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The Efficacy of Cryotherapy on Decreasing Swelling: A Critically Appraised Topic

Rachel A. Ziner, Jamie L. Mansell, Anne C. Russ, and Ryan T. Tierney

Context: Swelling is a major consequence of musculoskeletal conditions and can be a barrier to healing. Cryotherapy has been reported to decrease swelling. How effective is cryotherapy in reducing swelling during rehabilitation? Methods: PubMed was searched in June 2022 using the Boolean phrases: Swelling OR edema AND cryotherapy OR ice, Swelling AND injury AND cryotherapy. Included articles were published during or after 2017, consisted of one or more cryotherapy interventions, and listed swelling as an outcome measure. The PEDro scale was used to assess study validity. Swelling was measured by the figure-of-eight method (in centimeters). Means, SDs, and 95% confidence interval (CI) were calculated. Results: Three articles were screened. Stasinopoulos et al. received a score of 9/10; Sari et al. and Tittley et al. received a score of 10/10. Tittley et al. reported a decrease in swelling from 52.7 (SD = 0.8; 95% CI [52.35, 53.05]) to 52.0 (SD = 0.8; 95% CI [51.65, 52.35]). Stasinopoulos et al. reported decreases from 62.62 (SD = 0.34; 95% CI [62.51, 62.80]) to 61.10 (SD = 0.30; 95% CI [60.98, 61.24]). Sari et al. also found minimal change in swelling from pre- to posttreatment, 38.7 (SD = 2.6; 95% CI [37.83, 39.57]) to 38.2 (SD = 2.4; 95% CI [37.40, 39.00]). Conclusion: There is consistent evidence indicating that cryotherapy applied during rehabilitation does not decrease swelling in a patient with a musculoskeletal condition.

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Evaluation and Management of Exertional Rhabdomyolysis Following a Spin Class

Haley A. Turner, Lily C. Goodman, Christian J. Chang, Guillermo Moris, and Jose M. Moris

Exertional rhabdomyolysis (ER) has become prevalent over the last decade after performing spin classes. ER is characterized by the plasma elevation of creatine kinase as a marker of severe muscle damage. This case study highlights a 26-year-old healthy male that suffered from ER after performing their first ever spin class. The acute and chronic management of the ER is described, along with follow-up assessments that tracked the recovery following discharge from the hospital. Symptoms, such as localized swelling with complete loss of mobility and pain disproportionate to soreness, were characteristic in this individual with ER. Examining the concentration of plasma creatine kinase and monitoring urine output and color provided a good measure to determine when to discharge the patient. Management wise, ambulation should be minimized, and complete bed rest is ideal in conjunction with fluid replacement therapy. Although the individual in this case study did not develop compartment syndrome, its occurrence is always a possibility that should be routinely screened for. Lastly, further research is warranted to determine if there are any dietary interventions to promote a steadfast recovery from ER.

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Professional Conflict in Athletic Training and Nursing Environments: A Commentary on Comparisons and Solutions

Alicia M. Pike Lacy, Thomas G. Bowman, Craig R. Denegar, and Stephanie M. Singe

The athletic training and nursing professions have similar characteristics regarding workplace environment and challenges with interdependence. Professionals in both fields often face conflict with stakeholders while fulfilling their job responsibilities. Although sources and antecedents of conflict differ somewhat between the professions, the consequences of conflict are nearly identical. Job-related stress, depression and burnout, and interpersonal conflict can take a toll on clinicians’ mental and physical health. Greater efforts must be made to better prepare clinicians to diffuse and resolve conflict. Compared with athletic training, nursing has placed a greater emphasis on developing students’ conflict resolution skills in the professional curriculum. Therefore, athletic training educators and preceptors can learn from nursing education and adopt similar educational experiences for athletic training students. Providing students with tools early on can give them confidence to address conflict promptly and constructively, which may mitigate negative impacts of the conflict on patient care.

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NATA News & Notes

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Continuing Education Assessment

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Volume 28 (2023): Issue 5 (Sep 2023)

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Assessment of Aerobic Fitness Following Anterior Cruciate Ligament Rupture and Reconstruction

Dean M. Cordingley, Sheila M.B. McRae, Greg Stranges, and Peter B. MacDonald

Following anterior cruciate ligament rupture, physical activity may be limited due to restrictions placed on the patient while awaiting reconstruction (anterior cruciate ligament reconstruction [ACLr]). The purpose of the study was to evaluate aerobic fitness in individuals undergoing ACLr at the time of medical clearance following injury, 6-month post-ACLr, and 12-month post-ACLr. Seventeen individuals participated in the research study to completion (females, n = 6, age = 23.3 ± 5.5 years; males, n = 11, age = 23.2 ± 4.7 years). There were no changes in aerobic fitness from baseline to 12-month postoperative, but due to the length of time between injury and baseline assessments, it is unknown if aerobic deconditioning occurred before the patient was assessed preoperatively.

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Diagnosis and Treatment of Neurogenic Thoracic Outlet Syndrome in a Collegiate Ice Hockey Player: A Case Report

Anthony Berardo, Jacob Friedman, Stephanie Arlis-Mayor, and Eleni Diakogeorgiou

A 22-year-old male ice hockey player reported days of worsening bilateral upper-extremity weakness, hand tremors, and difficulty grasping his stick. Subjective information included sleeping in a “curled-up” position due to lack of heat in their residence. Provocation tests and imagining studies were positive for thoracic outlet syndrome. Primary treatment focused on decreasing stress on the anterior chest wall while secondary treatment focused on strengthening the posterior thorax to improve posture. Emphasis is given to core stability and scapular mobility. Removal from sport never occurred, but symptom alleviation occurred after 3 weeks. Thoracic outlet syndrome can be resolved quickly if proper recognition and adequate treatment are utilized. Athletic trainers fill a sociomedical role for their patients and should perform patient-centered care rather than tunnel vision on the pathology.

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Influence of Chronic Ankle Instability on Physical Activity: A Critically Appraised Topic

Priya Patel, Luke Donovan, Tricia Hubbard-Turner, and Abbey C. Thomas

Lateral ankle sprains are the most common injury sustained by physically active individuals. The overwhelming majority of people who sprain their ankle go on to develop chronic ankle instability (CAI). CAI may cause affected individuals to limit their physical activity, leading to health issues such as obesity and cardiovascular disease. The growing body of literature suggests that functional limitations reported by individuals with CAI may lead a the decrease in physical activity. This critically appraised topic sought to determine if adolescent and college-aged individuals with CAI have lower physical activity levels than their healthy peers. A literature search was conducted in between August 2021–February 2022 using the terms “chronic ankle instability” and “physical activity.” Studies were included if the participants were adolescent or college-aged and had CAI. Three studies meeting the inclusion criteria were identified. The first study reported that college students with CAI walk fewer steps per week than their healthy peers, while the second study observed higher physical activity levels among adolescents with CAI. The third study incorporated details on how there is a high prevalence of ankle injury in adolescents, so methods to prevent the injury should be followed to avoid injury earlier on. Despite the conflicting evidence on how CAI impacts physical activity levels, physical activity remains important for long-term health. Thus, it is necessary to emphasize that individuals with CAI should seek treatment to mitigate recurrent ankle sprains in order to safely continue with physical activity.

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Integrating Mindfulness to Reduce Injury Rates in Athletes: A Critically Appraised Topic

Elaine Reiche, Kevin Lam, Francesca Genoese, and Shelby Baez

Clinical Question: Is there evidence to support the use of mindfulness to reduce injury risk in athletic populations? Clinical Bottom Line: There is currently inconsistent, good-quality evidence to support that mindfulness interventions are effective in decreasing injury rates in athletes compared to the standard of care. Future research should investigate the effectiveness of mindfulness in other populations and types of sports activity (e.g., basketball, gymnastics, etc.). Additionally, future research should investigate different mindfulness delivery techniques in addition to the Mindfulness–Acceptance–Commitment (MAC) approach. Due to the inconsistent, good-quality evidence to support the use of mindfulness to reduce injury rates, the grade of B is recommended by the Strength of Recommendation Taxonomy. Mindfulness interventions should be incorporated into clinical practice but stakeholders (e.g., coaches, athletes, administration) should be included in the decision to implement these programs.