Journal of Athletic Training最新文献

Context: Menstrual dysfunction among adolescent female athletes is associated with both an increased musculoskeletal injury risk and poor psychological health. Objective: To examine if adolescent flag football athletes with menstrual dysfunction report different levels of energy, mood, sleep, and stress during the season compared to those without menstrual dysfunction. Design: Prospective cohort study Setting: A series of questionnaires pre-season, in-season weekly, and post-season to athletes in Denver Metro Area Patients or Other Participants: Female athletes with and without self-reported menstrual dysfunction who participated in a high school flag football season. Main Outcome Measure(s): Quality of life measures (energy, mood, sleep, and stress) rated weekly from 0 (low energy, poor mood, poor sleep, low stress) to 10 (high energy, best mood, great sleep, and high stress). Results: Of the 60 adolescent female flag football athletes enrolled, 15 (25%) reported menstrual dysfunction. The groups were not significantly different in mean ratings for energy (5.3±1.1 vs.5.1±1.4; p=0.70) or mood (5.6±1.1 vs. 6.0±1.5; p=0.32). However, the menstrual dysfunction group reported significantly worse sleep (4.2±1.3 vs. 5.2±1.4; p=0.02) and more stress (7.0±1.0 vs. 5.9±1.3; p=0.005) than those without menstrual dysfunction. When adjusting for school year, BMI, and injuries sustained during the season, menstrual dysfunction was significantly associated with worse sleep (β= -0.98; 95% CI= -1.82, -0.13; p=0.03) and more stress (β=1.11; 95% CI=0.35, 1.87; p=0.005). Conclusion: Flag football athletes with menstrual dysfunction reported worse sleep and more stress compared to those without menstrual dysfunction. These findings contribute to the importance of monitoring and addressing menstrual dysfunction and its association with quality of life factors in female adolescent athletes.

Context: Football is the most popular sport among high school boys in the United States. Concussion risk is elevated in the sport due to the high degree of physical contact. Healthcare providers are more likely to be present at the time of concussion during games and for varsity-level athletes, but how time to an immediate athletic trainer (AT) evaluation varies between sport levels and injury settings has yet to be investigated.Objective: Investigate associations between athlete sport level, injury setting, and same day AT evaluation among high school football players following a concussion. Design: Cross-sectional study.Setting: Retrospective analysis of de-identified patient records created within the Athletic Training Practice-Based Research Network.Patients: Patients evaluated and diagnosed with a concussion during in-season high school football participation from 2010-2023. Main outcome measure: Sport level (freshman, junior varsity [JV], varsity), injury setting (game, practice), and same-day evaluation following concussion (yes, no). Results: 1,260 patient cases were included in analysis. A significant association was found between sport level and same-day evaluation (p=0.02), and between injury setting and same-day evaluation (p<.001). A higher percentage of patients playing at the varsity level were evaluated the same day as their injury compared to those playing at the JV and freshman levels. Additionally, a higher percentage of football athletes were evaluated the same day if they sustained an injury during an in-season practice compared to a game. These associations remained significant after stratifying by sport level for freshman (p=0.01) and JV (p<.001) athletes, but not for varsity athletes (p=0.61).Conclusions: Freshman and JV football athletes, as well as those injured during games, are less likely to receive a same-day evaluation by an AT after concussion. Timely care improves recovery following concussion, emphasizing the need for equitable access to immediate care across sport levels and settings.

Athletes with autism spectrum disorder (ASD) experience lesser care for injuries, and athletic trainers (ATs) report feeling unprepared to provide care competently for this population. Provision of sports-related care can be impacted by sensory differences associated with ASD, such as hyperreactivity to sensation or poor integration of sensory information. An in-depth review of the literature using the Strength of Recommendation Taxonomy guidelines was used to identify articles that address the sensory features of autism for ATs with the purpose of informing ATs about the sensory features of ASD and to present the most current evidence-based recommendations for providing care to athletes with ASD and other neurodivergent individuals who present with sensory differences. Relevant articles were reviewed by 4 independent researchers and organized by theme. Key themes included use of sensory-friendly or sensory-adapted environments, sensory kits, and informed communication strategies that acknowledge sensory differences. Providing individualized care for athletes with ASD and sensory features can improve the quality of and participation in sports for persons with autism.

Context: Slower habitual walking speed and aberrant gait biomechanics are linked to clinically significant knee-related symptoms and articular cartilage composition changes linked to posttraumatic osteoarthritis after anterior cruciate ligament reconstruction (ACLR).

Objectives: To (1) determine whether specific gait biomechanical variables can accurately identify individuals with clinically significant knee-related symptoms post-ACLR and (2) determine the corresponding threshold values, sensitivity, specificity, and odds ratios for each biomechanical variable.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: A total of 71 individuals (38 female, 33 male; age = 21 ± 4 years, height = 1.76 ± 0.11 m, mass = 75.38 ± 13.79 kg, time after primary unilateral ACLR = 6.2 ± 0.4 months).

Main outcome measure(s): Three-dimensional motion capture of 5 overground walking trials was used to calculate discrete gait biomechanical variables of interest during stance phase (first and second peak vertical ground reaction force [vGRF], midstance minimum vGRF, peak internal knee-abduction and -extension moments, and peak knee-flexion angle), along with habitual walking speed. Previously established Knee Injury and Osteoarthritis Outcome Score cutoff scores were used to define patients with (ie, symptomatic; n = 51) and those without (ie, asymptomatic; n = 20) clinically significant knee-related symptoms. Separate receiver operating characteristic curves and respective areas under the curve (AUCs) were used to evaluate the capability of each biomechanical variable of interest to identify individuals with clinically significant knee-related symptoms.

Results: Habitual walking speed (AUC = 0.66), vGRF at midstance (AUC = 0.69), and second peak vGRF (AUC = 0.76) demonstrated low to moderate accuracy for identifying individuals with clinically significant knee-related symptoms. Individuals who exhibited habitual walking speeds ≤ 1.27 m/s, midstance minimum vGRF ≥ 0.82 body weights, and second peak vGRF ≤ 1.11 body weights demonstrated 3.13, 6.36, and 9.57 times higher odds of experiencing clinically significant knee-related symptoms, respectively.

Conclusions: Critical thresholds for gait variables may be used to identify individuals with increased odds of clinically significant knee-related symptoms and potential targets for future interventions.

Context: Nontraumatic shoulder pain (NSP) is common in volleyball, affecting performance and well-being. It is more prevalent in female players. Previous studies lack comprehensive assessments of shoulder pain that consider multiple factors, including range of motion, muscle strength, joint position sense, dynamic stability, and volleyball-specific mechanics.

Objective: To investigate NSP prevalence in female high school volleyball players, considering shoulder joint functional parameters and volleyball-specific factors.

Design: Cross-sectional study.

Setting: High school gymnasiums.

Patients or other participants: Fifty-nine female high school volleyball players (15-17 years).

Main outcome measure(s): Demographic data, environmental factors (years of experience, spiking technique, and serve type), shoulder joint function (passive glenohumeral joint's range of motion, muscle strength, joint position sense, and dynamic stability), and NSP prevalence during spiking and serving. Logistic regression analysis was conducted to identify significant factors associated with NSP.

Results: Nontraumatic shoulder pain prevalence was 54.2%, with 68.8% not informing coaches. Significant associations were found between NSP and factors such as Upper Quarter Y-Balance Test-Medial (P = .008; odds = 0.892; 95% confidence interval = 0.82, 0.97) and joint position sense of internal rotation (P = .031; odds = 1.411; 95% confidence interval = 1.03, 1.93).

Conclusion: Shoulder pain leads to impaired proprioception and dynamic stability. Effective communication between players and coaches is crucial for managing and preventing pain. Targeted training programs to enhance proprioception and dynamic stability may reduce shoulder pain and injuries. Educating players on the importance of reporting pain and encouraging early intervention is essential.

Context: A quadriceps setting exercise is commonly used 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 result in the greatest quadriceps electromyographical (EMG) activity during a quadriceps setting exercise in healthy individuals.

Design: Descriptive laboratory study.

Setting: University research laboratory.

Patients or other participants: Thirty healthy individuals volunteered for this study. Participants were given 1 of 5 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 measure(s): Normalized vastus lateralis electromyographical activity.

Results: Both visual biofeedback (83.2% ± 24.9%) and the press into the strap condition (76.8% ± 24.4%) produced significantly greater (P < .001) electromyographical 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 = .10) between the visual biofeedback and press into the strap conditions as well as no significant difference (P > .38) between the push knee down, tighten thigh, or push into the bolster conditions.

Conclusion: 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.

Context: Chronic ankle instability (CAI) is prevalent among individuals who sustain a lateral ankle sprain (LAS) injury. The persistence of the characteristic long-standing clinical symptoms of CAI may be attributable to the lack of adoption by physiotherapists of evidence-informed clinical guidelines.

Objective: To investigate the extent to which French-speaking physiotherapists implement the International Ankle Consortium rehabilitation-oriented assessment (ROAST) framework when providing clinical care for individuals with an acute LAS injury.

Design: Cross-sectional study.

Setting: Online survey informed by a Delphi process of foot-ankle experts.

Patients or other participants: A total of 426 French-speaking physiotherapists completed the online survey.

Main outcome measure(s): The survey was disseminated to French-speaking physiotherapists in France; Switzerland; Quebec, Canada; Luxembourg; and Belgium. It comprised closed and open-ended questions organized in 5 sections: (1) participant demographics, (2) participant self-assessment of expertise, (3) clinical diagnostic assessment of the ankle (bones and ligaments), (4) clinical evaluation after an acute LAS injury (ROAST framework), and (5) CAI. The qualitative data from the open-ended questions were analyzed using best-practice thematic-analysis guidelines.

Results: Only 6.3% (n = 27) of the respondents could name all Ottawa Ankle Rules criteria. Only 25.6% (n = 109) of the respondents cited or described criterion standard tests from the literature to assess the integrity of the lateral ankle ligaments. Less than 25% (n = 71) of the respondents reported using clinical evaluation outcome metrics (ROAST) recommended by the International Ankle Consortium to inform their clinical care for individuals with an acute LAS injury. In general, the respondents had a greater knowledge of the functional than the mechanical insufficiencies associated with CAI.

Conclusion: A minority of French-speaking physiotherapist survey respondents use the International Ankle Consortium ROAST to inform their clinical care for individuals with an acute LAS injury. This highlights the responsibility of the scientific community to better disseminate evidence-informed research to clinicians.

Context: Gait biomechanics and daily steps are important aspects of knee-joint loading that change after anterior cruciate ligament reconstruction (ACLR). Understanding their relationship during the first 6 months post-ACLR could help clinicians develop comprehensive rehabilitation interventions that promote optimal joint loading after injury, thereby improving long-term knee-joint health.

Objectives: To compare biomechanical gait waveforms throughout stance at early time points post-ACLR in individuals with different daily step behaviors at 6 months post-ACLR and to examine how these gait waveforms compare with those of uninjured controls.

Design: Case-control study.

Setting: Laboratory.

Patients or other participants: A total of 32 individuals with primary ACLR assigned to the low-step group (LSG; n = 13) or the high-step group (HSG; n = 19) based on their average daily steps at 6 months post-ACLR and 32 uninjured matched controls.

Main outcome measure(s): Gait biomechanics were collected at 2, 4, and 6 months post-ACLR for the ACLR groups and at a single session for the control group. Knee-adduction moment, knee-extension moment (KEM), and knee-flexion angle (KFA) waveforms were calculated during gait stance and then compared via functional waveform analyses. Mean differences and corresponding 95% CIs between groups were reported.

Results: Primary results demonstrated less KFA (1%-45% versus 79%-92% of stance) and greater KEM (65%-93% of stance) at 2 months and greater knee-adduction moment (14%-20% versus 68%-92% of stance) at 4 months post-ACLR for the HSG compared with the LSG. Knee-adduction moment, KEM, and KFA waveforms differed across various proportions of stance at all time points between the step and control groups.

Conclusions: Differences in gait biomechanics were present at 2 and 4 months post-ACLR between step groups, with the LSG demonstrating an overall more flexed knee and more profound stepwise underloading throughout stance than the HSG. The results indicate a relation between early gait biomechanics and later daily step behaviors post-ACLR.

Context: Collegiate female distance runners may be at risk for low energy availability (LEA) due to increased exercise energy expenditure with or without decreased energy intake. Furthermore, this population has an increased risk of disordered eating (DE), which can lead to LEA and negative health consequences, such as menstrual dysfunction (MD).

Objective: To (1) investigate risk of LEA, DE, and MD; (2) compare DE, training volume, and weight dissatisfaction between female collegiate runners at risk and those not at risk for LEA; and (3) compare the risk for LEA between National Collegiate Athletic Association Division I, II, and III female collegiate runners.

Design: Cross-sectional study.

Setting: Free-living conditions.

Patients or other participants: A total of 287 female runners who competed on a National Collegiate Athletic Association Division I, II, or III cross-country team, track team, or both.

Main outcome measure(s): Participants completed a 45-item questionnaire that included the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Disordered Eating Screen for Athletes (DESA-6).

Results: We observed that 54.4% (n = 156) of runners were at risk for LEA (LEAF-Q score ≥ 8), 40.8% (n = 117) were at risk for DE (DESA-6 score ≥ 3), and 56.5% (n = 162) reported MD (LEAF-Q menstrual function subsection score ≥ 4). Athletes at risk for LEA had higher DESA-6 scores than athletes not at risk for LEA (P < .001). Athletes at risk for LEA had greater weight dissatisfaction than those not at risk for LEA ( = 15.92, P = .001). Higher weekly training volume was not associated with risk for LEA ( = 4.20, P = .11).

Conclusions: A substantial percentage of collegiate female runners were found to be at risk for LEA and DE and to report MD. These findings demonstrate that the risks for DE, MD, and weight dissatisfaction are associated with risk for LEA.