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Jessica R. Edler, Kenneth E. Games, Lindsey E. Eberman and Leamor Kahanov

The tibial plateau is a critical load-bearing surface in humans. Although tibial plateau fractures represent only 1% of all fractures, proper management by all members of the health care team, including athletic trainers, physicians, and physical therapists, is required for successful patient outcomes. A 14-year-old national-level competitive female diver injured her right knee during the precompetition warm-up period. Upon evaluation by an athletic trainer, the patient was referred for imaging and examination by a physician. She was seen by an orthopedic surgeon for consultation. The patient elected for a surgical repair of the tibial plateau fracture. Following surgery she underwent an 11-week comprehensive therapeutic exercise program with athletic trainers and physical therapists. The patient’s return-to-play progression included dry land activities, platform diving, 1-m springboard diving, and 3-m springboard diving. The patient has successfully returned to competitive diving. Proper identification of tibial fractures can be difficult considering their low occurrence in youth and their similar clinical presentation to more common youth injuries such as anterior cruciate ligament ruptures. Clinicians providing immediate on-site medical care should be thorough in their clinical exam including palpation and axial loading of the joint.

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Bradford Strand, Shannon David, Katie J. Lyman and Jay M. Albrecht

The purpose of this original research was to survey high school coaches in four states in the Midwest region of the United States regarding their knowledge of first aid, cardiopulmonary resuscitation (CPR), and use of an Automated External Defibrillator (AED) as well as confidence in managing/treating emergency situations. Responses to general knowledge inquiries revealed that coaches were able to accurately answer questions related to return to play, level of consciousness, external bleeding, and cardiac arrest. However, coaches were unable to correctly answer questions specific to rest, ice, compression, and elevation (RICE) and also misidentified information related to pediatric AED use. Because sudden cardiac death is the leading cause of death and has been linked to lack of bystander intervention, the results of this project should be considered by coaches and administrators to implement certification and continuing education for high school coaches. Finally, coaches who were certified in first aid, CPR, and AED were more confident in treating an individual who required care compared with coaches not certified. Therefore, individuals who coach at all levels of sport and recreational activities should consider formal training and certification.

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Martin Buchheit and Ben Michael Simpson

With the ongoing development of microtechnology, player tracking has become one of the most important components of load monitoring in team sports. The 3 main objectives of player tracking are better understanding of practice (provide an objective, a posteriori evaluation of external load and locomotor demands of any given session or match), optimization of training-load patterns at the team level, and decision making on individual players’ training programs to improve performance and prevent injuries (eg, top-up training vs unloading sequences, return to play progression). This paper discusses the basics of a simple tracking approach and the need to integrate multiple systems. The limitations of some of the most used variables in the field (including metabolic-power measures) are debated, and innovative and potentially new powerful variables are presented. The foundations of a successful player-monitoring system are probably laid on the pitch first, in the way practitioners collect their own tracking data, given the limitations of each variable, and how they report and use all this information, rather than in the technology and the variables per se. Overall, the decision to use any tracking technology or new variable should always be considered with a cost/benefit approach (ie, cost, ease of use, portability, manpower/ability to affect the training program).

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Frank C. Mendel, Michael G. Dolan, Dale R. Fish, John Marzo and Gregory E. Wilding

Context:

High-voltage pulsed current (HVPC), a form of electrical stimulation, is known to curb edema formation in laboratory animals and is commonly applied for ankle sprains, but the clinical effects remain undocumented.

Objective:

To determine whether, as an adjunct to routine acute and subacute care, subsensory HVPC applied nearly continuously for the first 72 h after lateral ankle sprains affected time lost to injury.

Design:

Multicenter, randomized, double-blind, placebo-controlled trial.

Setting:

Data were collected at 9 colleges and universities and 1 professional training site.

Participants:

50 intercollegiate and professional athletes.

Interventions:

Near-continuous live or placebo HVPC for 72 h postinjury in addition to routine acute and subacute care.

Main Outcome Measure:

Time lost to injury measured from time of injury until declared fit to play.

Results:

Overall, time lost to injury was not different between treated and control groups (P = .55). However, grade of injury was a significant factor. Time lost to injury after grade I lateral ankle sprains was greater for athletes receiving live HVPC than for those receiving placebo HVPC (P = .049), but no differences were found between groups for grade II sprains (P = .079).

Conclusions:

Application of subsensory HVPC had no clinically meaningful effect on return to play after lateral ankle sprain.

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Tamara C. Valovich McLeod and Johna K. Register-Mihalik

Patient Scenario:

An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life.

Clinical Outcomes Assessment:

Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms.

Clinical Decision Making:

The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete’s symptoms.

Clinical Bottom Line:

Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management.

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Michelle Cleary, Daniel Ruiz, Lindsey Eberman, Israel Mitchell and Helen Binkley

Objective:

We present a case of severe dehydration, muscle cramping, and rhabdomyolysis in a high school football player followed by a suggested program for gradual return to play.

Background:

A 16-year-old male football player (body mass = 69.1 kg, height = 175.3 cm) reported to the ATC after the morning session on the second day of two-a-days complaining of severe muscle cramping.

Differential Diagnosis:

The initial assessment included severe dehydration and exercise-induced muscle cramps. The differential diagnosis was severe dehydration, exertional rhabdomyolysis, or myositis. CK testing revealed elevated levels indicating mild rhabdomyolysis.

Treatment:

The emergency department administered 8 L of intravenous (IV) fluid within the 48-hr hospitalization period, followed by gradual return to activity.

Uniqueness:

To our knowledge, no reports of exertional rhabdomyolysis in an adolescent football player exist. In this case, a high school quarterback with a previous history of heat-related cramping succumbed to severe dehydration and exertional rhabdomyolysis during noncontact preseason practice. We provide suggestions for return to activity following exertional rhabdomyolysis.

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Eric Emmanuel Coris, Stephen Walz, Jeff Konin and Michele Pescasio

Context:

Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.

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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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Ian W. Ford and Sandy Gordon

A two-part study was used to survey sport trainers and athletic therapists on both the frequency and significance of emotions and behaviors displayed by athletes during treatment and the importance of psychological techniques in injury management. A questionnaire, developed from a preliminary study with experienced sport trainers (Part 1), was mailed to sport trainers in Australia and New Zealand and athletic therapists in Canada(Part 2). Responses from Australian (n = 53), New Zealand (n = 11), and Canadian (n = 32) participants suggested that (a) wanting to return to play too soon, anxiety and frustration, noncompliance, and denial were experienced frequently by injured athletes during rehabilitation and significantly hindered effective recovery; (b) psychological skills training and learning to deal with psychological responses to injury would facilitate more effective treatment; and (c) athletes' self-presentation styles influence the support and attention received from trainers/therapists. Findings suggest that the applied sport psychology content of professional training programs for sport trainers and athletic therapists should be extended.

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Jonathon R. Staples, Kevin A. Schafer, Matthew V. Smith, John Motley, Mark Halstead, Andrew Blackman, Amanda Haas, Karen Steger-May, Matthew J. Matava, Rick W. Wright and Robert H. Brophy

Context: Patients with anterior cruciate ligament (ACL) tears are likely to have deficient dynamic postural stability compared with healthy sex- and age-matched controls. Objectives: To test the hypothesis that patients undergoing ACL reconstruction have decreased dynamic postural stability compared with matched healthy controls. Design: Prospective case-control study. Setting: Orthopedic sports medicine and physical therapy clinics. Patients or Other Participants: Patients aged 20 years and younger with an ACL tear scheduled for reconstruction were enrolled prospectively. Controls were recruited from local high schools and colleges via flyers. Interventions: Patients underwent double-stance dynamic postural stability testing prior to surgery, recording time to failure and dynamic motion analysis (DMA) scores. Patients were then matched with healthy controls. Main Outcome Measures: Demographics, time to failure, and DMA scores were compared between groups. Results: A total of 19 females and 12 males with ACL tears were matched with controls. Individuals with ACL tears were more active (Marx activity score: 15.7 [1.0] vs 10.8 [4.9], P < .001); had shorter times until test failure (84.4 [15.8] vs 99.5 [14.5] s, P < .001); and had higher (worse) DMA scores (627 [147] vs 481 [132], P < .001), indicating less dynamic postural stability. Six patients with ACL deficiency (1 male and 5 females) demonstrated lower (better) DMA scores than their controls, and another 7 (4 males and 3 females) were within 20% of controls. Conclusions: Patients undergoing ACL reconstruction had worse global dynamic postural stability compared with well-matched controls. This may represent the effect of the ACL injury or preexisting deficits that contributed to the injury itself. These differences should be studied further to evaluate their relevance to ACL injury risk, rehabilitation, and return to play.