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The Inclusion of a Complementary Running Progression Program in the Rehabilitation of Acute Hamstring Injuries: A Critically Appraised Topic

Michelle A. Sandrey

Introduction/Clinical Scenario : As many hamstring injuries occur when the hamstrings are in a lengthened state during the deceleration phase of running when the muscle is eccentrically contracting to slow the body down this functional aspect needs to be addressed. Thus, a rehabilitation program with a focus on progressive targeted eccentric hamstring exercises by gradually placing and exposing the muscle to eccentric force in a lengthened state supplemented with progressive running drills should be evaluated. Focused Clinical Question : Does the inclusion of a complementary running progression program for the rehabilitation of an acute hamstring injury reduce the time to safe return to sport with less hamstring reinjury occurrence for an athletic population? Summary of Key Findings: Three studies assessed the inclusion of a progressive running program with several types of running progression parameters addressed. Progressive running drills will load the hamstring in a functional manner, with a gradual increase in velocity of movement and lengthening of the muscle. Clinical Bottom Line : It appears that a complementary progressive running program within an acute hamstring rehabilitation program should be included as it caused no further harm and does not tend to increase hamstring reinjury occurrence. Strength of Recommendation : There is grade B evidence to include a complementary running progression program within an acute hamstring rehabilitation program.

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The Relationship Between Stress Fractures and Bone Turnover Markers Is Unclear in Athletic and Military Populations: A Critically Appraised Topic

Karrie L. Hamstra-Wright, Eddin Djelovic, and Justin Payette

Clinical Scenario: Having an indication of how bone is remodeling in response to training load could help identify athletes and military personnel at increased stress fracture (SFx) risk. Direct assessment of bone remodeling is impractical. Biochemical markers of bone turnover are used as an indirect measure of bone remodeling and have potential to inform prevention and treatment efforts. To date, the relationship between bone turnover markers and SFxs in athletes or military personnel remains unclear. Clinical Question: Are SFxs related to bone turnover markers in athletes and military personnel? Summary of Key Findings: Seven met eligibility criteria. In five studies, an association between SFxs and bone turnover markers existed. Clinical Bottom Line: The evidence supporting a relationship between SFxs and bone turnover markers in athletes and military personnel is mixed. While five of the seven studies reported some type of relationship, no studies prospectively measured bone turnover markers in a group of athletes or military personnel without an SFx or without SFx history and followed them over time to reassess bone turnover markers upon SFx occurrence. Strength of Clinical Recommendation: In accordance with the Strength of Recommendation Taxonomy, Grade C is the most appropriate strength of recommendation rating.

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Effectiveness of Kinesiotaping in Reducing Postoperative Knee Edema and Pain Compared to Other Standard Treatments: A Critically Appraised Topic

Erin Frey, Kayla Ruszin, and Emily E. Hildebrand

Focused Clinical Question: Does the application of kinesiotape compared with standard treatments result in greater/faster postoperative edema reduction after total knee replacement or anterior cruciate ligament repair?Clinical Bottom Line: There was sufficient evidence to support the application of kinesiotape to reduce postoperative edema brought on by a total knee replacement or anterior cruciate ligament repair. Patients who received kinesiotaping, applied to the skin with a pattern to enhance lymphatic drainage, showed significant decreases in postoperative knee circumference measurements and pain levels. Kinesiotaping application under these acute conditions offers an evidence-based approach for clinicians to optimize the physiological environment and promote progress through a patient’s phases of healing.

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The Effects of the Mulligan Concept on Adults With Lateral Epicondylalgia Compared With Traditional Physiotherapy: A Critically Appraised Topic

Shayane Santiago, Moni Syeda, Jason Bartholomew, and Russell T. Baker

Focused Clinical Question: What are the effects of the Mulligan Concept combined with traditional physiotherapy on lateral elbow pain and grip strength in adults with lateral epicondylalgia (LE) compared with traditional physiotherapy? Clinical Bottom Line: Grade B evidence supports positive effects of the Mulligan Concept combined with traditional physiotherapy on LE compared with traditional physiotherapy alone. However, the effects of the Mulligan Concept as a standalone intervention in the treatment of LE are not well known. Therefore, additional research is warranted to determine the individual effects of the Mulligan Concept compared with its use in a comprehensive rehabilitation protocol to treat LE in adults.

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NATA News & Notes

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True Grit? The Relationship Between Grit and Intentions to Enter the Athletic Training Profession

Andrew R. Gallucci, Ashlyne Elliott, Leslie Oglesby, Kristina White, and Katie Richardson

Grit is a construct measuring increased perseverance for long-term goals. Research suggests that healthcare students with higher grit scores perform better academically and professionally. Grit has not been assessed in athletic training students. A total of 756 athletic training students completed the survey. Over 90% of students intended to work as an athletic trainer. Grit was a predictor of a student’s intention to practice as an athletic trainer. Females and graduate students were also more likely to enter the field of athletic training. A student’s grit score could help predict their intention to practice as an athletic trainer.

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Changes in Amplitude of Hamstring Electromyographic Activity and Its Peak Location During Nordic Hamstring Exercise by Adding External Load

Toshiaki Soga, Hiromi Saito, Kei Akiyama, and Norikazu Hirose

This crossover trial aimed to investigate whether additional loading of unilateral Nordic hamstring exercise on a sloped platform would increase the biceps femoris long head electromyographic activity. Participants were randomly allocated to unilateral Nordic hamstring exercise under three conditions: bodyweight only (BW) or BW with an added weighted ball of 3 kg (BW + 3 kg) or 6 kg (BW + 6 kg), respectively. The biceps femoris long head electromyographic activity was significantly higher for BW + 6 kg (p < .001) than for BW and BW + 3 kg (p < .01). Therefore, adding a load to unilateral Nordic hamstring exercise on a sloped platform might be effective for rehabilitation and prevention of hamstring strain injury recurrence.

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Collegiate Athletic Trainers’ Use of Behavioral Health Screening Tools

Taylor B. Chandler, Matthew J. Rivera, Elizabeth R. Neil, and Lindsey E. Eberman

Screening for behavioral health (BH) concerns is important for early identification, referral, and management. The purpose of this study was to examine collegiate athletic trainers use of BH screening tools. We used a cross-sectional design with a web-based survey. Approximately 49% (n = 198/405) of participants used BH screening tools in their practice; the most used tools were PHQ-9 (n = 112/198, 56.6%) and GAD-7 (n = 54/198, 27.3%). Practice integration considerations and practice advancements occurred as a result of BH screening. Given rising incidence and severity of BH conditions in collegiate athletics, more training on screening and prevention is needed.

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Intra- and Interrater Reliability of the Directional Balance and Reach Tests With and Without Rotation

Larry R. Munger, Jean-Michel Brismée, Phillip S. Sizer, and C. Roger James

This study investigated whether the directional balance and reach with and without rotation is a reliable screening tool to measure dynamic balance and ability to control motion in three planes. Twenty healthy, collegiate athletes participated. The directional balance and reach exhibited good to excellent levels of intra- and interrater reliability (intraclass correlation coefficient = .77–.99). The directional balance and reach provides clinicians with a reliable method that requires minimum financial, spatial, and temporal costs to administer in small and large screening, training, and evaluation programs to recognize asymmetries and deficits in assessing dynamic balance in all three planes of motion.

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Continuing Education Assessment