Jaebin Shim, Deanna H. Smith, and Bonnie L. Van Lunen
Over the past decade, sport-related concussions have received increased attention due to their frequency and severity over a wide range of athletics. Clinicians have developed return-to-play protocols to better manage concussions in young athletes; however, a standardized process projecting the length of recovery time after concussion has remained an elusive piece of the puzzle. The recovery times associated with such an injury once diagnosed can last anywhere from 1 wk to several months. Risk factors that could lead to protracted recovery times include a history of 1 or multiple concussions and a greater number, severity, and duration of symptoms after the injury. Examining the possible relationship between on-field or sideline signs and symptoms and recovery times would give clinicians the confident ability to properly treat and manage an athlete’s recovery process in a more systematic manner. Furthermore, identifying factors after a head injury that may be predictive of protracted recovery times would be useful for athletes, parents, and coaches alike.
Focused Clinical Question:
Which on-field and sideline signs and symptoms affect length of recovery after concussion in high school and college athletes?
Bonnie L. Van Lunen, Clayton Carroll, Kristen Gratias, and Doug Straley
To determine the effects of a 20-min ice treatment on pain tolerance and peak torque.
A 2 × 2 × 6 factorial with repeated measures on 1 factor.
Outpatient rehabilitation clinic.
20 men and 15 women.
The participants were randomly assigned to an experimental (ice bag) or control (no ice bag) group.
Main Outcome Measures:
Peak electrical-stimulation output intensity (ESOI) was recorded in mV, and isokinetic peak torque (IPT), in N · m, every 4 min for 20 min.
ESOI and IPT increased over time. ESOI for the experimental condition was greater than for the control and within the experimental condition at 12, 16, and 20 min. No other differences were found for the IPT measures. There were no differences for ESOI and IPT between genders.
Cryotherapy enables patients to tolerate greater output intensities but does not result in increased peak torque
Lacey Nordsiden, Bonnie L. Van Lunen, Martha L. Walker, Nelson Cortes, Maria Pasquale, and James A. Onate
Many styles of foot pads are commonly applied to reduce immediate pain and pressure under the foot.
To examine the effect of 3 different foot pads on peak plantar pressure (PPP) and mean plantar pressure (MPP) under the first metatarsophalangeal joint (MTPJ) during slow running.
A 4 (pad) × 4 (mask) repeated-measures design.
University athletic training clinic and fitness facility.
20 physically active participants, 12 men (19.7 ± 1.3 y, 181.5 ± 6.3 cm, 83.6 ± 12.3 kg) and 8 women (20.8 ± 1.5 y, 172.7 ± 11.2 cm, 69.9 ± 14.2 kg) with navicular drop greater than or equal to 10 mm, no history of surgery to the lower extremity, and no history of pain or injury to the first MTPJ in the past 6 months.
PPP and MPP were evaluated under 4 areas of the foot: the rear foot, lateral forefoot, medial forefoot, and first MTPJ. Four pad conditions (no pad, metatarsal dome, U-shaped pad, and donut-shaped pad) were evaluated during slow running. All measurements were taken on a standardized treadmill using the Pedar in-shoe pressure-measurement system.
Main Outcome Measures:
PPP and MPP in 4 designated foot masks during slow running.
The metatarsal dome produced significant decreases in MPP (163.07 ± 49.46) and PPP (228.73 ± 63.41) when compared with no pad (P < .001). The U-shaped pad significantly decreased MPP (168.68 ± 50.26) when compared with no pad (P < .001). The donut-shaped pad increased PPP compared with no pad (P < .001).
The metatarsal dome was most effective in reducing both peak and mean plantar pressure. Other factors such as pad comfort, type of activity, and material availability must also be considered. Further research should be conducted on the applicability to other foot types and symptomatic subjects.
Megan N. Houston, Johanna M. Hoch, Bonnie L. Van Lunen, and Matthew C. Hoch
Health-related quality of life (HRQOL) is a broad term for the impact of injury or illness on physical, psychological, and social health dimensions. Injury has been associated with decreased HRQOL in athletes. However, the influence of injury history, participation status, time since last injury, and injury severity on HRQOL remains unclear.
To compare HRQOL in collegiate athletes based on injury history, participation status, time since last injury, and injury severity and to examine relationships between HRQOL outcomes.
3 National Collegiate Athletic Association (NCAA) institutions.
467 collegiate athletes (199 males, 268 females; 19.5 ± 1.3 y, 173.9 ± 10.5 cm, 71.9 ± 13.6 kg) were recruited from NCAA Division I (n = 299) and Division III (n = 168) institutions. Athletes were included regardless of participation status, which created a diverse sample of current and past injury histories.
Main Outcome Measures:
During a single session, participants completed an injury history form, the Disablement in the Physically Active Scale (DPA), and the Fear-Avoidance Beliefs Questionnaire (FABQ). Dependent variables included DPA-Physical Summary Component (DPA-PSC), DPA-Mental Summary Component (DPA-MSC), and FABQ Scores.
HRQOL differences were detected between groups based on injury history, participation status, and time since last injury. No differences were detected for injury severity. A moderate correlation was identified between the DPA-PSC and FABQ (rs = 0.503, P < .001) and a weak relationship was identified between the DPA-MSC and FABQ (rs = 0.266, P < .001).
Injury negatively influenced HRQOL in athletes with a current injury. While those individuals participating injured reported better HRQOL than the athletes sidelined due to injury, deficits were still present and should be monitored to ensure a complete recovery. Identifying the patient’s perception of impairment will help facilitate evidencebased treatment and rehabilitation strategies that target the physical and psychosocial aspects of health.
Cori Sinnott, Hayley M. White, Jennifer W. Cuchna, and Bonnie L. Van Lunen
Achilles tendinopathy is a painful condition commonly affecting the general and athletic population. It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration. While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors. The treatment for these patients is typically load management and eccentric strengthening of the gastrocnemius–soleus complex. Unfortunately, conservative treatment can lead to surgical intervention in up to 45% of cases. A relatively new phenomenon in the treatment of this condition is the use of autologous blood injections (ABI) and platelet-rich plasma injections (PRPI). This need for a less invasive treatment fostered more investigation into ABI and PRPI to treat these nonresponsive patients. However, the evidence concerning the effectiveness of these treatments in patients with Achilles tendinopathy has not been synthesized.
Focused Clinical Question:
In patients with Achilles tendinopathy, how do variations of ABI and PRPI compared with a placebo and/or eccentric training affect pain and function?
Roger O. Kollock Jr., Bonnie Van Lunen, Jennifer L. Linza, and James A. Onate
Assessment of hip strength can be performed with either isokinetic or isometric testing procedures, but the degree of association between values derived from the alternative testing methods has not been previously documented.
To investigate the relationship between isometric peak torque and isokinetic peak torque at 60°·s-1 for various hip motions.
Eighteen physically active males (N = 9) and females (N = 9) participated (22 ± 3 years, 173.0 ± 10.5 cm, 73.8 ± 16.7 kg).
Three isokinetic repetitions at 60°·s-1 and three isometric contractions of 5 s each for the hip fexors (HFs), hip extensors (HEs), hip abductors (ABs), hip adductors (ADs), hip external rotators (ERs), and hip internal rotators (IRs).
Pearson correlation coefficients and coefficients of determination were calculated for both absolute and allometric-scaled peak torque values.
Meaningful associations between isometric and isokinetic peak torque values were found for each hip motion. Allometric-scaled strength values demonstrated stronger correlations than absolute strength values.
The results suggest that portable fixed isometric testing of hip strength is an alternative to isokinetic testing at 60°·s-1.
Jennifer W. Cuchna, Lauren Welsch, Taylor Meier, Chyrsten L. Regelski, and Bonnie Van Lunen
Are Nordic hamstring exercises more effective than standardized training in reducing hamstring strain injury rates in competitive soccer players over the course of at least one season?
Clinical Bottom Line:
The evidence supports the use of Nordic hamstring exercises to reduce hamstring injury incidence rates over a competitive soccer season. Therefore, progressive Nordic hamstring exercises should be included within some aspect of a practice to prevent the occurrence of hamstring injuries.