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Sarah B. Willwerth, Landon B. Lempke, Vipul Lugade, William P. Meehan III, David R. Howell, and Alexandra F. DeJong Lempke

Context: Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures. Design: Cross-sectional study. Methods: We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance. Results: Athletes with and without a history of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = .19). Conclusions: Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments.

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Kimberly A. Clevenger, Katherine L. McKee, Melitta A. McNarry, Kelly A. Mackintosh, and David Berrigan

Purpose: To assess the association between the amount of recess provision and children’s accelerometer-measured physical activity (PA) levels. Methods: Parents/guardians of 6- to 11-year-olds (n = 451) in the 2012 National Youth Fitness Survey reported recess provision, categorized as low (10–15 min; 31.9%), medium (16–30 min; 48.0%), or high (>30 min; 20.1%). Children wore a wrist-worn accelerometer for 7 days to estimate time spent sedentary, in light PA, and in moderate to vigorous PA using 2 different cut points for either activity counts or raw acceleration. Outcomes were compared between levels of recess provision while adjusting for covariates and the survey’s multistage, probability sampling design. Results: Children with high recess provision spent less time sedentary, irrespective of type of day (week vs weekend) and engaged in more light or moderate to vigorous PA on weekdays than those with low recess provision. The magnitude and statistical significance of effects differed based on the cut points used to classify PA (eg, 4.7 vs 11.9 additional min·d−1 of moderate to vigorous PA). Conclusions: Providing children with >30 minutes of daily recess, which exceeds current recommendations of ≥20 minutes, is associated with more favorable PA levels and not just on school days. Identifying the optimal method for analyzing wrist-worn accelerometer data could clarify the magnitude of this effect.

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Andrew Newland, Colum Cronin, Gillian Cook, and Amy Whitehead

Developing high-quality athlete–coach (A–C) relationships improves both athlete performance and well-being. However, content relating to the A–C relationship has been underrepresented within coach education. The study evaluates how coaches completing the English Football Association’s Union of European Football Associations A and B licenses develop knowledge of the A–C relationship. It does so by drawing on the perspectives of those who design and deliver the courses. Semistructured interviews were completed with nine experienced Football Association coach developers alongside a document analysis of seven key course documents. Data were analysed through an inductive thematic analysis and five themes were generated: (a) coach developers understand that the A–C relationship is built on trust, care, and hard and soft interpersonal approaches; (b) the triad of knowledge impacts on the A–C relationship, not just interpersonal knowledge; (c) the A–C relationship is not meaningfully addressed in the formalised course content; (d) in situ visits provide an effective medium to develop knowledge of the A–C relationship; and (e) the assessment framework does not align with the formalised course content. Findings demonstrate, despite a diversification in content, the A–C relationship is introduced in a superficial manner. Future research should clarify the knowledge coaches require to develop high-quality A–C relationships within a high-performance footballing context.

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John W. Evers-Smith and Kevin C. Miller

Clinical Scenario: Exercise-associated muscle cramps (EAMC) are sudden, painful, and involuntary contractions of skeletal muscles during or after physical activity. The best treatment for EAMC is gentle static stretching until abatement. Stretching is theorized to relieve EAMC by normalizing alpha motor neuron control, specifically by increasing Golgi tendon organ activity, and physically separating contractile proteins. However, it is unclear if stretching or flexibility training prevents EAMC via the same mechanisms. Despite this, many clinicians believe prophylactic stretching prevents EAMC occurrence. Clinical Question: Do athletes who experience EAMC during athletic activities perform less prophylactic stretching or flexibility training than athletes who do not develop EAMC during competitions? Summary of Key Findings: In 3 cohort studies and 1 case-control study, greater preevent muscle flexibility, stretching, or flexibility training (ie, duration, frequency) was not predictive of who developed EAMC during competition. In one study, athletes who developed EAMC actually stretched more often and 9 times longer (9.8 [23.8] min/wk) than noncrampers (1.1 [2.5] min/wk). Clinical Bottom Line: There is minimal evidence that the frequency or duration of prophylactic stretching or flexibility training predicts which athletes developed EAMC during competition. To more effectively prevent EAMC, clinicians should identify athletes’ unique intrinsic and extrinsic risk factors and target those risk factors with interventions. Strength of Recommendation: Minimal evidence from 3 prospective cohort studies and 1 case-control study (mostly level 3 studies) that suggests prophylactic stretching or flexibility training can predict which athletes develop EAMC during athletic competitions.

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Kylie S. Boldt, Bernadette L. Olson, and Ryan M. Thiele

Clinical Scenario: Achilles tendon ruptures are prevalent and devastating injuries that require the need for extensive rehabilitation. The methods for preventing these injuries vary between different exercise methods and nutritional supplementation. Although proven effective for decreasing pain and increasing tendon properties, the influence of these 2 methods in combination has not yet been evaluated. Clinical Question: Does exercise combined with collagen supplementation improve Achilles tendon structural and mechanical properties and diminish subsequent patient-reported pain compared with exercise alone in adults? Summary of Key Findings: Exercise training, including eccentric training protocols and concentric resistance training protocols, combined with collagen supplementation influence Achilles tendon properties and subsequent patient-reported pain compared with exercise alone. Clinical Bottom Line: Evidence supports that collagen along with exercise training has a significant influence on pain mitigation, augmented cross-sectional area, and tendon thickness, but may have little to no influence on tendon stiffness and microvascularity compared with exercise alone. Further research is needed to determine the effects of combined methods on various populations. Strength of Recommendation: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A.