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Shane P. Murphy, Zach B. Barrons, and Jeremy D. Smith

Context: The quality of running mechanics is often characterized by limb pattern symmetry and used to support clinical decisions throughout the rehabilitation of lower-extremity injuries. It is valuable to ensure that gait analyses provide stable measures while not asking an individual to complete an excessive number of running strides. The present study aimed to determine the minimum number of strides required to establish a stable mean symmetry index (SMSI) of discrete-level measures of spatiotemporal parameters, joint kinematics, and joint kinetics. Further, the study aimed to determine if differences occurred between random and consecutive strides for directional and absolute symmetry indices. Design: Descriptive laboratory study. Methods: A sequential average was used to determine how many strides were required to achieve a SMSI within a 60-second trial. Multiple 2-factor repeated-measure analysis of variances were used to determine if differences between bins of strides and symmetry calculations were significantly different. Results: A median SMSI was achieved in 15 strides for all biomechanical variables. There were no significant differences (P > .05) found between consecutive and random bins of 15 strides within a 60-second trial. Although there were significant differences between symmetry calculation values for most variables (P < .05), there appeared to be no systematic difference between the numbers of strides required for stable symmetry for either index. Conclusions: As 15 strides were sufficient to achieve a SMSI during running, a continued emphasis should be placed on the number of strides collected when examining interlimb symmetry.

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Reid Skeel, Anissa Maffett, Abigail Feder, Cayla Mitzkovitz, and Sofia Lesica

Context: Recovery protocols for treatment of sports concussion have received widespread adoption across the country. While stages of recovery and treatment are relatively clearly defined, there remains variability in implementation of specific recommendations, particularly regarding activities that constitute rest during stages calling for limitations on activity participation. Specific recommendations being employed by practitioners have not been previously assessed. In an aim to document current concussion management practices in the field, athletic trainers were surveyed regarding how activities that may constitute rest are utilized and defined. Design: The study was based on a cross-sectional vignette-based survey. Methods: The sample used was a geographically representative convenience sample of United States-based high school athletic trainers. E-mails were sent to 2146 potential survey respondents yielding a final sample of 226 athletic trainers. Data were gathered for questions concerning recommendations for follow-up care and rest based on provided vignettes, factors considered when developing recommendations, and differences in recommendations associated with varying symptom presentations. The percentage of practitioners that would utilize each potential recommendation was used to characterize results. Results: Participants demonstrated consensus on the importance of physical and cognitive rest as well as school accommodations (all greater than 97% endorsement). Greater variability was present for recommendations regarding pain medication for headache, repeating baseline cognitive testing, and engaging in subsymptom threshold activities. Recommendations for attending but not participating in games and practice yielded conflicting information. Conclusions: Responses indicated general consensus regarding factors considered when making recommendations. There was also consensus regarding general recommendations for activity limitation following recovery with almost all participants strongly recommending cognitive and physical rest, in accordance with consensus guidelines. However, substantial differences were found for specific activities that should be limited or encouraged following youth concussion. Further research concerning the relationship between community and social interaction and clinical outcomes after concussion is warranted.

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Brandon M. DeSantis, Victor R. Kalman, and Steven Browne

Antigravity treadmills are being used in rehabilitation programs but have not been used consistently with posthip labral repair arthroscopy surgeries. The purpose of this study was to review the posthip labral protocol used by eight National Collegiate Athletic Association Division I collegiate athletes (all ages 18–21) from multiple sports that used the antigravity treadmill as a bridge between “no running” and “on-ground running.” The authors found that athletes who did this returned to play between 4.5 and 7 months, had a better overall functional status, and had no re-injuries. This is the first known study of its kind available in the literature.

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Ryan S. McCann, Ashley M.B. Suttmiller, Phillip A. Gribble, and Julie M. Cavallario

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.

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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.

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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.

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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.

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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.

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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.

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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.