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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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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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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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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.

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Andrea Cripps and Scott C. Livingston

Clinical Scenario:

Sport-related concussions are a significant health issue due to the high incidence of concussions sustained each sports season. Current approaches to the evaluation of acutely concussed athletes include the use of balance assessments to identify and monitor underlying postural instability arising from concussion. Balance assessment has been recommended as a primary measurement tool for monitoring recovery and for making return-to-play decisions. Balance impairments have been shown to occur in the initial postconcussion period (ie, 1–10 d). Numerous clinical and laboratory measures have been used in the assessment of balance immediately after concussion, and clinicians are faced with deciding which measures to use.

Focused Clinical Question:

How do clinical or field-based balance-assessment tools compare to laboratory-based balance measures in identifying deficits in postural stability among acutely concussed athletes?

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Sheri J. Brock, Danielle Wadsworth, Shelby Foote and Mary E. Rudisill

Institutions of higher education have a responsibility to prioritize the needs of society and local communities. One essential need prevalent in all communities is to address the rise of obesity and health risks due to lack of participation in physical activity. In the United States, children spend a small percentage of time engaged in physical activity, and engagement decreases further in adolescence and adulthood. Collaborative partnerships between kinesiology faculty at universities and community organizations are one avenue for engaging children in physical activity. Partnerships must be multilevel and community wide to evoke change and have long-term impact and sustainability. Within the context of community-based research, we propose a three-step framework for establishing collaborative partnerships: (1) determining the needs of partners; (2) discussing expertise, services, and philosophy; and (3) providing a quality product. In addition, we outline and illustrate our experiences when collaborating with community partners to promote physical activity.

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Sally A. Perkins and John E. Massie

Objective:

To determine whether patients were satisfied after thermal shrinkage on the capsule of the glenohumeral joint (GHJ).

Design and Setting:

The affected shoulder was assessed preoperatively and 2 months postoperatively. The assessment evaluated pain on activities of daily living (ADLs), physical activity level, satisfaction with shoulder function, and a modified UCLA pain scale.

Subjects:

Eight athletes, 4 men and 4 women, with a mean age of 21 years, participated. Each had sustained a traumatic injury to the GHJ resulting in multidirectional instability.

Measurements:

Subjects were evaluated preoperatively and 2 months postoperatively for GHJ laxity and labral deformity. Goniometric measurements of flexion/extension, abduction/adduction, and internal/external rotation of the GHJ were completed.

Results:

Six of the 8 subjects had reduced pain. Active extension increased significantly in 7. ADLs were all improved. All 8 subjects were satisfied with the thermal-shrinkage procedure.

Conclusions:

Thermal shrinkage of the capsule of the GHJ results in patient satisfaction and reduced pain.

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Szabolcs Lajos Molnár, Péter Hidas, György Kocsis, Gábor Rögler, Péter Balogh, Miklós Farkasházi and Péter Lang

Background:

Upper extremity injuries are common in wrestling, most of which do not require surgery.

Methods:

We retrospectively documented the case histories of six elite wrestlers who sustained elbow injuries that required surgical treatment, three of which involved reinjury and another surgical procedure.

Results:

All but one of the six initial injuries were associated with a defensive maneuver. Reinjury was more common for freestyle wrestling than for Greco-Roman style. The average time between the initial elbow injury and surgical intervention was 22 months. One-half of the wrestlers with elbow injuries that required surgery were reinjured and underwent revision surgery.

Conclusions:

All of the elite wrestlers waited for a long period of time before receiving surgery for the initial injury, and the reinjury rate was high.

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Michael J. Axe, Katherine Linsay and Lynn Snyder-Mackler

The purpose of this study was to determine whether there was a relationship between knee hyperextension and intra-articular pathology in 100 consecutive patients whose sole ligament injury was an arthroscopically confirmed anterior cruciate ligament (ACL) rupture. Hyperextension of both knees was measured using a supine heel-height measurement of high reliability. There was more articular damage to the total joint, lateral joint, and lateral meniscus in patients who hyperextended than in those who did not. There was more articular damage to the total joint and medial joint in patients who were chronically ACL deficient than in those who were acutely or subacutely ACL deficient. The results demonstrate that individuals with ACL injuries whose knees hyperextend 3 cm or more sustain significantly more joint damage at the time of injury than in those whose knees hyperextend less than 3 cm. This study further defines the role of knee hyperextension in ACL injuries and offers a useful and reliable means of measuring knee hyperextension.

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Lynda Mainwaring and Max Trenerry

This current special issue of the Journal of Clinical Sport Psychology was conceived and developed to provide a resource for clinicians who have contact with athletes who are at risk for or have sustained a concussion during sport participation. The special issue is part of an exciting two-issue series. This first installment contains papers from leaders in the field of sport concussion who review the frequency and mechanisms of concussion, models for managing concussion, the emotional aspects of concussion in sport, practical examples from a model sport concussion clinic, and the importance of sport concussion education and prevention. As Guest Editors, we hope that this timely and unique special series will be used by clinicians who help care for athletes and their families who have experienced concussion in their sport life.