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Eleni Diakogeorgiou, R. Richard Ray Jr., Sara Brown, Jay Hertel, and Douglas J. Casa

Athletic training is a health care profession with roots in athletics and kinesiology that has evolved into a critical component of contemporary sports medicine. The aim of this article is to review the history and evolution of the athletic training profession, contextualize the current state of athletic training education and research, and address priorities and challenges that the athletic training profession must confront if it is to continue to thrive. Specific challenges include addressing health disparities in sports medicine, increasing the diversity of the athletic training profession, clearly delineating athletic training’s place in the health care arena, and increasing salaries and retention of athletic trainers in the profession.

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Jaison L. Wynne and Patrick B. Wilson

Beer is used to socialize postexercise, celebrate sport victory, and commiserate postdefeat. Rich in polyphenols, beer has antioxidant effects when consumed in moderation, but its alcohol content may confer some negative effects. Despite beer’s popularity, no review has explored its effects on exercise performance, recovery, and adaptation. Thus, a systematic literature search of three databases (PubMed, SPORTDiscus, and Web of Science) was conducted by two reviewers. The search resulted in 16 studies that were appraised and reviewed. The mean PEDro score was 5.1. When individuals are looking to rehydrate postexercise, a low-alcohol beer (<4%) may be more effective. If choosing a beer higher in alcoholic content (>4%), it is advised to pair this with a nonalcoholic option to limit diuresis, particularly when relatively large volumes of fluid (>700 ml) are consumed. Adding Na+ to alcoholic beer may improve rehydration by decreasing fluid losses, but palatability may decrease. These conclusions are largely based on studies that standardized beverage volume, and the results may not apply equally to situations where people ingest fluids and food ad libitum. Ingesting nonalcoholic, polyphenol-rich beer could be an effective strategy for preventing respiratory infections during heavy training. If consumed in moderation, body composition and strength qualities seem largely unaffected by beer. Mixed results that limit sweeping conclusions are owed to variations in study design (i.e., hydration and exercise protocols). Future research should incorporate exercise protocols with higher ecological validity, recruit more women, prioritize chronic study designs, and use ad libitum fluid replacement protocols for more robust conclusions.

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Brice Picot, Romain Terrier, Nicolas Forestier, François Fourchet, and Patrick O. McKeon

The Star Excursion Balance Test (SEBT) is a reliable, responsive, and clinically relevant functional assessment of lower limbs’ dynamic postural control. However, great disparity exists regarding its methodology and the reported outcomes. Large and specific databases from various population (sport, age, and gender) are needed to help clinicians when interpreting SEBT performances in daily practice. Several contributors to SEBT performances in each direction were recently highlighted. The purpose of this clinical commentary is to (a) provide an updated review of the design, implementation, and interpretation of the SEBT and (b) propose guidelines to standardize SEBT procedures for better comparisons across studies.

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Margot A. Rogers, Michael K. Drew, Renee Appaneal, Greg Lovell, Bronwen Lundy, David Hughes, Nicole Vlahovich, Gordon Waddington, and Louise M. Burke

The Low Energy Availability in Females Questionnaire (LEAF-Q) was validated to identify risk of the female athlete triad (triad) in female endurance athletes. This study explored the ability of the LEAF-Q to detect conditions related to low energy availability (LEA) in a mixed sport cohort of female athletes. Data included the LEAF-Q, SCOFF Questionnaire for disordered eating, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, Mini International Neuropsychiatric Interview, blood pressure, and blood metabolic and reproductive hormones. Participants were grouped according to LEAF-Q score (≥8 or <8), and a comparison of means was undertaken. Sensitivity, specificity, and predictive values of the overall score and subscale scores were calculated in relation to the triad and biomarkers relevant to LEA. Fisher’s exact test explored differences in prevalence of these conditions between groups. Seventy-five athletes (18–32 years) participated. Mean LEAF-Q score was 8.0 ± 4.2 (55% scored ≥8). Injury and menstrual function subscale scores identified low bone mineral density (100% sensitivity, 95% confidence interval [15.8%, 100%]) and menstrual dysfunction (80.0% sensitivity, 95% confidence interval [28.4%, 99.5%]), respectively. The gastrointestinal subscale did not detect surrogate markers of LEA. LEAF-Q score cannot be used to classify athletes as “high risk” of conditions related to LEA, nor can it be used as a surrogate diagnostic tool for LEA given the low specificity identified. Our study supports its use as a screening tool to rule out risk of LEA-related conditions or to create selective low-risk groups that do not need management as there were generally high negative predictive values (range 76.5–100%) for conditions related to LEA.

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Francesca A. Harvey and Eric Schussler

Due to increasing rugby participation in the United States, understanding the factors affecting injury rate during participation have gained in importance. The primary objective of this research is to determine the effect of experience on injury rate in collegiate union rugby. Forty-three participants (23 men and 20 women) from the club rugby team participated over the course of one season. Injury data were analyzed by high (3+) and low (<3) seasons of experience. Twenty-four unique injuries were identified for an overall rate of 36.14 injuries per 1,000 exposures. Females with low experience (n = 14) had a rate of 47.34/1,000 exposures; females with high experience (n = 19) had a rate of 34.38/1,000 exposures. Males with low experience (n = 10) had a rate of 28.57/1,000 exposures; males with high experience (n = 13) had a rate of 42.06/1,000 exposures. Inexperienced female participants and experienced male participants showed higher rate of injury during rugby play. Identifying this at-risk group can aid coaches and responsible health care providers in making safer training and game play decisions.

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Eric Schussler, Ryan S. McCann, Nicholas Reilly, Thomas R. Campbell, and Jessica C. Martinez

The effect of subconcussive impacts on balance are not well known. The purpose of this study is to determine the effect of subconcussive impacts on dynamic balance over the course of a rugby season. Significant negative linear correlations were found between total peak linear acceleration and dominant leg (r = −.585, p = .046) and bilateral score (r = −.615, p = .033); also between total impacts over 10g and dominant leg (r = −.653, p = .021), nondominant leg (r = −.687, p = .014), and the combined total (r = −.731, p = .007). Results indicate subconcussive impacts may affect dynamic balance over the course of a competitive season of women’s collegiate rugby.

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Allison H. Gruber, Shuqi Zhang, Jiahao Pan, and Li Li

The running footwear literature reports a conceptual disconnect between shoe cushioning and external impact loading: footwear or surfaces with greater cushioning tend to result in greater impact force characteristics during running. Increased impact loading with maximalist footwear may reflect an altered lower-extremity gait strategy to adjust for running in compliant footwear. The authors hypothesized that ankle and knee joint stiffness would change to maintain the effective vertical stiffness, as cushioning changed with minimalist, traditional, and maximalist footwear. Eleven participants ran on an instrumental treadmill (3.5 m·s−1) for a 5-minute familiarization in each footwear, plus an additional 110 seconds before data collection. Vertical, leg, ankle, and knee joint stiffness and vertical impact force characteristics were calculated. Mixed model with repeated measures tested differences between footwear conditions. Compared with traditional and maximalist, the minimalist shoes were associated with greater average instantaneous and average vertical loading rates (P < .050), greater vertical stiffness (P ≤ .010), and less change in leg length between initial contact and peak resultant ground reaction force (P < .050). No other differences in stiffness or impact variables were observed. The shoe cushioning paradox did not hold in this study due to a similar musculoskeletal strategy for running in traditional and maximalist footwear and running with a more rigid limb in minimalist footwear.

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Sadie Rose Adado and Kenneth E. Games

Integrative patient-centered care (PCC) models encompass all dimensions of the patient, including physical well-being, evidence-based shared decision making, and determinants of health as they relate to quality of life. The purpose of this study was to explore parental experiences with the principles of PCC, related to the healthcare of their dependent after interactions with a provider. Using an observational design, our results demonstrated that parents of adolescent athletes rated PCC concepts as “very important” and the care delivered in relation to PCC by providers as “very effective.” PCC is perceived as valuable to parents, and therefore, athletic trainers must continue to develop and integrate PCC in the delivery of care within their clinical practice.

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Timothy L. Miller and Rose Backs

Presented here is the case of a 16-year-old male cross-country runner with chronic leg pain who was diagnosed with popliteal artery entrapment syndrome. An extensive workup was performed on the athlete that eventually included a postexercise arteriogram to reach the diagnosis. Ultimately the athlete’s symptoms required him to undergo bilateral leg surgeries to decompress the popliteal arteries. Extensive collaboration between athletic trainers, physical therapists, orthopedic surgery, sports medicine, and vascular surgery was required to treat the athlete’s condition and return him to distance running.