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Concussive Biomechanics in a Women’s Soccer Player: A Validation Clinical Case Report

Hallie D. Sayre and Tom G. Bowman

A concussed 19-year-old female midfielder on an National Collegiate Athletic Association (NCAA) Division III soccer team reported to the athletic training clinic complaining of a headache that began 4 days previously during a game where she headed several long punts. Despite delayed reporting, the patient returned to full participation without complication 13 days after her injury. The biomechanical data for the impacts she received on the day of injury were much lower than those presented in the literature as causing concussion for male athletes. Therefore, impact magnitude should not be used as an indicator for injury, as smaller, seemingly insignificant impacts can cause concussion.

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Effects of COVID-19 Sport Suspension on Injury Rates in Elite Athletes: A Critically Appraised Topic

Courtney N. Copeland, Emily A. Hall, and Gary W. Cohen

Clinical Scenario: With the enforcement of COVID-19 lockdown restrictions, sports teams worldwide were required to make drastic adjustments to their training regimen. This prolonged sport suspension resulted in a significant decrease in off-season and preseason training periods. Clinical Question: Are professional athletes who experienced a sport suspension during the COVID-19 pandemic at a higher risk of injury once they return to competition compared with pre-COVID-19 seasons? Summary of Key Findings: The literature was searched for articles examining the effects of COVID-19 sport suspension on athletic injury rates in elite athletes. A total of 240 articles were retrieved, and after exclusion criteria and removal of duplicates, four retrospective cohort studies remained. An increase in injury rates across studies after their sport suspension compared with pre-COVID-19 seasons was found. Clinical Bottom Line: The extended suspension from physical activity increased the risk of injury as players returned to sport training post-COVID-19 restrictions. While these studies demonstrated the effects on elite-level athletes, prolonged sport suspension may impact different patient populations. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy Scale, this critically appraised topic received a B grade for consistent but limited-quality patient-oriented evidence, with a low number of articles included.

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The Effects of Preparedness and Activity on Head Impacts in Lacrosse Athletes

Catherine E. Rogerson, Bradley C. Jackson, Katherine M. Breedlove, and Thomas G. Bowman

Considering the frequency and magnitude of head impacts occurring during sport participation is important to guide prevention initiatives. Our purpose was to compare magnitude and frequency of lacrosse players’ head impacts based on anticipation level and impact activity. Lacrosse athletes (16 men, 15 women) wore xPatch sensors during games and practices that measured impact magnitude (linear and rotational accelerations) and frequency of video verified head impacts. The interaction between impact activity and preparedness was not significant, multivariate: F(8, 1,730) = 1.03, p = .41, η2 = .01. Having a detailed understanding of the characteristics of head impacts could allow for focused interventions to reduce injury risk.

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Low Back Pain and the Social Determinants of Health: A Systematic Review and Narrative Synthesis: A Critically Appraised Paper

J.C. Andersen and Heather VanOpdorp

Focused Clinical Question: In adult patients with persistent low back pain, what relationship do social determinants of health have on pain frequency or severity? Bottom Line: This systematic review identified several particular social risk factors (including education status, socioeconomic status, and occupational factors) that are consistently associated with adverse low back pain outcomes. In addition, the analysis of the population-representative (cross-sectional) studies demonstrated support for important associations between specific social determinants of health, such as low socioeconomic status/income status and employment status and chronic low back pain prevalence.

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Continuing Education Assessment

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Volume 28 (2023): Issue 1 (Jan 2023)

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Efficacy of Helmet Use on Head Injury Reduction in Snow Sports: A Critically Appraised Topic

Kaelin Agar, Spencer DeMedal, Abbigail Delmonte, Lauren Bell, Kyle Fisher, and Erica Beidler

Context: Review articles published in 2010 concluded that there was strong evidence to support the use of helmets as a way to decrease the risk of sustaining a head injury during snow sport participation. However, new research published over the last decade on this relationship warrants revisiting this primary injury prevention approach. Clinical Question: What is the effect of helmet use on the occurrence of head injuries in snow sports? Clinical Bottom Line: The results from the included studies did not consistently find a reduction in head injury occurrence with helmet use in snow sports. Rather, the collective findings were more supportive of a neutral relationship between helmet use and head injuries. Therefore, these heterogeneous findings indicate there is SORT Level B evidence to support the use of helmets as a primary head injury prevention approach in snow sports. Future initiatives should acknowledge the multifaceted nature of injury occurrence and seek to educate the public more clearly on the limitations of helmet use during skiing and snowboarding.

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Perceived Stress as an Indicator of Work–Family Conflict and Burnout Among Secondary School Athletic Trainers

Alexandrya H. Cairns, Stephanie M. Singe, and Christianne M. Eason

Burnout and work–family conflict (WFC) are stressors faced by secondary school athletic trainers, however, the concept of perceived stress and its relationship to burnout or WFC is not well understood. The purpose of this study was to investigate perceived stress’ relationship with burnout and WFC. Participants reported a WFC score of 40.36 (±15.63), low burnout (40.1 ± 16.28), and moderate stress (15.99 ± 7.02). Perceived stress predicted WFC, but not burnout (b = 1.13, t 572 = 14.132, p ≤ .001). One’s level of perceived stress impacts WFC, which indicates higher stress will equal greater work–family conflict.

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Test–Retest Reliability and Minimum Detectable Change of the Athletic Trainers’ Self-Confidence Scale

Hannah L. Stedge, Thomas Cappaert, Valerie W. Herzog, Beth Kinslow, and Malissa Martin

The Athletic Trainers’ Self-Confidence Scale (ATSCS) is a nine-item Likert-scale questionnaire assessing the respondent’s level of agreement with statements regarding confidence in recognizing and managing exertional heat illnesses. Test–retest reliability of this instrument has not yet been established. The purpose of this study was to investigate the internal consistency, test–retest reliability, and minimum detectable change score for the composite score of the ATSCS. A total of 18 professional master of science in athletic training students (nine first-year and nine second-year students) completed the ATSCS at three testing sessions with 48 hr between sessions. The nine items of the ATSCS demonstrated good internal consistency (α = .86; 95% confidence interval [.78, .94]). The composite scores of the ATSCS demonstrated moderate test–retest reliability (intraclass correlation coefficient = .75; 95% confidence interval [.497, .893]). The calculated minimal detectable change for the composite change score was 6.19. The ATSCS has good internal reliability as well as test–retest reliability. These results display that the tool will provide consistent, reliable results of changes in athletic training students’ self-confidence.

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The Inclusion of a Complementary Running Progression Program in the Rehabilitation of Acute Hamstring Injuries: A Critically Appraised Topic

Michelle A. Sandrey

Introduction/Clinical Scenario : As many hamstring injuries occur when the hamstrings are in a lengthened state during the deceleration phase of running when the muscle is eccentrically contracting to slow the body down this functional aspect needs to be addressed. Thus, a rehabilitation program with a focus on progressive targeted eccentric hamstring exercises by gradually placing and exposing the muscle to eccentric force in a lengthened state supplemented with progressive running drills should be evaluated. Focused Clinical Question : Does the inclusion of a complementary running progression program for the rehabilitation of an acute hamstring injury reduce the time to safe return to sport with less hamstring reinjury occurrence for an athletic population? Summary of Key Findings: Three studies assessed the inclusion of a progressive running program with several types of running progression parameters addressed. Progressive running drills will load the hamstring in a functional manner, with a gradual increase in velocity of movement and lengthening of the muscle. Clinical Bottom Line : It appears that a complementary progressive running program within an acute hamstring rehabilitation program should be included as it caused no further harm and does not tend to increase hamstring reinjury occurrence. Strength of Recommendation : There is grade B evidence to include a complementary running progression program within an acute hamstring rehabilitation program.