Purpose: To quantify, for an elite-level racewalker, altitude training, heat acclimation and acclimatization, physiological data, and race performance from January 2007 to August 2008. Methods: The participant performed 7 blocks of altitude training: 2 “live high:train high” blocks at 1380 m (total = 22 d) and 5 simulated “live high:train low” blocks at 3000 m/600 m (total = 98 d). Prior to the 2007 World Championships and the 2008 Olympic Games, 2 heat-acclimation blocks of ~6 weeks were performed (1 session/week), with ∼2 weeks of heat acclimatization completed immediately prior to each 20-km event. Results: During the observation period, physiological testing included maximal oxygen uptake (VO2max, mL·kg−1·min−1), walking speed (km·h−1) at 4 mmol·L−1 blood lactate concentration [La−], body mass (kg), and hemoglobin mass (g), and 12 × 20-km races and 2 × 50-km races were performed. The highest VO2max was 67.0 mL·kg−1·min−1 (August 2007), which improved 3.1% from the first measurement (64.9 mL·kg−1·min−1, June 2007). The highest percentage change in any physiological variable was 7.1%, for 4 mmol·L−1 [La−] walking speed, improving from 14.1 (June 2007) to 15.1 km·h−1 (August 2007). Personal-best times for 20 km improved from (hh:mm:ss) 1:21:36 to 1:19:41 (2.4%) and from 3:55:08 to 3:39:27 (7.1%) in the 50-km event. The participant won Olympic bronze and silver medals in the 20- and 50-km, respectively. Conclusions: Elite racewalkers who regularly perform altitude training may benefit from periodized heat acclimation and acclimatization prior to major international competitions in the heat.
Amelia J. Carr, Philo U. Saunders, Laura A. Garvican-Lewis and Brent S. Vallance
Abbey Thomas and Jeffrey B. Driban
Jennifer L. Rizzo
The diagnosis of thoracic outlet syndrome (TOS) is challenging and primarily determined by clinical examination. Symptoms such as numbness and tingling in the arms when raised above the head make the rehabilitation process difficult due to the various manifestations of TOS presented to the athletic trainer (AT). An AT should understand the intricate anatomical characteristics of the thoracic outlet and how various TOS presentations may impact treatment. In this clinical commentary, I provide my own insights for understanding TOS from my perspective as a patient and AT. These insights are valuable when making diagnostic, therapeutic, and prognostic clinical decisions.
Emily R. Hunt, Cassandra N. Parise and Timothy A. Butterfield
Clinical Scenario: Anterior cruciate ligament (ACL) ruptures are one of the most common injuries in young athletic populations. The leading treatment for these injuries is ACL reconstruction (ACL-r); however, nonoperative treatments are also utilized. Following ACL-r, patients experience prolonged muscle weakness and atrophy of the quadriceps muscle group, regardless of rehabilitation. Nonoperative treatment plans following ACL injury exist, but their outcomes are less familiar, in spite of providing insight as a nonsurgical “control” for postsurgical rehabilitation outcomes. Therefore, the purpose of this critically appraised topic was to evaluate quadriceps strength and function following nonoperative ACL rehabilitation using objective and subjective measures including isokinetic dynamometry, the single-leg hop test, and the International Knee Documentation Committee (IKDC) subjective knee form. Focused Clinical Question: What are the effects of nonoperative treatment on peak isokinetic knee-extensor torque, the single-leg hop tests, and the IKDC in patients who have sustained an ACL rupture? Summary of Key Findings: Patients who underwent nonsurgical ACL treatment produced limb symmetry index, with the side-to-side torque difference expressed as a percentage, and values at or above 90% for all 4 single-leg hop tests and strength tests similar to ACL-r patients. All studies showed individuals had higher IKDC scores at baseline collection when compared with patients who underwent ACL-r but showed lower IKDC scores at long-term follow-up compared with ACL-r patients. Clinical Bottom Line: Nonoperative treatments of ACL injuries yield similar long-term results in quadriceps strength as ACL-r. Due to the quality of evidence and the absence of randomized controlled trials on this topic, these outcomes should be considered with caution. Strength of Recommendation: The Oxford Centre for Evidence-Based Medicine taxonomy recommends a grade of B for level 2 evidence with consistent findings.
Cecilia Stenling and Michael Sam
Despite an increase of advocacy by established nongovernmental sport organizations, little is known about how advocacy is enacted and with what effects. Building conceptually on frame alignment theory and empirically on interview data from 19 Swedish Regional Sport Federations, this article investigates how advocates politicize sport to gain “insider status” and analyses the by-products of such efforts. This research demonstrates that the architecture of advocacy claims perpetuates a separation between organizations that “sell” sport from those that “produce” it. Framing also impels centralized authority because advocates safeguard their credibility as political actors by taking up a “leadership-position” vis-à-vis clubs. Advocacy frame alignment has further by-products insofar as they narrow advocates’ room for maneuver and become institutionalized over time.