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Jennifer Ostrowski, Angelina Purchio, Maria Beck and JoLynn Leisinger

Context: Rest, ice, compression, and elevation are commonly recommended immediately after injury. Traditionally, ice bag (IB) with elastic wrap compression has been utilized; however, recently intermittent cryocompression units are being used. Limited research has evaluated tissue temperature decreases with intermittent cryocompression units. Objective: Evaluate magnitude of muscle and skin cooling. Design: Repeated-measures counterbalanced study. Setting: University research laboratory. Patients or OtherParticipants: Twelve healthy college-aged participants (4 males and 8 females; age = 23.08 [1.93] y; height = 171.66 [9.47] cm; mass = 73.67 [13.46] kg; subcutaneous thickness = 0.90 [0.35] cm) without compromised circulation or injury. Intervention(s): Salted IB, GameReady (GR), and PowerPlay-ice bag (PP-ice) were applied to the posterior aspect of the nondominant calf for 30 minutes; participants underwent each treatment in counterbalanced order. Main Outcome Measure(s): Muscle temperature measured via 21-gauge catheter thermocouple; skin temperature measured via a surface thermocouple. Temperatures were recorded at baseline and during a 30-minute treatment. Correlations were evaluated between muscle and skin temperatures. Results : Nonsignificant treatment × time interaction and nonsignificant main effect of treatment for intramuscular cooling. Mean Decrease From Baseline : IB, 6.4°C (±2.8); GR, 5.4°C (±1.1); PP-ice, 4.8°C (±2.8). Nonsignificant treatment × time interaction for skin cooling (F 20,200 = 1.440, P = .65, ηp2=.346, and observed β = 0.773), but significant main effect for treatment (F 10,100 = 5.279, P = .03, ηp2=.883, and observed β = 1.00). Mean Decrease From Baseline: IB, 17.0°C; GR, 16.4°C; PP-ice, 14.6°C. No significant correlation between intramuscular and skin temperatures in any condition at any time point. No significant correlation between adipose tissue thickness and maximum temperature decrease with any modality. Conclusions: Salted IB with elastic wrap compression, GR, and PP-ice produced equivalent intramuscular temperature decreases during the treatment period.

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Bailey Peck, Timothy Renzi, Hannah Peach, Jane Gaultney and Joseph S. Marino

Context: Professional football linemen are at risk for sleep-disordered breathing (SDB) compared with other types of athletes. It is currently unknown whether college football linemen display a similar risk profile. Objective: (1) To determine for the first time whether college football linemen show risk for SDB and (2) test the hypothesis that SDB risk is higher in college football linemen compared with an athletic comparison group. Design: Descriptive laboratory study. Setting: The Health Risk Assessment Laboratory. Participants: Male football linemen (n = 21) and track (n = 19) Division I athletes between the ages of 18 and 22 years. Interventions: Participants completed the Multivariable Apnea Prediction Index and Epworth Sleepiness Scale surveys, validated measures of symptoms of sleep apnea and daytime sleepiness, respectively. Neck and waist circumferences, blood pressure, Modified Mallampati Index (MMPI), and tonsil size were determined, followed by body composition assessment using dual-energy X-ray absorptiometry. Main Outcome Measures: Scores from surveys, anthropometric data, MMPI, and body composition. Results: Survey data demonstrated a deficiency in sleep quality and efficiency, coinciding with increased self-reported symptoms of apnea (Multivariable Apnea Prediction Index = 0.78) in college linemen relative to track athletes. Neck circumference (44.36 cm), waist circumference (107.07 cm), body mass index (35.87 kg/m2), and percent body fat (29.20%), all of which exceeded the clinical predictors of risk for obstructive sleep apnea, were significantly greater in linemen compared with track athletes. Multivariable Apnea Prediction variables were significantly correlated with MMPI, neck circumference, percent body fat, body mass index, and systolic blood pressure (r ≥ .31, P < .05), indicating that college football linemen are at increased risk for SDB. Conclusions: Risk factors for SDB recognized in professional football linemen are also present at the college level. Screening may minimize present or future risk for SDB, as well as the downstream risk of SDB-associated metabolic and cardiovascular disease.

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Jahan Heidari, Johanna Belz, Monika Hasenbring, Jens Kleinert, Claudia Levenig and Michael Kellmann

Context: Explanatory approaches for back pain (BP) in athletes focus on biomechanical factors while neglecting psychological perspectives. Psychological factors have gained importance in the prediction of injuries in athletes and BP in the general population, with stress and recovery emerging as central risk factors. However, scarce evidence exists regarding the role of these aspects for the prevalent burden of BP. Objective: To investigate the association between stress and recovery parameters and the presence of BP. Design: Cross-sectional design. Setting: The questionnaires were distributed after the training sessions. Participants: A total of 345 competitive athletes (mean age = 18.31 y [SD = 5.40]) were investigated. The classification of the athletes’ competitive status was based on performance level. Interventions: Data were collected using questionnaires for the assessment of stress, recovery, and BP. Main Outcome Measures: The authors performed a multiple logistic regression to obtain odds ratios for stress and recovery parameters with regard to the outcome variable BP status. Results: For stress, the dimension “overall stress” (odds ratio = 1.83; 95% confidence interval, 1.30–2.59; P = .001) and the scale “physical complaints” (odds ratio = 1.68; 95% confidence interval, 1.25–2.25; P = .001) of the general version of the Recovery-Stress Questionnaire resulted to be significantly associated with BP. None of the recovery-related scales displayed a statistically significant relationship with BP. Conclusion: The outcomes of this study imply a modest association between stress and the presence of BP in competitive athletes. Practitioners may take these findings into account regarding the conception of training and for monitoring purposes.

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Kenneth C. Lam and Jessica G. Markbreiter

Context: Current evidence suggests that, despite returning to full participation, physically active adults with a previous knee injury experience lower health-related quality of life (HRQOL) than those with no knee injury history. It is unknown if this relationship is present in adolescent athletes. Objective: To determine the impact of knee injury history on HRQOL in adolescent athletes who were medically cleared for full participation. Design: Cross-sectional. Setting: Athletic training clinics. Participants: A convenience sample of 183 adolescent athletes, who were medically cleared for full participation, were grouped by self-report of a previous knee injury: positive knee injury history (HIS; n = 36, age = 15.7 [1.4] y, height = 168.0 [11.9] cm, and weight = 71.8 [11.9] kg) and no knee injury history (NO-HIS; n = 147, age = 15.5 [1.4] y, height = 166.0 [10.5] cm, and weight = 67.6 [14.6] kg). Interventions: Participants completed the Pediatric International Knee Documentation Committee form and Pediatric Quality of Life Inventory during their preparticipation examination. Main Outcome Measures: Generalized linear models were used to compare group differences for the total and subscale scores of the Pediatric International Knee Documentation Committee and Pediatric Quality of Life Inventory. Results: Main effects of injury group indicated that the HIS group reported significantly lower scores than the NO-HIS group for the Pediatric International Knee Documentation Committee total score (P < .001; HIS = 79.2 [21.7], NO-HIS = 95.8 [8.6]) and for the Pediatric Quality of Life Inventory total (P = .001; HIS = 85.7 [10.9], NO-HIS = 90.9 [7.3]), physical functioning (P = .002; HIS = 86.7 [13.6], NO-HIS = 92.1 [8.2]), school functioning (P = .01; HIS = 80.6 [12.4], NO-HIS = 86.8 [12.2]), and social functioning (P = .01; HIS = 89.3 [12.4], NO-HIS = 94.6 [8.9]) scores. No group differences were reported for the emotional functioning subscale (P = .13; HIS = 85.7 [17.7], NO-HIS = 89.7 [13.1]). No interactions or main effects of sex were reported (P > .05). Conclusions: Our findings suggest that, despite returning to full sport participation, adolescent athletes with a previous knee injury generally experience lower HRQOL than their peers with no knee injury history, specifically for knee-specific HRQOL, physical functioning, school functioning, and social functioning. Our results are similar to previous findings reported in college athletes and military cadets.

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Gabriel Andrade Paz, Marianna de Freitas Maia, Haroldo Gualter Santana, Humberto Miranda, Vicente Lima and John D. Willson

Study Design: Observational study. Context: Altered frontal plane knee mechanics during dynamic tasks have been often associated with lower-extremity injuries. Strategies to decrease these risk factors and improve knee joint stability are often applied in rehabilitation and training environments. Objective: The purpose of this study was to compare knee joint frontal plane projection angles (FPPA) via 2-dimensional video analysis during drop vertical jump (DVJ) and step-down test (SDT) tasks in the preferred and nonpreferred limbs of young male and female volleyball players. Methods: A total of 60 young male (n = 29) and female (n = 31) volleyball players (13.6 [1.1] y, 62.2 [11.2] kg, and 170.8 [10] cm) participated in this study. Once the athletes were screened for inclusion and exclusion criteria, limb preference was operationally defined as the preferred kicking leg or the foot used for stair climbing. In a randomized study design, participants were asked to perform a bilateral DVJ and unilateral step-down landing tasks for both preferred and nonpreferred limb. Kinematic analysis was performed via a 2-dimensional video recording of knee joint FPPA alignment. Results: No difference was noted in FFPA during DVJ and SDT tasks between preferred and nonpreferred limbs in both male and female groups (P > .05). The FFPA was significantly higher for both limbs during DVJ versus SDT in both groups (P ≤ .05), but it was not different between male and female athletes. Conclusions: Based on these findings, clinicians may expect young male and female volleyball athletes to demonstrate similar and symmetrical lower-extremity 2-dimensional knee joint FPPA values across screening tests intended to identify lower-extremity injury risk factors. However, greater FPPA values should be expected during the more dynamic DVJ task.

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Leanne Sawle, Jennifer Freeman and Jonathan Marsden

Context: Athletic pelvic/groin pain is a common yet often challenging problem to both diagnose and manage. A new tool has been developed based on the clinical effects of applied force on the pelvis. Early findings indicate that this customized compression orthosis may have a positive effect on pelvic/groin pain and performance measures. Objectives: To inform the design and test the practicality of procedures for a future definitively powered randomized controlled trial and to provide an estimate of the effect size of this orthosis on selected clinical and performance measures. Design: Pilot randomized controlled trial with participants randomly allocated to an intervention or waiting-list control group. Setting: The training location of each athlete. Participants: 24 athletes with subacute and chronic pelvic conditions were proposed to be recruited. Intervention: A customized compression orthosis, delivering targeted compression to the pelvic girdle. Outcome Measures: Measures were the active straight leg raise (ASLR) test, squeeze test, broad jump, and the multiple single-leg hop-stabilization test. Results: A total of 16 athletes completed the study. The invention group demonstrated moderate to large estimated effect sizes on the squeeze test and active straight leg raise tests (d = 0.6–1.1) while wearing the orthosis. Small effect sizes (d = 0.2) were seen on jump distance and the dominant leg balance score. Compared with the control group, the intervention group also showed moderate to large estimated effect sizes on the active straight leg raise measures (d = 0.5–0.9) when wearing sports shorts. Conclusions: The protocol was feasible. Effect sizes and recruitment/attrition rates suggest that the intervention holds promise and that a future definitively powered randomized controlled trial appears feasible and is indicated.

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André Bateman and Kai A.D. Morgan

Context: Athletes at the highest levels appear to be most affected by sport-related injuries and suffer both physiologically and psychologically. Established models of psychological responses to injury, however, do not offer a comprehensive explanation based on posttraumatic stress disorder (PTSD), although some studies suggest that injuries may be interpreted as traumatic. Studies also suggest that perceived self-efficacy may be a mediator of PTSD development. Objective: This study examines the psychological sequelae experienced by high-level athletes as a result of sport-related injuries based on a PTSD–self-efficacy framework. Design: A cross-sectional survey design was used. Participants: Forty-six athletes (30 males and 16 females) from 4 different sports were conveniently sampled and completed a questionnaire battery assessing injury characteristics, trauma sequelae, and self-efficacy. Main Outcome Measures: Present injury status, PTSD symptomatology, and general self-efficacy. Results: Injury was found to be associated with elevated levels of PTSD symptomatology. The presence of injury was a significant predictor of general PTSD and, specifically, hyperarousal symptoms; however, general self-efficacy was not found to predict trauma-related symptoms. There were indications, however, that self-efficacy beliefs may affect injury-related factors. Conclusions: This research highlights the presence of PTSD-related psychological dysfunction associated with sport injury, and further uncovers the possible impacts of self-efficacy beliefs in managing the stress of injury. These findings highlight the need for psychological support as injured athletes undergo rehabilitation.

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Christopher Kuenze, Lisa Cadmus-Bertram, Karin Pfieffer, Stephanie Trigsted, Dane Cook, Caroline Lisee and David Bell

Context: Reductions in objectively measured moderate to vigorous physical activity (MVPA) have been reported among individuals with anterior cruciate ligament reconstruction (ACLR). Self-reported measures of physical activity are commonly used to assess participation in physical activity after ACLR despite the lack of evidence to support the validity of such measures within this population. Objective: The objective of this research was to determine the relationships between objectively measured MVPA, self-reported physical activity, and knee function among individuals with ACLR. Setting: University laboratory. Patients (or Other Participants): Thirty-one participants with a history of ACLR (sex: 23 females and 8 males; age = 19.8 [1.4] y) and 31 matched controls (sex: 23 females and 8 males; age = 20.6 [1.7] y) enrolled in this study. Intervention(s): None. Main Outcome Measures: Participants completed self-reported physical activity using the Tegner Activity Scale and the Marx Activity Rating Scale. Participant MVPA was objectively measured using an ActiGraph wGT3X-BT accelerometer for a 7-day period during which the monitor was worn for not less than 10 hours per day. Primary outcome measures were the amount of time spent in MVPA (minutes per week) and time spent in MVPA performed in bouts of ≥10 minutes (minutes per week). Relationships between the Tegner Activity Score, Marx Activity Rating Scale, and objectively measured MVPA variables were assessed using partial Spearman’s rank correlation coefficients after controlling for activity monitor wear time. Results: There were no significant relationships between objectively measured MVPA and self-reported physical activity (ρ ≤ 0.31, P ≥ .05) or self-reported knee-related function (ρ ≤ .41, P ≥ .05) among ACLR participants. Conclusions: Objectively measured physical activity is not significantly related to self-reported physical activity or self-reported knee function among individuals with a history of ACLR. Consideration of objective and self-reported physical activity within this population may provide key insights into disconnects between perception and the reality of physical activity engagement following ACLR.

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Ian J. Dempsey, Grant E. Norte, Matthew Hall, John Goetschius, Lindsay V. Slater, Jourdan M. Cancienne, Brian C. Werner, David R. Diduch and Joseph M. Hart

Context: Postoperative rehabilitation is critical to optimize outcomes after anterior cruciate ligament reconstruction (ACLR). However, the relationship between physical therapy (PT) and clinical outcomes is unclear. Objective: To describe PT characteristics following ACLR and to assess the relationships between PT characteristics, surgical procedure, and clinical outcomes. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 60 patients (31 females/29 males, age = 22.4 [9.2] y, height = 171.7 [9.9] cm, and mass = 70.2 [14.7] kg) with a history of primary unilateral ACLR (53.6% patellar tendon and 46.4% hamstring) participated. Intervention(s): Patients completed a performance assessment and rated subjective knee function prior to physician clearance (mean = 6.3 [1.3] mo postoperatively) and were contacted within 6 months of clearance to complete a PT questionnaire. Main Outcome Measures: PT questionnaire item response, knee extension maximum voluntary isometric contraction (MVIC) torque, peak isokinetic knee extension torque, single leg hop distance, and International Knee Documentation Committee were measured. Correlations assessed relationships between PT quantity and clinical outcomes. Independent t tests compared PT quantity and clinical outcomes based on return-to-sport status, readiness to return to sport, and surgical procedure. Results: Patients completed regular PT (2 d/wk, 25 wk, 58 visits) and were most likely to conclude when discharged by the therapist (68.3%). More than half (56.7%) returned to sport, yet most (73.3%) felt unready at discharge. Isokinetic torque was correlated with days of PT/week (r = .29, P = .03). Isokinetic torque and hop symmetry were reduced in patients who returned to sport (P < .05). Patients who felt ready to return completed fewer weeks of PT (P < .05). Patients with a patellar tendon graft completed more days of PT/week and total visits, but demonstrated lower MVIC torque, MVIC symmetry, and isokinetic symmetry (P < .05). Conclusions: Many patients felt unready to return to sport at PT discharge. PT frequency was associated with isokinetic torque, yet this relationship was small. Outcomes were reduced in patients who returned to sport, suggesting premature resumption of preinjury activity.

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Gabrielle G. Gilmer, Jessica K. Washington, Jeffrey R. Dugas, James R. Andrews and Gretchen D. Oliver

Context: Studies have found that a 20% reduction in energy generation from the lumbopelvic-hip complex during overhead throws leads to a 34% increase in load on the shoulder. Objective: The purpose of this study was to assess the effects of lumbopelvic-hip complex stability, via the single leg squat assessment, on throwing mechanics of softball athletes. Design: Prospective cohort study. Setting: Laboratory setting. Participants: A total of 50 softball athletes (164.0 [104.0] cm, 65.6 [11.3] kg, 16.3 [3.8] y, 8.61 [3.62] y of experience) performed 3 overhead throws and a single leg squat on each leg. Intervention: Four stability groups were derived: (1) stable on both legs (bilateral stability), (2) unstable on the throwing side leg (TS instability) and stable on the nonthrowing side leg, (3) unstable on the nonthrowing side leg (NTS instability) and stable on the throwing side leg, and (4) unstable on both legs (bilateral instability). All throws were analyzed across 4 throwing events: foot contact (FC), maximum external shoulder rotation (MER), ball release (BR), and maximum internal shoulder rotation (MIR). Main Outcome Measures: Mann–Whitney U tests revealed significant differences between the bilateral stability and the TS instability groups in trunk flexion at BR; the bilateral stability and the NTS instability groups in trunk flexion at BR, shoulder horizontal abduction at FC, shoulder rotation at FC, and pelvis flexion at MIR; the TS instability and the bilateral instability groups in trunk rotation at FC; and the NTS instability and the bilateral instability groups in trunk flexion at MER and shoulder rotation at FC. Conclusion: These findings demonstrate the different mechanisms in which energy can be lost through lumbopelvic-hip complex instability as evident in throwing mechanics. The findings from this study suggest that the current methods used for classification could act as a tool for coaches, physicians, and athletic trainers when assessing their athletes’ injury susceptibility.