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Kevin R. Heinsimer, Nicolas G. Nelson, Kristin J. Roberts and Lara B. McKenzie

Background:

The objective was to describe the patterns and mechanisms of water tubing–related injuries treated in U.S. emergency departments.

Methods:

The National Electronic Injury Surveillance System was used to examine cases of water tubing–related injuries. Sample weights were used to calculate national estimates of water tubing–related injuries. Analyses were conducted in 2010.

Results:

From 1991−2009 an estimated 69,471 injuries were treated in US emergency departments for water tubing–related injuries. The annual number of cases increased 250% over the 19-year study period (P < .001). Sprains and strains accounted for the largest portion of injuries (27.2%). The head was the most frequently injured body part (27.5%). Children and adolescents ≤ 19 years were more likely to be injured by contact with another person (OR: 2.47; 95% CI = 1.61−3.80) and were more likely to sustain injuries to the head (OR: 2.61; 95% CI = 2.01−3.38) compared with adults. Adults ≥ 20 years, were more likely than individuals ≤ 19 years to sustain sprains and strains (OR: 2.11; 95% CI = 1.64−2.71) and were most commonly injured by impact with the water (54.6%).

Conclusions:

Patterns of water tubing–related injuries differ for children and adults. Research is needed to determine how best to reduce these injuries.

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Brandon M. Ness, Kory Zimney and William E. Schweinle

Context:

Injury risk factors and relevant assessments have been identified in women’s soccer athletes. Other tests assess fitness (eg, the Gauntlet Test [GT]). However, little empirical support exists for the utility of the GT to predict time loss injury.

Objectives:

To examine the GT as a predictor of injury in intercollegiate Division I female soccer athletes.

Design:

Retrospective, nonexperimental descriptive cohort study.

Setting:

College athletic facilities.

Participants:

71 female Division I soccer athletes (age 19.6 ± 1.24 y, BMI 23.0 ± 2.19).

Main Outcome Measures:

GT, demographic, and injury data were collected over 3 consecutive seasons. GT trials were administered by coaching staff each preseason. Participation in team-based activities (practices, matches) was restricted until a successful GT trial. Soccer-related injuries that resulted in time loss from participation were recorded.

Results:

71 subjects met the inclusion criteria, with 12 lower body time loss injuries sustained. Logistic regression models indicated that with each unsuccessful GT attempt, the odds of sustaining an injury increased by a factor of 3.5 (P < .02). The Youden index was 2 GT trials for success, at which sensitivity = .92 and specificity = .46. For successive GT trials before success (1, 2, or 3), the predicted probabilities for injury were .063, .194, and .463, respectively.

Conclusions:

The GT appears to be a convenient and predictive screen for potential lowerbody injuries among female soccer athletes in this cohort. Further investigation into the appropriate application of the GT for injury prediction is warranted given the scope of this study.

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Jeffrey Liew, Ping Xiang, Audrea Y. Johnson and Oi-Man Kwok

Background:

Schools often include running in their physical education and health curriculum to increase physical activity and reduce childhood overweight. But having students run around may not be enough to sustain physical activity habits if motivational factors are not well understood. This study examined effortful persistence as a predictor of running.

Methods:

Participants were 246 5th graders, and data on their demographic information, body mass index (BMI), effortful persistence, and time to complete a 1-mile run were collected across 4 years.

Results:

Between 5th to 8th grades, effortful persistence predicted time to complete a 1-mile run even when BMI was taken into account at every grade except for 7th grade. Rank-order stability was found in major variables across-time, but no across-time prediction was found for effortful persistence on a 1-mile run.

Conclusions:

Lack of longitudinal predictions bodes well for interventions aimed at increasing physical activity, because children or youth with high BMIs or low effortful persistence are not destined for future underachievement on physically challenging activities. Given the stability of variables, interventions that target fostering self-regulatory efficacy or effortful persistence may be particularly important for getting children on trajectories toward healthy and sustained levels of physical activity.

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Ellen Yard and Dawn Comstock

Background:

There are over 7 million US high school athletes and one-third are overweight or obese. Our objective was to examine injury patterns by body mass index (BMI) in high school athletes.

Methods:

Certified athletic trainers (ATCs) at 100 nationally representative US high schools submitted exposure and injury information during the 2005 to 08 school years via High School RIO (Reporting Information Online). We retrospectively categorized injured athletes as underweight (≤15th percentile), normal weight (15th−85th percentile), overweight (85th−95th percentile), or obese (≥95th percentile).

Results:

ATCs reported 13,881 injuries during 5,627,921 athlete-exposures (2.47 injuries per 1000 athlete-exposures). Nearly two-thirds (61.4%) of injured high school athletes were normal weight. The prevalence of overweight and obesity was highest among injured football athletes (54.4%). Compared with normal weight athletes, obese athletes sustained a larger proportion of knee injuries (Injury Proportion Ratio [IPR] = 1.27, 95% CI: 1.14 to 1.42) and their injuries were more likely to have resulted from contact with another person (IPR = 1.31, 95% CI: 1.26 to 1.37). Compared with normal weight athletes, underweight athletes sustained a larger proportion of fractures (IPR = 1.45, 95% CI: 1.10 to 1.92) and a larger proportion of injuries resulting from illegal activity (IPR = 1.59, 95% CI: 1.03 to 2.46).

Conclusions:

Injury patterns differ by BMI. BMI-targeted preventive interventions should be developed to help decrease sports injury rates.

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Raymond Chronister, George C. Balazs, Adam Pickett, John-Paul H. Rue and David J. Keblish

Context:

Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.

Objective:

To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.

Design:

Case series and review of the literature.

Setting:

Division I NCAA institution.

Patients:

Two collegiate athletes who sustained first-time acute lateral patellar dislocations.

Interventions:

Traditional standard of care for acute lateral patellar dislocation after reduction involves 1–7 weeks of immobilization in full extension. Knee stiffness commonly results from this method, and return to full activity typically takes 2–4 months. We used a protocol involving immobilization in maximal flexion for 24 hr, with early aggressive range of motion and quadriceps strengthening in the first week after injury.

Main Outcome Measures:

Time to return to play.

Results:

Immediate on-site reduction of the patella followed by 24 hr of immobilization in maximal knee flexion was performed. Following an accelerated rehabilitation regimen, patients were able to return to sport an average of 3 days postinjury. Neither patient has experienced a recurrent dislocation.

Conclusions:

Our protocol is based on anatomic studies demonstrating reduced tension on the medial patellofemoral ligament, reduced hemarthrosis, and reduced soft tissue swelling in maximal knee flexion. This method apparently bypasses the knee stiffness and deconditioning commonly seen with traditional nonoperative regimens, allowing return to sport weeks or months sooner.

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Brigid Byrd, Tamara Hew-Butler and Jeffrey J. Martin

The purpose of the study was to assess changes in multidimensional physical self-concept (PSC) over time of novice obese female runners participating in a 10-week running intervention. Multidimensional Physical Self-Concept was assessed at pre- and postintervention times and 3 months postintervention. A repeated measures MANOVA was significant, F (2, 7) = 8.82, p < .05. Follow-up tests indicated that 4 of the 9 PSCs significantly changed from Time 1 to Time 2 (p < .05) in the expected directions for physical activity (t = -2.45; h2 = 1.0), body fat (t = Ò3.21; h2 = 0.78), endurance (t = -3.75; h2 = 0.90), and general physical (t = -2.36; h2 = 0.99) self-concepts and these positive changes were maintained 3 months later at Time 3. We found that a 10-week running program appeared to produce positive changes in physical self-concept. Importantly, these positive changes were sustained for 3 months past the end of the intervention. These findings suggest that women running programs may be a viable way to increase physical self-concept, and sustain such positive changes in months following.

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Xiaoya Ma, Kaitlyn J. Patterson, Kayla M. Gieschen and Peter F. Bodary

The prevalence of iron deficiency tends to be higher in athletic populations, especially among endurancetrained females. Recent studies have provided evidence that the iron-regulating hormone hepcidin is transiently increased with acute exercise and suggest that this may contribute to iron deficiency anemia in athletes. The purpose of this study was to determine whether resting serum hepcidin is significantly elevated in highly trained female distance runners compared with a low exercise control group. Due to the importance of the monocyte in the process of iron recycling, monocyte expression of hepcidin was also measured. A single fasted blood sample was collected midseason from twenty female distance runners averaging 81.9 ± 14.2 km of running per week. Ten age-, gender-, and BMI-matched low-exercise control subjects provided samples during the same period using identical collection procedures. There was no difference between the runners (RUN) and control subjects (CON) for serum hepcidin levels (p = .159). In addition, monocyte hepcidin gene expression was not different between the two groups (p = .635). Furthermore, no relationship between weekly training volume and serum hepcidin concentration was evident among the trained runners. The results suggest that hepcidin is not chronically elevated with sustained training in competitive collegiate runners. This is an important finding because the current clinical conditions that link hepcidin to anemia include a sustained elevation in serum hepcidin. Nevertheless, additional studies are needed to determine the clinical relevance of the well-documented, transient rise in hepcidin that follows acute sessions of exercise.

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Marcus A. Badgeley, Natalie M. McIlvain, Ellen E. Yard, Sarah K. Fields and R. Dawn Comstock

Background:

With more than 1.1 million high school athletes playing annually during the 2005−06 to 2009−10 academic years, football is the most popular boys’ sport in the United States.

Methods:

Using an internet-based data collection tool, RIO, certified athletic trainers (ATs) from 100 nationally representative US high schools reported athletic exposure and football injury data during the 2005−06 to 2009−10 academic years.

Results:

Participating ATs reported 10,100 football injuries corresponding to an estimated 2,739,187 football-related injuries nationally. The injury rate was 4.08 per 1000 athlete-exposures (AEs) overall. Offensive lineman collectively (center, offensive guard, offensive tackle) sustained 18.3% of all injuries. Running backs (16.3%) sustained more injuries than any other position followed by linebackers (14.9%) and wide receivers (11.9%). The leading mechanism of injury was player-player contact (64.0%) followed by player-surface contact (13.4%). More specifically, injury occurred most commonly when players were being tackled (24.4%) and tackling (21.8%).

Conclusions:

Patterns of football injuries vary by position. Identifying such differences is important to drive development of evidence-based, targeted injury prevention efforts.

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Scott J. Montain, Samuel N. Cheuvront and Henry C. Lukaski

Context:

Uncertainty exists regarding the effect of sustained sweating on sweat mineral-element composition.

Purpose:

To determine the effect of multiple hours of exercise-heat stress on sweat mineral concentrations.

Methods:

Seven heat-acclimated subjects (6 males, 1 female) completed 5 × 60 min of treadmill exercise (1.56 m/s, 2% grade) with 20 min rest between exercise periods in 2 weather conditions (27 °C, 40% relative humidity, 1 m/s and 35 °C, 30%, 1 m/s). Sweat was collected from a sweat-collection pouch attached to the upper back during exercise bouts 1, 3, and 5. Mineral elements were determined by using inductively coupled plasma-emission spectrography.

Results:

At 27 °C, sweat sodium (863 [563] µg/mL; mean [SD]), potassium (222 [48] µg/mL), calcium (16 [7]) µg/mL), magnesium (1265 [566] ng/mL), and copper (80 [56] ng/mL) remained similar to baseline over 7 h of exercise-heat stress, whereas sweat zinc declined 42–45% after the initial hour of exercise-heat stress (Ex1 = 655 [362], Ex3 = 382 [168], Ex5 = 355 [288] µg/mL, P < 0.05). Similar outcomes were observed for sweat zinc at 35 °C when sweat rates were higher. Sweat rate had no effect on sweat trace-element composition.

Conclusions:

Sweat sodium, potassium, and calcium losses during multiple hours of sustained sweating can be predicted from initial sweat composition. Estimates of sweat zinc losses, however, will be overestimated if sweat zinc conservation is not accounted for in sweat zinc-loss estimates.

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Ralph Beneke, Renate M. Leithäuser and Oliver Ochentel

A link between lactate and muscular exercise was seen already more than 200 years ago. The blood lactate concentration (BLC) is sensitive to changes in exercise intensity and duration. Multiple BLC threshold concepts define different points on the BLC power curve during various tests with increasing power (INCP). The INCP test results are affected by the increase in power over time. The maximal lactate steady state (MLSS) is measured during a series of prolonged constant power (CP) tests. It detects the highest aerobic power without metabolic energy from continuing net lactate production, which is usually sustainable for 30 to 60 min. BLC threshold and MLSS power are highly correlated with the maximum aerobic power and athletic endurance performance. The idea that training at threshold intensity is particularly effective has no evidence. Three BLC-orientated intensity domains have been established: (1) training up to an intensity at which the BLC clearly exceeds resting BLC, light- and moderate-intensity training focusing on active regeneration or high-volume endurance training (Intensity < Threshold); (2) heavy endurance training at work rates up to MLSS intensity (Threshold ≤ Intensity ≤ MLSS); and (3) severe exercise intensity training between MLSS and maximum oxygen uptake intensity mostly organized as interval and tempo work (Intensity > MLSS). High-performance endurance athletes combining very high training volume with high aerobic power dedicate 70 to 90% of their training to intensity domain 1 (Intensity < Threshold) in order to keep glycogen homeostasis within sustainable limits.