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John Henderson, Brian C. Lyons, W. Steven Tucker and Ben Davidson

The purpose of this study was to examine the effects of cloth wrap (CW) and ankle tape (TAP) techniques on vertical jump performance in 29 Division I football players. There was a significant reduction in vertical jump performance for both the TAP (76.2 ± 1.3 cm; t28= 6.5, p < .0005) and CW (77.3 ± 1.3 cm; t28= 3.9, p = .001) conditions as compared with the control (78.4 ± 1.3 cm). The TAP group also had reduced vertical jump scores as compared with the CW group (t28= 4.9, p < .0005). Both prophylactic techniques resulted in decreased vertical jump capability with the TAP having a greater negative impact than the CW.

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Jeremy R. Hawkins and Shawn W. Hawkins

Cryotherapy is commonly used by athletic trainers, although evidence is inconsistent to support its usage. Data are also lacking as to how athletic trainers treat common injuries with cryotherapy. The purpose of this study was to ascertain how collegiate athletic trainers approach the use of cryotherapy and whether that usage reflects what little we know about the modalities. Survey results indicated great variability in respondents’ approaches to the treatment of an acute and subacute ankle sprain. Additional data are needed to create clear treatment guidelines with respect to cryotherapy. Certain aspects of the application of cryotherapy should be reviewed and use adjusted accordingly.

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Jeremy R. Hawkins and Shawn W. Hawkins

Thermotherapy is commonly used by athletic trainers. Data are lacking as to how athletic trainers treat common injuries with thermotherapy. The purpose of this study was to ascertain how collegiate athletic trainers approach the use of thermotherapy and whether that usage reflects what current knowledge we have of thermotherapy. Survey results indicated respondents took three different approaches to the treatment of three different types of injuries. The majority of their approaches were applied according to current knowledge. Treatment guidelines could be strengthened with additional clinical outcomes data. Certain aspects of the application of the different thermotherapies should be reviewed and use adjusted accordingly.

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Janice K. Loudon and Marcie Swift

Clinical Question:

Is there evidence to suggest that runners with a history of ITBS demonstrate altered lower extremity kinematics compared with runners without a history of ITBS?

Clinical Bottom Line:

There is moderate evidence suggesting that hip kinematics differ between runners with a history of ITBS compared with healthy runners. Results are contradictory related to the plane of movement and direction of the kinematic change. In addition, assessing hip kinematics following an exhaustive run may be beneficial to detect change.

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Kaitlyn J. Weiss, Sian V. Allen, Mike R. McGuigan and Chris S. Whatman

Purpose:

To establish the relationship between the acute:chronic workload ratio and lower-extremity overuse injuries in professional basketball players over the course of a competitive season.

Methods:

The acute:chronic workload ratio was determined by calculating the sum of the current week’s session rating of perceived exertion of training load (acute load) and dividing it by the average weekly training load over the previous 4 wk (chronic load). All injuries were recorded weekly using a self-report injury questionnaire (Oslo Sports Trauma Research Center Injury Questionnaire20). Workload ratios were modeled against injury data using a logistic-regression model with unique intercepts for each player.

Results:

Substantially fewer team members were injured after workload ratios of 1 to 1.49 (36%) than with very low (≤0.5; 54%), low (0.5–0.99; 51%), or high (≥1.5; 59%) workload ratios. The regression model provided unique workload–injury trends for each player, but all mean differences in likelihood of being injured between workload ratios were unclear.

Conclusions:

Maintaining workload ratios of 1 to 1.5 may be optimal for athlete preparation in professional basketball. An individualized approach to modeling and monitoring the training load–injury relationship, along with a symptom-based injury-surveillance method, should help coaches and performance staff with individualized training-load planning and prescription and with developing athlete-specific recovery and rehabilitation strategies.

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Harold King, Stephen Campbell, Makenzie Herzog, David Popoli, Andrew Reisner and John Polikandriotis

Background:

More than 1 million US high school students play football. Our objective was to compare the high school football injury profiles by school enrollment size during the 2013–2014 season.

Methods:

Injury data were prospectively gathered on 1806 student athletes while participating in football practice or games by certified athletic trainers as standard of care for 20 high schools in the Atlanta Metropolitan area divided into small (<1600 students enrolled) or large (≥1600 students enrolled) over the 2013–2014 football season.

Results:

Smaller schools had a higher overall injury rate (79.9 injuries per 10,000 athletic exposures vs. 46.4 injuries per 10,000 athletic exposures; P < .001). In addition, smaller schools have a higher frequency of shoulder and elbow injuries (14.3% vs. 10.3%; P = .009 and 3.5% vs. 1.5%; P = .006, respectively) while larger schools have more hip/upper leg injuries (13.3% vs. 9.9%; P = .021). Lastly, smaller schools had a higher concussion distribution for offensive lineman (30.6% vs. 13.4%; P = .006) and a lower rate for defensive backs/safeties (9.2% vs. 25.4%; P = .008).

Conclusions:

This study is the first to compare and show unique injury profiles for different high school sizes. An understanding of school specific injury patterns can help drive targeted preventative measures.

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Sonia DelBusso and Michael Matheny

The following case presents an 18-year-old male collegiate soccer player 11 months after initial injury, who was previously diagnosed with and treated for a navicular stress fracture. Unlike most patients who are treated conservatively, he presented with lingering symptoms that had not resolved after the standard course of treatment. After 11 months, the athlete then underwent further testing to reveal a navicular stress fracture with nonunion due to avascular necrosis. Open reduction internal fixation was performed 17 months after the initial injury to stabilize the midfoot. This case presents many unique components, including the presentation of the injury, the unsuccessful course of initial treatment, and the complications that arose from it.

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Matt Greig, Hannah Emmerson and John McCreadie

Context: Contemporary developments in Global Positioning System (GPS) technology present a means of quantifying mechanical loading in a clinical environment with high ecological validity. However, applications to date have typically focused on performance rather than rehabilitation. Objective: To examine the efficacy of GPS microtechnology in quantifying the progression of loading during functional rehabilitation from ankle sprain injury, given the prevalence of reinjury and need for quantifiable monitoring. Furthermore, to examine the influence of unit placement on the clinical interpretation of loading during specific functional rehabilitation drills. Design: Repeated measures. Setting: University athletic facilities. Participants: Twenty-two female intermittent team sports players. Intervention: All players completed a battery of 5 drills (anterior hop, inversion hop, eversion hop, diagonal hop, and diagonal hurdle hop) designed to reflect the mechanism of ankle sprain injury, and progress functional challenge and loading. Main Outcome Measures: GPS-mounted accelerometers quantified uniaxial PlayerLoad for each drill, with units placed at C7 and the tibia. Main effects for drill type and GPS location were investigated. Results: There was a significant main effect for drill type (P < .001) in the mediolateral (η 2 = .436), anteroposterior (η 2 = .480), and vertical planes (η 2 = .516). The diagonal hurdle hop elicited significantly greater load than all other drills, highlighting a nonlinear progression of load. Only the mediolateral load showed evidence of progressive increase in loading. PlayerLoad was significantly greater at the tibia than at C7 for all drills, and in all planes (P < .001, η 2 ≥ .662). Furthermore, the tibia placement was more sensitive to between-drill changes in mediolateral load than the C7 placement. Conclusions: The placement of the GPS unit is imperative to clinical interpretation, with both magnitude and sensitivity influenced by the unit location. GPS does provide efficacy in quantifying multiplanar loading during (p)rehabilitation, in a field or clinical setting, with potential in extending GPS analyses (beyond performance metrics) to functional injury rehabilitation and prevention.

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Sara J. Golec and Alison R. Valier

Clinical Scenario: Health care clinicians are encouraged to practice according to the best available evidence for the purpose of improving patient outcomes. Clinical practice guidelines are one form of evidence that has been developed to enhance the care that patients receive for particular conditions. Low back pain is a common condition in rehabilitation medicine that places a significant financial burden on the healthcare system. Patients with low back pain often suffer great pain and disability that can last a long time, making effective and efficient care a priority. Several guidelines for the treatment of low back pain have been created; however, there is no consensus on whether following these guidelines will positively reduce the pain and disability experienced by patients. Clinical Question: Does adherence to clinical practice guidelines for patients with nonspecific low back pain reduce pain and disability? Summary of Key Findings: A total of 4 studies of level 3 or higher were found. Four studies noted an improvement in disability following guidelines adherent care. Two studies reported greater reduction in pain with guideline adherent care and 2 did not.  Clinical Bottom Line: Moderate evidence exists to support adherence to clinical practice guidelines to improve pain and disability ratings in patients with nonspecific low back pain.

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Johanna M. Hoch, Cori W. Sinnott, Kendall P. Robinson, William O. Perkins and Jonathan W. Hartman

Context: There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. Objective: To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Design: Case control. Setting: Laboratory. Participants: A total of 20 post-ACLR and 40 healthy control participants. Main Outcome Measures: The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. Results: There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Conclusions: Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.