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Context: The sequelae of concussion may have psychological consequences that affect an athlete’s ability to return to play (RTP). However, confidence of RTP readiness is rarely monitored after a concussion. Design: This study examined the acute and longitudinal implications of concussion on an athlete’s confidence to RTP, the relationship between self-reported symptoms and athlete confidence to RTP, and interactions between concussion symptoms, sex, sport type (contact vs noncontact), and confidence to RTP. Methods: Forty-six college athletes (65% female) sustained a concussion and completed the Injury Psychological Readiness to Return to Sport (I-PRRS) scale at 3 timepoints: within 72 hours of injury (acute), within 72 hours of beginning the RTP protocol (pre-RTP), and within 72 hours of being fully cleared to RTP (post-RTP). Results: Athletes reported acute low confidence after concussion (I-PRRS mean [SD] = 32.59 [18.45]), which improved over time (pre-RTP mean [SD] = 52.11 [9.60]; post-RTP mean [SD] = 57.45 [5.96]). Some athletes returned to competition (post-RTP) with lingering confidence concerns (ie, I-PRRS < 50; 95% CI = 0.03–0.26). Acute symptom severity was associated with worse confidence (P < .001). Sex and sport type (contact vs noncontact) had no relationship with confidence (P = .406, P = .3314, respectively). These results indicate that athletes lack confidence acutely (within 72 h) following concussion. Conclusions: Although confidence improves over time, those who report greater acute symptoms also exhibit decreased confidence, and some athletes are returning to play with lingering concerns about their confidence (I-PRRS < 50). This preliminary evidence of heterogeneous confidence following concussion encourages the assessment and monitoring of confidence throughout concussion rehabilitation.

Most injuries that dancers sustain are to the lower extremities, specifically the foot and ankle region. Numerous potential risk factors have been examined for dancer injuries such as technical mistakes and fatigue. The purpose of this study was to compare landing kinematics and kinetics during jumps that are common in dance pre and postfatigue. Ten adolescent advanced level dancers participated in this study. Subjects completed 3 split leaps and 3 center leaps before and after a fatigue protocol performed on a stationary bike. Live motion capture was used to record landing kinematic and kinetic data. Results of this study showed a significant increase in ankle eversion and external rotation angles for center leaps from pre- to postfatigue protocol (P = .020 and P = .020, respectively) as well as significant increases in ankle eversion and knee adduction moments for center leaps (P = .020 and P = .036, respectively). These results show that after a fatigue protocol, there are changes to the kinematics of dancers that may make them more susceptible to ankle injury.

Context: Epidemiological studies have shown an increased risk of musculoskeletal injury after concussion. The purpose of this study was to determine whether the reverse relationship exists, specifically whether there is an increased risk of concussion after an anterior cruciate ligament (ACL) injury in a population-based cohort. Design: Retrospective cohort. Methods: The Rochester Epidemiology Project was searched between 2000 and 2017 for International Classification of Diseases, 9th and 10th Revision codes relevant to the diagnosis and treatment of concussion and ACL tear. A total of 1294 unique patients with acute, isolated ACL tears and no previous history of concussion were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion after the ACL injury. Cases were matched by age, sex, and Rochester Epidemiology Project availability to patients without an ACL tear (1:3 match), resulting in 3882 controls. Medical records of matched control patients were reviewed to rule out history of ACL injury. The hazard ratio of concussion injury following an ACL injury was determined. Results: Nine patients with an ACL injury suffered concussion up to 3 years after the ACL injury. The rate of concussion was no different between ACL-injured cases (0.7%) compared with matched controls with no ACL injury (1.2%), which corresponded to a hazard ratio of 0.55 (95% confidence interval, 0.3–1.1; P = .10). Conclusions: Based on the current evidence, there does not appear to be a significant association between ACL injury and subsequent concussion, which suggests that a concussion uniquely affects the risk of future subsequent musculoskeletal injury.

Context: Translating new evidence into clinical practice is a dynamic and iterative process. Research is ever evolving specific to concussion rehabilitation and requires a systematic approach rooted in science for translation into clinical practice. The knowledge-to-action (KTA) cycle framework is an effective strategy to ensure optimal outcomes and sustainability. The objective of this study was to investigate changes in clinical outcomes and clinician self-efficacy specific to concussion management in a suburban health care system utilizing the KTA framework. Design: Pretraining and posttraining intervention study. Methods: Rehabilitation professionals were electronically surveyed pre–post targeted concussion educational intervention. Questions were adapted from the General Self-Efficacy scale and tailored specifically to confidence in current concussion management. Retrospective chart reviews were also completed pre–post knowledge translation educational intervention to examine practice patterns. Data from the presurvey and retrospective chart review were utilized to identify the know–do gap and design intentional educational interventions. Statistical analysis was performed utilizing SPSS (version 28). Results: Within-group differences revealed an increase in confidence with evaluation (P = .01), intervention (P = .01), and consultation (P = .01) in concussion management. When comparing physical therapists who participated in the intervention with those who did not, there was significantly higher self-confidence in all areas (P ≤ .001) for those who engaged in the educational intervention. Pre–post chart reviews revealed improvement in clinical practice patterns in the following constructs: use of patient-reported outcome measures (P ≤ .001), objective outcome measures (P = .002), exertional testing (P ≤ .001), completion of comprehensive evaluation (P ≤ .001), and use of evidence-based practice (P ≤ .001). Conclusions: Utilizing the KTA framework resulted in improved self-efficacy of clinicians as well as improved clinical practice patterns in concussion management in an outpatient hospital-based practice. The KTA framework is a potential tool for translating current evidence related to concussion management for improved clinical outcomes.

Context: Sport and physical activity (PA) programs are an important developmental resource for youth with Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders. The purpose of this study is to assess sport participation rates, PA participation, and after-school supervision rates among African American children with ADHD and/or Disruptive Behavior Disorders. Design: In this cross-sectional study, parents of African American children with elevated symptoms of ADHD, oppositional defiant disorder, and/or conduct disorder (N = 175, 6- to 12-y-old, 31% female) reported after-school program participation over the past year. Methods: Logistic regression analyses tested relationships between ADHD symptoms, oppositional defiant disorder symptoms, and conduct disorder symptoms, likelihood of regular participation (≥2 d/wk) in sport, PA, and sedentary after-school programs, and likelihood of being supervised and unsupervised after school. All regressions controlled for age, sex, income, and medication status. Sample participation rates were descriptively compared with participation rates of same-aged peers regionally, and nationally, reported in 3 national surveys. Results: Parents in the local sample reported higher rates of sedentary after-school program participation (54%) but lower rates of PA program participation (31%), and sport participation (12%) compared with same-aged peers. The local sample was less likely to be unsupervised after-school compared with same-aged peers with only 27% of parents reporting that their child was unsupervised ≥ 2 days per week. Children endorsing oppositional defiant disorder (odds ratio = 2.05; P < .05) and conduct disorder (odds ratio = 5.74; P < .05) were more likely to be unsupervised more frequently after-school as compared with those not meeting endorsement. Conclusions: Given demonstrated benefits of youth sport programming and observed inequities in participation, there is a need to develop support models that connect parents, coaches, and social services agencies to facilitate inclusion. Sports medicine professionals are uniquely positioned to contribute to these efforts, as they are often key opinion leaders in both the youth sport and health care contexts.

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.