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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).

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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.

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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 (ηp2) effect size. The predictive validity of ITS for LBP was checked with receiver operating characteristics (area under the curve). Results: The authors found significant differences in extensor and flexor ITS in favor of male athletes (medium ηp2, P < .05), while sex differences in lateral flexion ITS had a low size effect (P < .05). A low size effect was also observed for the differences in strength ratios extensors/flexors (mean 1.47; 95% confidence interval, 1.45–1.50) and left flexors/right flexors (mean 0.99; 95% confidence interval, 0.98–1.01) among sexes. The sport discipline-related differences generally had a low size effect. No significant differences in ITS were found between LBP and LBP-free athletes. Only 50% to 58% of athletes (area under the curve, 0.501–0.582) were correctly classified as LBP or LBP-free using different ITS and strength ratio variables. Conclusions: ITS and strength ratios have low predictive validity for LBP history but may discriminate between sex and sport disciplines. Our data are a useful reference point for meaningful individual results interpretation when athletes are evaluated during training or rehabilitation.

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David G. Behm, Nehara Herat, Gerard M.J. Power, Joseph A. Brosky, Phil Page, and Shahab Alizadeh

Context: Both health professionals and consumers use menthol-based topical analgesics extensively for the temporary relief of pain from musculoskeletal ailments or injury. However, there are no reports of differences in the pain pressure threshold (PPT) or the relative effectiveness of topical analgesics to reduce pain in the upper and lower body muscles and tendons. The objective of this study was to investigate whether differences existed in PPT and relative pain attenuation associated with a menthol-based topical analgesic over a variety of upper and lower body muscles and tendons. Design: Randomized allocation, controlled, intervention study. Methods: Sixteen participants (10 females and 6 males) were tested on their dominant or nondominant side. The order of specific muscle/tendon testing was also randomized, which included upper body (middle deltoid, biceps brachii, and lateral epicondylar tendon) and lower body locations (quadriceps, hamstrings, gastrocnemius, lumbosacral erector spinae muscles, and patellar and Achilles tendons). The PPT was monitored before and 15 minutes following the application of a menthol-based topical analgesic. Results: A menthol-based topical analgesic increased PPT (decreased pain sensitivity) overall (P = .05; 11.6% [2.4%]; d = 1.05) and PPT was higher (P < .0001; 31.5%–44.2%; d = 1.03–1.8) for lower versus upper body locations. Conclusions: Health professionals and the public can be assured of similar reductions in pain sensitivity independent of the location of application of a menthol-based topical analgesic.

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Tsz Lun (Alan) Chu, Bailey Sommerfeld, and Tao Zhang

Building on recent research examining athlete burnout trajectories, this study implemented the developmental model of sport participation to compare emotional and physical exhaustion, reduced sense of accomplishment, and sport devaluation between age groups (specializing [aged 13–15 years] vs. investment [aged 16–18 years]) and gender (boys vs. girls) among U.S. high school athletes. Participants were 367 high school athletes (M = 15.53; 212 males; 186 specializing) across various individual and team sports who completed a survey assessing their demographic information, sport backgrounds, and burnout perceptions. A 2 × 2 multivariate analysis of covariance, controlling for training hours, showed greater emotional and physical exhaustion and sport devaluation in the investment than the specializing group, but no developmental differences in reduced sense of accomplishment. Contrary to our hypothesis, no gender or interaction effects were found. Findings inform interventions and future research that address the role of developmental stages and gender in athlete burnout.

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Aaron S. Fox, Reed Ferber, and Jason Bonacci

Altered gait variability occurs in those with patellofemoral pain and may be relevant to pain progression. We examined gait kinematic and coordination variability between individuals with acute and chronic patellofemoral pain and healthy controls. Eighty-three patellofemoral pain runners (37 men and 46 women) and 142 healthy controls (52 men and 90 women) ran on a treadmill while 3-dimensional lower limb kinematic data were collected. Patellofemoral pain runners were split into acute (n = 22) and chronic (n = 61) subgroups based on pain duration (< and ≥3 mo, respectively). Approximate entropy assessed continuous hip, knee, and ankle kinematic variability. Vector coding calculated coordination variability for select joint couplings. Variability measures were compared between groups using 1-way analysis of variance and post hoc comparisons with Cohen d effect sizes. The chronic patellofemoral pain subgroup displayed higher frontal plane knee kinematic variability compared with controls (P = .0004, d = 0.550). No statistically significant effects for any coordination variability couplings were identified. Minimal differences in gait variability were detected between those with acute and chronic patellofemoral pain and healthy controls.

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Dean R. Watson, Andrew P. Hill, and Daniel J. Madigan

Attitudes toward help-seeking will contribute to whether athletes ask for support for performance and mental health issues when needed. While research outside of sport has found perfectionism is related to negative attitudes toward help-seeking, no studies have examined the relationship in sport. The authors provided the first test of whether perfectionism predicted attitudes toward both sport psychology support and mental health support. One hundred and sixty-six collegiate athletes completed measures of perfectionism and attitudes toward sport psychology support and mental health support. Multiple regression analyses revealed that perfectionistic concerns positively predicted closedness and stigma toward sport psychology support and mental health support, and negatively predicted help-seeking toward mental health support. However, perfectionistic strivings negatively predicted stigma toward sport psychology support and mental health support, and positively predicted confidence in sport psychology support and help-seeking toward mental health support. Athletes higher in perfectionistic concerns are less likely to seek support when required.

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Georgia A. Bird, Mary L. Quinton, and Jennifer Cumming

This study investigated the relationship between reappraisal and suppression with depression and mental well-being among university athletes. It was hypothesized reappraisal would associate with lower depression and greater mental well-being, whereas suppression would associate with greater depression and reduced mental well-being. Employing a cross-sectional design, 427 participants (M age = 20.18, SD = 1.52; 188 males and 239 females) completed questionnaires assessing mental health and strategy use. Hierarchical multiple regressions revealed reappraisal was positively associated, and suppression negatively associated with mental well-being, ΔR 2 = 4.8%, ΔF(2, 422) = 17.01, p ≤ .001; suppression, β = −0.08, p = .028; reappraisal, β = 0.21, p ≤ .001, but neither were associated with depression, ΔR 2 = 0.4%, ΔF(2, 422) = 1.33, p = .267; suppression, β = 0.06, p = .114; reappraisal, β = 0.03, p = .525. Results highlight reappraisal as correlated with mental well-being in student-athletes, and therefore, reappraisal could be beneficial for managing stress in sport. Reappraisal may implicate how well-being is promoted through sport, but future experimental research is needed to confirm causal relationships.

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Erhan Seçer and Derya Özer Kaya

Context: Dynamic stretching (DS) is typically suggested during warm-up protocols. Also, foam rolling (FR), which is applied with a foam cylinder, has increased popularity in recent years. However, the combined effects of DS and FR in improving flexibility, dynamic balance, and agility performance are unclear in current literature. Therefore, this study aim to evaluate and compare the acute effects of DS as well as DS followed by FR (DS + FR) on flexibility, dynamic balance, and agility in male soccer players. Design: This study was a crossover study with a within-subject design. Methods: Thirty volunteer male soccer players (mean age 18.80 [0.66] y) were included in the study. Each participant performed the 2 sessions (DS and DS + FR) on separate occasions in a randomized order, with an interval of 72 hours. All sessions were performed in the indoor gym at the sports club. Flexibility was assessed by sit-and-reach test, dynamic balance was assessed by Y balance test, and agility was assessed by t test. Results: Compared with the pretest results, significant improvement in flexibility was observed in both groups (change = 0.55, percentage change = 2.05, effect size [ES] = 0.15, P = .041; change = 0.64, percentage change = 2.36, ES = 0.20, P = .025; respectively). Balance scores did not significantly improve in either group (change = 0.40, percentage change = 0.45, ES = 0.09, P = .342; change = 0.93, percentage change = 1.02, ES = 0.23, P = .103; respectively). Agility performance significantly improved in both groups (change = −0.12, percentage change = −1.18, ES = 0.19, P = .021; change = −0.21, percentage change = −2.18, ES = 0.38, P = .005; respectively). Conclusions: Both DS and DS + FR improved flexibility and agility and did not affect balance. DS + FR was not superior to DS at improving flexibility and agility as compared only with DS. Both methods are effective warm-up protocols to augment factors related to injury risk and performance. It seems that further studies that investigate the combined effects of FR and DS are needed.

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Jeff M. Barrett, Colin D. McKinnon, Clark R. Dickerson, and Jack P. Callaghan

Relatively few biomechanical models exist aimed at quantifying the mechanical risk factors associated with neck pain. In addition, there is a need to validate spinal-rhythm techniques for inverse dynamics spine models. Therefore, the present investigation was 3-fold: (1) the development of a cervical spine model in OpenSim, (2) a test of a novel spinal-rhythm technique based on minimizing the potential energy in the passive tissues, and (3) comparison of an electromyographically driven approach to estimating compression and shear to other cervical spine models. The authors developed ligament force–deflection and intervertebral joint moment–angle curves from published data. The 218 Hill-type muscle elements, representing 58 muscles, were included and their passive forces validated against in vivo data. Our novel spinal-rhythm technique, based on minimizing the potential energy in the passive tissues, disproportionately assigned motion to the upper cervical spine that was not physiological. Finally, using kinematics and electromyography collected from 8 healthy male volunteers, the authors calculated the compression at C7–T1 as a function of the head–trunk Euler angles. Differences from other models varied from 25.5 to 368.1 N. These differences in forces may result in differences in model geometry, passive components, number of degrees of freedom, or objective functions.