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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.

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Middle Facet Tarsal Coalition in a National Collegiate Athletic Association Basketball Athlete: An Exploration Clinical Case Report

Melinda Watts and Keilea Sumrall

The patient is a 22-year-old female basketball player initially diagnosed with a calcaneal fracture. Five months after the pain began, the patient was referred to a foot and ankle surgeon and diagnosed with middle facet tarsal coalition. The patient received one X-ray-guided subtalar steroid injection and two platelet-rich plasma injections to aid in pain relief while completing her senior year of collegiate basketball. She elected to end her senior season early to have the recommended subtalar fusion surgery. The surgery ended her basketball career but provided pain-free activities of daily living. This case presents unique components compared with available literature on how injury presentation in adult populations can complicate a timely and accurate initial diagnosis. This case is also unique because despite conservative efforts, a surgical fusion was required to optimize pain and function during activities of daily living.

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The Relationship Between Isometric Hip Strength and Incidence of Noncontact Anterior Cruciate Ligament Injuries in Female Athletes: A Critically Appraised Topic

Cayla A. Lee, Jessica L. Jacobs, and Jennifer L. Volberding

Clinical Scenario: Noncontact anterior cruciate ligament (ACL) injuries are prevalent among athletes in multiplanar sports, especially females. Hip strength may contribute to the incidence of these injuries due to dynamic movement patterns at the knee. Clinical Question: Does hip strength impact the incidence of noncontact ACL injuries in female athletes? Summary of Key Findings: A literature search was conducted on the relationship between hip strength and noncontact ACLs. Three prospective studies measuring isometric hip strength and recording the number of noncontact ACL injuries that occurred within a time period were included. One study demonstrated lower isometric hip adductor-to-abductor ratio was associated with noncontact ACL injuries. Two studies demonstrated those with noncontact ACL injuries had greater isometric hip abduction strength. Clinical Bottom Line: Evidence suggests that greater isometric hip strength and low hip adductor-to-abductor strength ratio may be a risk factor that is associated with noncontact ACL injuries in females. Future research should investigate the impact of hip strength on the incidence of noncontact ACL injuries, across all genders. Strength of Recommendation: Based on the Center of Evidence-Based Medicine, these studies provide Level 3 evidence that hip strength is associated with the risk of noncontact ACL injuries in females.

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Integrating Athletic Trainers in Esports Healthcare

Tyler A. Wood, Nicholas E. Grahovec, and Catrina M. Sanfilippo

Esports’ increasing popularity has led to esport athletes receiving similar healthcare to traditional athletes. Thus, this study aims to identify how athletic trainers have been integrated into the esports healthcare team and identify the attitudes of athletic trainers toward esports through a novel online survey. Of the 151 responses received, 13 reported experiences with esports, and they identified common injuries and explained how their skills were utilized; 138 reported no experience with esports and were divided based on positive, neutral, or negative sentiment. More information should be disseminated to athletic trainers on the uniqueness of esport activity.

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Concussion Incidence and Recovery of Neurocognitive Dysfunction Among Youth Athletes Taking Antibiotics: A Preliminary, Multicenter Retrospective Cohort Study

Nek Asghar, Muhammad Ali, Theodore Hannah, Adam Y. Li, Zerubabbel Asfaw, Eugene I. Hrabarchuk, Addison Quinones, Lily McCarthy, Vikram Vasan, Muhammad Murtaza-Ali, Anthony Lin, Husni Alasadi, Zaid Nakadar, Alexander J. Schupper, Alex Gometz, Mark R. Lovell, and Tanvir F. Choudhri

Concussions are the leading cause of injury among youth athletes, and antibiotics are the most prescribed pediatric medication in the United States. Antibiotics have shown to exert neuroprotective effects in animal models of traumatic brain injury, but to date, no human studies exist. Between 2009 and 2019, 6,343 adolescent athletes with differential antibiotic use at baseline were administered Immediate Post-concussion Assessment and Cognitive Testing at baseline and twice postinjury. Chronic antibiotic use was associated with a reduced risk for concussion (odds ratio 0.54), increased postconcussive symptomology and neurocognitive burden, and improved recovery by follow-up, a median of 7 days after concussion. This preliminary retrospective analysis suggests antibiotic use may impart neuroprotection up to a certain severity threshold, leading to fewer, yet more severe concussions that tend to recover faster.

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The Efficacy of Dry Needling in Combination With Electrical Stimulation on Pain Reduction and Improved Function in Chronic Plantar Heel Pain: A Critically Appraised Topic

Kelly J. Lumpkin, Eric J. Fuchs, and Jeff N. Lowes

Focused Clinical Question: What is the efficacy of dry needling (DN) in combination with electrical stimulation on pain and function when compared with DN alone, conservative care, or placebo treatments for chronic plantar heel pain? Clinical Bottom Line: Based on a review of three good-quality randomized controlled trials, it appears the lasting effects of utilizing DN in combination with electrical stimulation on chronic plantar heel pain for reduction in pain and an increase in function are superior in some outcome measures but not all outcome measures over time as compared with other treatments. It is unclear whether DN in combination with electrical stimulation is superior to DN alone; however, both are clinically useful when used adjunctively more than four times in a month. Based on conflicting results, needling protocol variations, treatment type comparison variations, and good-quality studies, the grade of a B is assigned to this critically appraised topic.

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Readability of Postconcussion Home Care Instructions

Kristen C. Schellhase, Andrew A. McIntosh, Isis I.A. Jennings-Collier, Madison D. Dininny, Richard I. Zraick, and L. Colby Mangum

Patient education materials should be written at or below a fifth grade reading level. Postconcussion home care instructions outline what signs/symptoms warrant a visit to the emergency department and actions that should be taken/not taken by the caregiver. The purpose of this study was to determine the readability of postconcussion home care instructions provided by national organizations seen as setting the standard of care. Readability analyses were performed using the Readability Studio 2019 Standard Edition, by Oleander Software (Oleander Solutions). All postconcussion home care instructions were written above the recommended reading grade level. Poor comprehension of written material may lead to poor health outcomes; therefore, those organizations should consider amending handouts to meet the recommended reading level. Athletic trainers should examine the readability of home care instructions they provide, use both written and verbal instructions, and ensure caregiver understanding by using the skills in the Health Literacy Universal Precautions Toolkit.

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Fractures, Glycemic Control, and Bone Mineral Density in Females With Type 1 Diabetes Mellitus: A Critically Appraised Topic

Antoinette Lee, Nancy A. Uriegas, Morgan G. Adams, and Amy F. Hand

Clinical scenarios have risen where females with Type 1 diabetes mellitus (T1-DM), whose demographics are similar to their male counterparts, have sustained bone injuries, whereas the males with T1-DM have not. These scenarios bring into question the effect of T1-DM on various aspects of bone health and injury risk in females. The purpose of this study was to investigate the impact of T1-DM in females on their fracture risk, glycemic control abilities, and bone mineral density when compared to their male counterparts. Results were consistent across all studies, indicating that individuals with T1-DM had poor glycemic control abilities during ages within peak bone accrual, had significantly lower bone mineral density, and had a greater fracture incidence. Given these results, there is a need for future education to emphasize the importance of glycemic management, future research to investigate differences in physically active populations, and for clinicians to recognize their at-risk patients and take the necessary measures to prevent injury.

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NATA News & Notes

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Continuing Education Assessment