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Focused Clinical Question: In individuals reporting low back pain postpartum, is exercise an effective intervention to reduce symptoms? Clinical Bottom Line: There is moderate evidence to support the use of an exercise intervention to reduce pain and improve functional disability in postpartum females with low back pain.

A 24-year-old male collegiate tennis athlete presented with pain, weakness, and numbness consistent with the ulnar nerve distribution in the left distal upper extremity following excessive wrist and forearm flexion and pronation. The patient was diagnosed with lacertus syndrome after referral for imaging. Lacertus syndrome is an exertional compartment syndrome of the forearm, typically including median nerve entrapment and surgical intervention. The uniqueness of this case included ulnar nerve involvement and resolution with interprofessional conservative management. Athletic trainers should consider including other health care professionals to conservatively manage lacertus syndrome in patients with delayed symptom onset during repetitive wrist and forearm activities.

Clinical Scenario: Headaches can be categorized as tension-type headaches, migraine, trigeminal autonomic cephalgia, and other primary headache disorders according to the Third International Classification of Headache Disorders. Headaches are one of the most common disorders within the nervous system and have a prevalence of >48% within the general population. Nerve blocks are a type of nerve stimulation that is believed to help reduce the frequency and severity of headaches. The physiological effect of the greater occipital nerve block on headaches is thought to be due to the central nervous system connections of the greater occipital nerve and trigeminal and cervical afferent fibers, which is believed to be the prime origin of migraine headaches. Nerve blocks can contain a variety of drug regimens including steroids, local anesthetics, or a mixture of both. Trigger point injections (TPIs) are an invasive therapy where a needle is guided directly into a trigger point that has been previously identified upon examination. Botulinum toxin A is an alternative treatment modality that can be injected with TPIs. Botulinum toxin A is a potent naturally occurring toxin that causes dose-dependent muscular relaxation by inhibiting the release of acetylcholine at the neuromuscular junction. Summary of Key Findings: (1) Both greater occipital nerve blocks and TPIs have been shown to reduce headache frequency and severity in the short term; however, it appears to be due to the needle injected into the soft tissue structures and not due to the type of solution injected. (2) Ultrasound guidance allows for a more accurate and effective technique than a blind injection as it allows for accurate injection into the targeted muscles, thereby minimizing complications and increasing the chance of success. (3) Once symptoms have been alleviated, clinicians should evaluate the patient’s mechanics in the upper trunk to determine whether there are any mechanical abnormalities leading to the formation of myofascial pain and/or trigger points causing the headache symptoms. If identified and treated appropriately, this can allow for a long-term solution in correcting the cause rather than the symptoms alone. (4) Participants receiving a greater occipital nerve block or TPI, despite the drug regimen or dosage, experienced similar benefits with no statistical significance. In deciding which treatment approach to take, the clinician should speak with the patient to educate them on the available options and allow the patient to be part of the decision-making process to best meet their needs and include a rehabilitation plan with all the treatment approaches. Clinical Question: In patients who experience chronic headaches, was there a greater decrease in headache frequency and severity with a greater occipital nerve block or TPI? Clinical Bottom Line: Needles into the supraclavicular region for headaches lead to decreased severity and frequency of headaches in the short term but will not lead to headache resolution. Strength of Recommendation: B.

Clinical Scenario: Reaction time is integral in many tasks during work, sport, and life, thus, alterations in reaction time may impact performance and injury risk. There are various factors that can influence reaction time, such as the physical state of the individual, including their age or sex. When comparing males and females, there is a major physiological difference to their physical state as hormones fluctuate during menstrual cycle phases, which not only affects the reproductive system, but females may experience physiological, cardiovascular, respiratory, or metabolic changes throughout their menstrual cycle phases. Therefore, this goal of this critically appraised topic is to examine whether reaction time changes during menstrual cycle phases. Focused Clinical Question: In healthy, eumenorrheic females, does reaction time change from one menstrual cycle phase to other menstrual cycle phases? Summary of Key Findings: Among the five studies evaluated in this CAT, all found significant changes to reaction time during phases of the menstrual cycle. Most studies found that reaction time was inversely related to sex hormone levels, indicating that phases with low hormone levels had longer reaction time than those phases with higher hormone levels; however, one study found reaction time to be prolonged or slower during the luteal phase, when hormone levels are higher. Clinical Bottom Line: Both auditory and visual reaction times vary across the menstrual cycle in healthy females with regular menstrual cycles (frequency and length). Given these findings, it is important to incorporate reaction time training across all phases of the menstrual cycle in female athletes. Strength of Clinical Recommendation: Based on the Strength of Recommendation Taxonomy, a Grade C is the strength of recommendation.

A sport-related musculoskeletal injury carries substantial consequences. It is essential to individualize management of these injuries with a model optimizing goal-oriented rehabilitation. A major challenge is to link a patient’s goal for returning to sport with the restoration of performance assessed through the rehabilitation process. Even more challenging is that the demanded movement competence is a moving target based on the type of sport and level of competition the athlete seeks to return to. Currently, no single standardized test battery can elucidate a patient’s readiness to return to their desired sport at their desired level. We propose a clinical framework to link the assessed capacity (AC) of patients and the demanded competence (DC) of a sport/recreational activity to develop a readiness score (the AC-DC score). The AC-DC score provides a starting point for exploring the critical elements in the decision-making process surrounding the return-to-sport continuum.

Mindful Sport Performance Enhancement (MSPE) training is a relatively new concept, which focuses on helping athletes manage a variety of stressors experienced throughout a season, including performing well academically, staying fit, having a productive season in their sport, and maintaining a healthy social life. A need for a critical appraisal is needed to assess the effectiveness of the intervention. Two cohort studies and one randomized control trial were included in the study and assessed using STROBE and PEDro Scale. Key results show, all 3 studies identified participants experiencing benefits after MSPE with aspects of awareness, acceptance, and emotion regulation. Furthermore, student-athletes who attended either all the sessions or more sessions after the 6-week course showed greater satisfaction with mental and physical health. Overall, there is level “B” evidence to support effectiveness of MSPE for college athletes in reducing sport anxiety and improving their overall well-being.

Hydration status monitoring through weight charts can help active individuals maintain optimal fluid balance and prevent health/performance impairments. This study aimed to determine the prevalence of athletes above an acute hypohydration threshold (within practices), a chronic hypohydration threshold (across practices), and the prevalence of athletes below the acute hypohydration threshold and above the chronic hypohydration threshold simultaneously (e.g., undetected chronic hypohydration). Second, involvement of baseline hydration verification (BV; with/without), sex, and competition level (high school, college/university) with acute hypohydration, chronic hypohydration, and undetected chronic hypohydration were also examined. Undetected chronic hypohydration was prevalent across sexes (6.4 ± 16.7% males; 1.4 ± 5.8% females) and competition levels (6.5 ± 16.4% high school; 5.4 ± 15.6% college/university). No significant differences existed across BV status for average acute hypohydration (with BV = 0.8; without BV = 0.8) or chronic hypohydation (with BV = 0.7; without BV = 0.8). All three calculations, absolute body mass loss, acute hypohydration, and chronic hypohydration, should be utilized to determine the prevalence of hypohydration, and they should also be used to assist athletic trainers while making clinical decisions regarding appropriate rehydration interventions.