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Jaebin Shim, Deanna H. Smith and Bonnie L. Van Lunen

Clinical Scenario:

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?

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Franciele Marques Vanderlei, Isadora Lessa Moreno, Luiz Carlos Marques Vanderlei, Carlos Marcelo Pastre, Luiz Carlos de Abreu and Celso Ferreira

Despite the importance of hydration during exercise, the impact of ingesting water or isotonic solution during and after exercise on the regulation of autonomic modulation is unclear. The study aimed to compare the effect of ingesting water or isotonic solution (Gatorade®, Brazil) on cardiac autonomic modulation in young people after submaximal aerobic exercise. Thirty-one young men were subjected to a protocol consisting of 4 steps: 1) incremental test, 2) control protocol without hydration, 3) protocol with ingestion of water, and 4) protocol with ingestion of isotonic solution. The protocol consisted of 10 min of rest, 90 min of treadmill exercise at 60% VO2peak, and 60 min of recovery at rest. In the hydration protocols, hydration occurred during and after exercise, every 15 min beginning after the 15th minute of exercise, with the amount ingested proportional to body mass lost in the control protocol. Autonomic modulation was evaluated by heart rate variability. The hydration protocols promoted a more efficient recovery of autonomic modulation, and for the exercise performed, regardless of the hydration administered, the effect on autonomic modulation was similar.

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Douglas J. Casa, Samuel N. Cheuvront, Stuart D. Galloway and Susan M. Shirreffs

are high, especially if exercise lasts more than about 2 h. Athletes should not drink so much that they gain weight during exercise. During recovery from exercise, rehydration should include replacement of both water and salts lost in sweat. Sports nutrition, and sports hydration in particular, is a

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Jennifer S. Howard, Carl G. Mattacola, David R. Mullineaux, Robert A. English and Christian Lattermann

Context:

It is well established that autologous chondrocyte implantation (ACI) can require extended recovery postoperatively; however, little information exists to provide clinicians and patients with a timeline for anticipated function during the first year after ACI.

Objective:

To document the recovery of functional performance of activities of daily living after ACI.

Patients:

ACI patients (n = 48, 29 male; 35.1 ± 8.0 y).

Intervention:

All patients completed functional tests (weight-bearing squat, walk-across, sit-to-stand, step-up/over, and forward lunge) using the NeuroCom long force plate (Clackamas, OR) and completed patient-reported outcome measures (International Knee Documentation Committee Subjective Knee Evaluation Form, Lysholm, Western Ontario and McMaster Osteoarthritis Index [WOMAC], and 36-Item Short-Form Health Survey) preoperatively and 3, 6, and 12 mo postoperatively.

Main Outcome Measures:

A covariance pattern model was used to compare performance and self-reported outcome across time and provide a timeline for functional recovery after ACI.

Results:

Participants demonstrated significant improvement in walk-across stride length from baseline (42.0% ± 8.9% height) at 6 (46.8% ± 8.1%) and 12 mo (46.6% ± 7.6%). Weight bearing on the involved limb during squatting at 30°, 60°, and 90° was significantly less at 3 mo than presurgery. Step-up/over time was significantly slower at 3 mo (1.67 ± 0.69 s) than at baseline (1.49 ± 0.33 s), 6 mo (1.51 ± 0.36 s), and 12 mo (1.40 ± 0.26 s). Step-up/over lift-up index was increased from baseline (41.0% ± 11.3% body weight [BW]) at 3 (45.0% ± 11.7% BW), 6 (47.0% ± 11.3% BW), and 12 mo (47.3% ± 11.6% BW). Forward-lunge time was decreased at 3 mo (1.51 ± 0.44 s) compared with baseline (1.39 ± 0.43 s), 6 mo (1.32 ± 0.05 s), and 12 mo (1.27 ± 0.06). Similarly, forward-lunge impact force was decreased at 3 mo (22.2% ± 1.4% BW) compared with baseline (25.4% ± 1.5% BW). The WOMAC demonstrated significant improvements at 3 mo. All patient-reported outcomes were improved from baseline at 6 and 12 mo postsurgery.

Conclusions:

Patients' perceptions of improvements may outpace physical changes in function. Decreased function for at least the first 3 mo after ACI should be anticipated, and improvement in performance of tasks requiring weight-bearing knee flexion, such as squatting, going down stairs, or lunging, may not occur for a year or more after surgery.

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Jennifer Kappenstein, Jaime Fernández-Fernández, Florian Engel and Alexander Ferrauti

The aim of this study was to compare the effect of active (AR) and passive recovery (PR) after a high-intensive repeated sprint running protocol on physiological parameters in children and adults. Blood lactate (La) and blood pH were obtained during two sets of 5 × 5 s all-out sprints and several times during subsequent 30-min recovery in 16 children and 16 adults. End-exercise La was significantly lower and pH significantly higher in children (La: 5.21 ± 2.73 mmol·L1; pH: 7.37 ± 0.06) compared with adults (La: 10.35 ± 5.76 mmol·L−1; pH: 7.27 ± 0.10) (p > .01). La half-life during postexercise recovery was significantly shorter in children (AR: 436 ± 371 s, PR: 830 ± 349 s) than in adults (AR: 733 ± 371 s, PR: 1361 ± 372 s), as well as in active compared with passive recovery for both age groups (p > .01). The age x recovery interaction for La half-life only approached statistical significance (p = .06). The results suggest a faster lactate disappearance and an earlier return to resting pH after a repeated sprint running protocol in children compared with adults and a less pronounced advantage of active recovery in children.

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Neil Gibson, Callum Brownstein, Derek Ball and Craig Twist

Purpose:

To examine the physiological and perceptual responses of youth footballers to a repeated sprint protocol employing standardized and self-selected recovery.

Methods:

Eleven male participants (13.7 ± 1.1 years) performed a repeated sprint assessment comprising 10 × 30 m efforts. Employing a randomized cross-over design, repeated sprints were performed using 30 s and self-selected recovery periods. Heart rate was monitored continuously with ratings of perceived exertion (RPE) and lower body muscle power measured 2 min after the final sprint. The concentration of blood lactate was measured at 2, 5 and 7 min post sprinting. Magnitude of effects were reported using effect size (ES) statistics ± 90% confidence interval and percentage differences. Differences between trials were examined using paired student t tests (p < .05).

Results:

Self-selected recovery resulted in most likely shorter recovery times (57.7%; ES 1.55 ± 0.5; p < .01), a most likely increase in percentage decrement (65%; ES 0.36 ± 0.21; p = .12), very likely lower heart rate recovery (-58.9%; ES -1.10 ± 0.72; p = .05), and likely higher blood lactate concentration (p = .08–0.02). Differences in lower body power and RPE were unclear (p > .05).

Conclusion:

Self-selected recovery periods compromise repeated sprint performance.

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Mary Caitlin Stevenson Wilcoxson, Samantha Louise Johnson, Veronika Pribyslavska, James Mathew Green and Eric Kyle O’Neal

Runners are unlikely to consume fluid during training bouts increasing the importance of recovery rehydration efforts. This study assessed urine specific gravity (USG) responses following runs in the heat with different recovery fluid intake volumes. Thirteen male runners completed 3 evening running sessions resulting in approximately 2,200 ± 300 ml of sweat loss (3.1 ± 0.4% body mass) followed by a standardized dinner and breakfast. Beverage fluid intake (pre/postbreakfast) equaled 1,565/2,093 ml (low; L), 2,065/2,593 ml (moderate; M) and 2,565/3,356 mL (high; H). Voids were collected in separate containers. Increased urine output resulted in no differences (p > .05) in absolute mean fluid retention for waking or first postbreakfast voids. Night void averages excluding the first void postrun (1.025 ± 0.008; 1.013 ± 0.008; 1.006 ± 0.003), first morning (1.024 ± 0.004; 1.015 ± 0.005; 1.014 ± 0.005), and postbreakfast (1.022 ± 0.007; 1.014 ± 0.007; 1.008 ± 0.003) USG were higher (p < .05) for L versus M and H respectively and more clearly differentiated fluid intake volume between L and M than color or thirst sensation. Waking (r = -0.66) and postbreakfast (r = -0.71) USG were both significantly correlated (p < .001) with fluid replacement percentage, but not absolute fluid retention. Fluid intake M was reported as most similar to normal consumption (5.6 ± 1.0 on 0–10 scale) after breakfast and equaled 122 ± 16% of sweat losses. Retention data suggests consumption above this level is not warranted or actually practiced by most runners drinking ad libitum, but that periodic prerun USG assessment may be useful for coaches to detect runners that habitually consume low levels of fluids between training bouts in warm seasons.

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Melissa Skein, Rob Duffield, Geoffrey M. Minett, Alanna Snape and Alistair Murphy

Purpose:

This study examined the effects of overnight sleep deprivation on recovery after competitive rugby league matches.

Methods:

Eleven male amateur rugby league players played 2 competitive matches, followed by either a normal night’s sleep (~8 h; CONT) or a sleep-deprived night (~0 h; SDEP) in a randomized fashion. Testing was conducted the morning of the match, immediately postmatch, 2 h postmatch, and the next morning (16 h postmatch). Measures included countermovement-jump (CMJ) distance, knee-extensor maximal voluntary contraction (MVC) and voluntary activation (VA), venous-blood creatine kinase (CK) and C-reactive protein (CRP), perceived muscle soreness, and a word–color recognition cognitive-function test. Percent change between postmatch and 16-h postmatch was reported to determine the effect of the intervention the next morning.

Results:

Large effects indicated a greater postmatch to 16-h-postmatch percentage decline in CMJ distance after SDEP than in CONT (P = .10–.16, d = 0.95–1.05). Similarly, the percentage decline in incongruent word–color reaction times was increased in SDEP trials (P = .007, d = 1.75). Measures of MVC did not differ between conditions (P = .40–.75, d = 0.13–0.33), although trends for larger percentage decline in VA were detected in SDEP (P = .19, d = 0.84). Furthermore, large effects indicated higher CK and CRP responses 16 h postmatch in SDEP than in CONT (P = .11–.87, d = 0.80–0.88).

Conclusions:

Sleep deprivation negatively affected recovery after a rugby league match, specifically impairing CMJ distance and cognitive function. Practitioners should promote adequate postmatch sleep patterns or adjust training demands the next day to accommodate the altered physical and cognitive state after sleep deprivation.

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Hugh H.K. Fullagar, Andrew Govus, James Hanisch and Andrew Murray

Purpose:

To investigate the recovery time course of customized wellness markers (sleep, soreness, energy, and overall wellness) in response to match play in American Division I-A college football players.

Methods:

A retrospective research design was used. Wellness data were collected and analyzed for 2 American college football seasons. Perceptions of soreness, sleep, energy, and overall wellness were obtained for the day before each game (GD–1) and the days after each game (GD+2, GD+3, and GD+4). Standardized effect-size (ES) analyses ± 90% confidence intervals were used to interpret the magnitude of the mean differences between all time points for the start, middle, and finish of the season, using the following qualitative descriptors: 0–0.19 trivial, 0.2–0.59 small, 0.6–1.19 moderate, 1.2–1.99 large, <2.0 very large.

Results:

Overall wellness showed small ES reductions on GD+2 (d = 0.22 ± 0.09, likely [94.8%]), GD+3 (d = 0.37 ± 0.15, very likely), and GD+4 (d = 0.29 ± 0.12, very likely) compared with GD–1. There were small ES reductions for soreness between GD–1 and GD+2, GD+3, and GD +4 (d = 0.21 ± 0.09, likely, d = 0.29 ± 0.12, very likely, and 0.30 ± 0.12, very likely, respectively). Small ES reductions were also evident between GD–1 and GD+3 (d = 0.21 ± 0.09, likely) for sleep. Feelings of energy showed small ESs on GD+3 (d = 0.27 ± 0.11, very likely) and GD+4 (d = 0.22 ± 0.09, likely) compared with GD–1.

Conclusion:

All wellness markers were likely to very likely worse on GD+3 and GD+4 than on GD–1. These findings show that perceptual wellness takes longer than 4 d to return to pregame levels and thus should be considered when prescribing training and/or recovery.

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Column-editor : Susan Kleiner