective implementation of HSI prevention strategies, including player and coach buy-in, compliance, workload management, and scheduling.

Conclusions: This was the first survey to investigate MLB practitioner beliefs and practices regarding HSI prevention. Responses from practitioners regarding their beliefs about risk factors and appropriate prevention strategies varied, and discrepancies existed between the perceived most effective strategies and those most frequently used.

Context: Shoulder muscles are active during front-crawl swimming to provide propulsion and stabilize the glenohumeral and scapulothoracic joints. Researchers have proposed that fatigue might contribute to altered activation of these muscles and represent a risk factor for injuries. Tensiomyography (TMG) might function as a noninvasive tool to detect changes in contractile measures of the skeletal muscles due to exercise-induced neuromuscular fatigue, though it has not yet been used in the shoulder muscles of swimmers.

Objective: To assess the effects of a fatiguing swimming protocol on shoulder muscle TMG measures and isometric strength in competitive swimmers.

Design: Cross-sectional study.

Setting: Swimming pool facility.

Patients or other participants: A total of 14 young front-crawl competitive swimmers (11 males and 3 females; age = 21 ± 3 years [range, 17-26 years], height = 1.78 ± 0.06 m, mass = 73.1 ± 9.2 kg).

Main outcome measure(s): Participants completed TMG and isometric strength assessments before and after 30-minute, high-intensity swim training. The TMG assessment was performed on 7 muscles of the shoulder according to front-crawl biomechanics and the applicability of the technique to obtain data, such as time to contraction and muscle-belly radial displacement. Isometric strength was assessed using a digital handheld dynamometer during shoulder flexion, extension, external rotation, and internal rotation.

Results: Fatigue induced a smaller radial displacement, mostly observable in latissimus dorsi (-1.0 mm; 95% CI = -1.7, -0.3 mm; P = .007) and pectoralis major muscles (-1.4 mm; 95% CI = -2.4, -0.4 mm; P = .007). Only shoulder extension showed an isometric strength reduction after the fatiguing protocol (-0.03 N/kg; 95% CI = -0.05, -0.01 N/kg; F1,13 = 4.936; P = .045; ηp2 = 0.275).

Conclusions: This study provides preliminary evidence for the usefulness of TMG to detect fatigue-induced changes in contractile properties of the shoulder muscles in swimmers, in particular the latissimus dorsi and pectoralis major.

Context: Concussions incurred during high school athletics are a significant health concern, and studies examining concussions with a symptom resolution time (SRT) of 15 to 28 days have been limited.

Objective: To compare concussions that had an SRT of 15 to 28 days with concussions that had an SRT of greater than 28 days among US high school athletes.

Design: Descriptive epidemiology study.

Setting: Secondary school athletic training clinics.

Patients or other participants: Secondary school athletes.

Main outcome measure(s): Concussion frequency, symptom number, and symptom prevalence.

Results: Among all 917 reported concussions (of which 50.8% had missing SRT), 88 had an SRT recorded as 15 to 28 days, and 29 had an SRT recorded as greater than 28 days. Greater frequencies of concussions with an SRT of 15 days or more were reported in boys' sports (n = 78) than girls' sports (n = 39). Boys' football (51.7%) and girls' basketball (11.5%) accounted for the largest proportions of all reported concussions with an SRT of 15 to 28 days; boys' football (58.6%) accounted for the greatest proportion of concussions reported with an SRT greater than 28 days. The average number of symptoms was 6.3 ± 3.4 for concussions with an SRT of 15 to 28 days and 7.2 ± 3.8 for those with an SRT greater than 28 days. The most frequently reported symptoms in concussions with both SRT of 15 to 28 days and greater than 28 days were headache, dizziness, sensitivity to light, and difficulty concentrating. The prevalence of irritability was higher in concussions with an SRT of 15 to 28 days as compared with concussions with an SRT greater than 28 days (26.1% versus 13.8%); visual problems (48.3% versus 35.2%) and hyperexcitability (24.1% versus 15.9%) were more prevalent in concussions with an SRT greater than 28 days, although differences were not statistically significant.

Conclusions: Symptom prevalence and total count were comparable between concussions with an SRT of 15 to 28 days and those with an SRT of greater than 28 days with no statistically significant difference, suggesting that symptom burdens within these groups are more similar than they are different.