Athletic trainers are commonly responsible for clearing patients with ankle sprains for return to activity. What criteria athletic trainers typically use to determine return to activity readiness in this population remains unclear. The purpose of this qualitative study was to examine criteria athletic trainers use to determine patients’ return to activity readiness following an ankle sprain. Participants varied in selected clinician-, patient-rated, and functional assessments for patients with ankle sprains. As many selected methods did not agree with expert consensus recommendations, more work is likely needed to instill best practices for evaluation of patients with ankle sprains.
Ryan S. McCann, Ashley M.B. Suttmiller, Phillip A. Gribble, and Julie M. Cavallario
Ryan S. McCann, Ashley M.B. Suttmiller, Phillip A. Gribble, and Julie M. Cavallario
Athletic trainers’ reasons for selecting or avoiding certain evaluation techniques for patients with an ankle sprain are not fully understood. Such information is important to facilitating evidence-based practice and eliminating barriers. The purpose of this qualitative study was to determine what factors influence athletic trainers’ selection or avoidance of specific outcomes used to determine patients’ return to activity readiness following an ankle sprain. Participants cited many factors that facilitate and inhibit their use of best-practice recommendations and alternative methods for evaluating patients with ankle sprains. Athletic trainers’ should continue to promote facilitators and eliminate barriers to the use of best practices.
Diane Richmond, Kathleen Castro, Vaibhavi Rathod, Thais Medeiros da Costa Dias, Nelson Marinho de Lima Filho, Judith Meer, and Smita Rao
Context: Yoga is increasingly popular, not only as a form of recreational exercise but also as a physician-recommended intervention for health conditions. While serious adverse effects accompanying yoga practice are rare, poses that involve upper-extremity weight-bearing have a high risk of discomfort. To better understand factors contributing to adverse effects, there is a critical need for robust instruments that objectively evaluate pose performance. The purpose of this study was to assess the interrater reliability of an observational scale developed to assess the alignment of 3 yoga poses. Design: Cross-sectional experimental study. Methods: Thirty-eight individuals were given standardized instructions and performed 3 poses (Downward Dog, Plank, and Side Plank). Lateral videos were rated by 2 raters. A rating scale evaluating the alignment of 7 regions was developed by the study team with input from yoga teachers. Descriptive statistics were used to summarize the percentage of subjects showing ideal alignment and deviations. Interrater reliability was quantified using Cohen kappa coefficient (κ). Results: In Downward Dog, the prevalence of ideal alignment was 20%, 28%, and 37%, at the neck, shoulder, and back, respectively; κ ranged from .44 to .69. In Plank, the prevalence of ideal alignment was 31%, 45%, and 54% at the neck, shoulder, and back, respectively; κ ranged from .47 to .95. In Side Plank, the prevalence of ideal alignment was 16, 41%, and 24%, at the neck, shoulder, and back, respectively; κ ranged from .20 to .84. Conclusion: The observational scale found a high prevalence of deviations, and demonstrated fair to substantial interrater agreement.
Katherine A. Bain, Paige A. Clawson, Stacey A. Slone, Phillip A. Gribble, Johanna M. Hoch, Matthew C. Hoch, and Kyle B. Kosik
Context: Strength deficits and decreased scores on generic, dimension-specific, and region-specific health-related quality of life (HRQL) PRO measures are commonly documented among individuals with chronic ankle instability (CAI). However, it is unknown if there is a relationship between hip strength and self-reported patient-reported outcome (PRO) scores. Objective: To compare isometric peak torque for hip-extension (H-EXT) and hip-abduction (H-ABD), as well as PRO scores between CAI, lateral ankle sprain copers (LAS copers), and uninjured controls (UC). The secondary purpose was to examine the relationship between isometric hip peak torque and PROs in participants with CAI. Design: Cross-sectional. Setting: Laboratory. Participants: Sixty-three individuals, 45 women (23.02 [3.83] y, 165.91 [7.55] cm, 67.28 [11.95] kg) and 18 men (26.28 [5.43] y, 179.28 [9.01] cm, 83.87 [13.26] kg), grouped as uninjured control (n = 26), LAS coper (n = 15), or CAI (n = 22). Main Outcome Measures: The Foot and Ankle Ability Measure was used to assess region-specific HRQL. The Fear Avoidance Beliefs Questionnaire was used to assess injury-related fear. The Disablement in Physically Active was used to assess global HRQL. Isometric peak torque was measured with a handheld dynamometer for H-EXT and H-ABD. Results: No group differences were observed for H-ABD (P = .34) or H-EXT (P = .35). The CAI group had significantly worse scores on all PROs compared with LAS coper (P < .001) and HC (P < .001). Moderate–weak correlations were found between H-ABD and Foot and Ankle Ability Measure—activities of daily living (P = .047; ρ = .392) and Foot and Ankle Ability Measure-Sport (P = .013; ρ = .482) and H- EXT and Fear Avoidance Beliefs Questionnaire-Work (P = .007; ρ = −.517). Conclusions: Individuals with CAI displayed lower HRQL based on worse scores on generic, dimension-specific, and region-specific PROs compared with LAS copers and uninjured controls. There were no significant between-group differences for H-EXT and H-ABD isometric peak torque production, but there was a moderate positive relationship between isometric H-ABD and self-reported ankle disability in individuals with CAI.
Andrea Lucena Reis, Thaís Lucena Reis, Lucas Soares de Aguiar, José de Jesus Soares Reis, Thiago Lucena Reis, Lysleine Alves Deus, Rodrigo Vanerson Passos Neves, Hugo de Luca Corrêa, Fernando Sousa Honorato, Thais Branquinho de Araújo, Victor Lopes Silva, Bernardo Neme Ide, and Thiago Santos Rosa
Context: The elastic tubes have been used for clinical rehabilitation programs in which exercises are performed with submaximal intensities due to the difficulty in the measure the applied force. The authors aimed to quantify the elastic constant of elastic tubes used in neuromuscular rehabilitation programs predicting the force related to elastic tube elongation. A force test was performed by stretching the elastic tubes to determine the relationship between force and elongation. Eight elastic tubes with progressive levels of resistance represented by colors (yellow, red, blue, gray, black, grape, purple, and gold—low to higher resistance) were used. Design: Experimental. Methods: The test and retest were compared using the paired t test. The agreement and reliability between the test versus retest of pooled means colors were analyzed by plotting the Bland–Altman graph and intraclass correlation coefficient and the coefficient of variation. Pearson correlation was used to verify the validity between measurements. Results: The force values generated from the elastic tube elongation increase according to the color and thickness of elastic tubes with a strong and significant association between them (P < .0001). The elastic constant measurements were similar and presented high intraclass correlation coefficient values, low coefficient of variation values, and were reproducible (P < .0001). Conclusions: The force could be quantified according to elastic tube length variation by the linear regression equation with reproducibility. It gives greater measurement precision and better training load control when using elastic tubes in strength training programs.
Courtney R. Anderson, Kara N. Gange, Bryan Christensen, and Rachelle Vettern
Cryotherapy is a popular treatment chosen by health care providers to treat musculoskeletal injuries. The purpose of this study was to determine which cryotherapy method, Game Ready® or a wetted ice bag with elastic wrap, caused a greater and faster decline in tissue temperature during a 30-min treatment. At 2 cm below adipose, intramuscular tissue temperatures decreased more and faster with the wetted ice treatment compared with the Game Ready® treatment at all three time points: 10 min, 20 min, and 30 min. Furthermore, wetted ice significantly decreased temperature more than Game Ready® at 20 min (peak change [Ca]GR = 3.40 °C, [Ca]WI = 6.14 °C, p = .03) and 30 min ([Ca]GR = 5.62 °C, [Ca]WI = 8.67 °C, p = .02). One of the primary goals after injury is to lower tissue temperature to decrease cellular metabolism to reduce the risk of secondary ischemic injury. No evidence exists to support the optimal tissue temperature decrease for specific physiological results with cryotherapy. However, the literature is consistent with modalities producing colder temperatures are considered a better immediate care modality to decrease cell metabolism as much as possible. Therefore, these findings suggest wetted ice with an ACE wrap would be the more effective treatment in the immediate care phase.
Siobhan K. Fitzpatrick and Janine V. Olthuis
American student-athletes (SAs) are at heightened risk for hazardous alcohol consumption compared with their nonathlete peers. However, little is known about this risk or the influence of psychosocial predictors on drinking behavior among Canadian SAs. This study compared rates of alcohol use across Canadian SAs and nonathletes and investigated whether the use of athlete-specific psychosocial predictors can improve the prediction of alcohol use outcomes in SAs. Participants (179 varsity athletes and 366 nonathletes) completed anonymous self-report questionnaires. Results suggest that Canadian athletes are at a heightened risk for experiencing alcohol-related problems compared with nonathletes, with general psychosocial predictors explaining the majority of variance in SA alcohol use. However, and quite notably, athlete-specific positive reinforcement motives predicted SA binge drinking. This research provides some of the first evidence of drinking-related problems among Canadian SAs and supports the potential use of preventative efforts to help SAs develop safe strategies for alcohol use.
Katie Stephenson, Melissa N. Womble, Shawn R. Eagle, Philip Schatz, Tatiana Gervase, Brett Gustman, Eric Castor, Anthony P. Kontos, and R.J. Elbin
Objective: (1) To compare patient- and clinician-administered measurements of near point of convergence (NPC) distance including the percentage of patients exceeding clinical cutoffs among concussed adolescents and (2) to assess the reliability of patient- and clinician-measured NPC distances. Methods: A total of 762 patients (mean = 15.51, SD = 3.09 y) within 30 days of concussion participated. The NPC distance was measured consecutively with the patient and clinician controlling the fixation target. The differences between patient (PT) and clinician (CLIN) measurements and cases exceeding cutoffs (ie, ≥5 cm) were examined with a series of t tests and chi-square tests, respectively. Intraclass correlation coefficients and unbiased estimate of reliability were performed. Results: The NPC measurements were similar, t(761) = −.26, P = .79, between the PT (mean = 3.52, SD = 3.77 cm) and CLIN (mean = 3.54, SD = 3.97 cm) conditions. The number of measurements that exceeded cutoffs was similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10), and the number of measurements classified as abnormal/invalid was also similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10). There was excellent reliability between the methods (intraclass correlation coefficients = .85, unbiased estimate of reliability = .92). Conclusion: The findings support the application of this assessment in clinical settings where the clinician may not have direct contact with their patient and rely on the patient (eg, telehealth).
Carrie B. Scherzer, Jeremy Trenchuk, Meaghan Peters, and Robert Mazury
Athletes can be at elevated risk for developing eating disorders, the effects of which can be devastating. Few researchers have examined the influence of a predisposition toward an eating disorder on athletic injury. Exercise dependence might bridge the gap toward understanding this relationship. This study sought to examine the relationship between predisposition toward an eating disorder and exercise dependence and looked at both as predictors of athletic injury. College students (n = 132) completed the Eating Disorders Inventory and the Exercise Dependence Questionnaire, as well as provided demographic, activity, and injury information. Subscales of the Eating Disorders Inventory and Exercise Dependence Questionnaire were significant predictors of having at least one athletic injury in the preceding year. These findings suggest that both predisposition toward an eating disorder and exercise dependence may be contributing factors to injury.
Darjan Spudić, Janez Vodičar, Miha Vodičar, and Vedran Hadžić
Context: The importance of isometric trunk strength (ITS) among sport science professionals is higher than its actual reported effect size on either performance or low back pain (LBP) occurrence. Objective: To provide normative values of ITS and strength ratios, and to evaluate the effect of sex, sports discipline, and LBP status. Design: Crossover study. Setting: University research laboratory. Participants: Five hundred and sixty-seven elite athletes (186 females) with and without a history of LBP from different sports. Main Outcome Measure: Participants underwent ITS testing for trunk flexors, extensors, and lateral flexors. Normalized maximal strength (in newton meter per kilogram) and strength ratios were calculated. Differences between sex, LBP, and sport disciplines were assessed with 3-way analysis of variance (sex × LBP status × 7 sport categories) and partial eta-squared (