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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.

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Jill Alexander and David Rhodes

Context: The effect of local cooling on muscle strength presents conflicting debates, with literature undecided as to the potential implications for injury, when returning to play following cryotherapy application. Objective: To investigate concentric muscle strength following local cooling over the anterior thigh compared with the knee joint in males and females and the temporal pattern over a 30-minute rewarming period. Design: Repeated-measures crossover design. Method: Twelve healthy participants randomly assigned to receive cooling intervention on one location, directly over either the anterior thigh or the knee, returning 1 week later to receive the cooling intervention on opposite location. Muscle strength measured via an isokinetic dynamometer at multiple time points (immediately post, 10-, 20-, and 30-min post) coincided with measurement of skin surface temperature (T sk) using a noninvasive infrared camera. Results: Significant main effects for time (P ≤ .001, η 2 = .126) with preice application higher than all other time points (P ≤ .05) were demonstrated for both peak torque and average torque. There were also significant main effects for isokinetic testing speed, sex of the participant, and position of the ice application for both peak torque and average torque (P ≤ .05). Statistically significant decreases in T sk were reported in both gender groups across all time points compared with preintervention T sk for the anterior thigh and knee (P < .05). Conclusions: Reductions reported for concentric peak torque and average torque knee-extensor strength in males and females did not fully recover to baseline measures at 30-minute postcryotherapy interventions. Sports medicine practitioners should consider strength deficits of the quadriceps after wetted ice applications, regardless of cooling location (joint/muscle) or gender.

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Thomas Koesterer, Aaron Blanchard and Patrick Donnelly


To present a unique case of meralgia paresthetica.


A 21-year-old male collegiate lacrosse player fell, twisted his right leg, and felt a “pop” in his hip. Objective fndings included: antalgic gait, mild palpable swelling, and tenderness to touch with limited range of motion due to pain. Joint stability tests were negative.

Differential Diagnosis:

Right hip abductor strain, hip sprain, trochanteric bursitis, or labral tear.


The physician’s findings included deep hip pain that increased with hip scouring and pain with active and passive motion. The physician’s diagnosis was hip sprain; treatment was to continue with ice and begin active progression for return to play. The athlete was treated over the next several days with warm whirlpools, stretching, and a hip fexor wrap. Ten days postinjury, the athlete played in a game, but in the fourth quarter came off the field stating he couldn’t feel his thigh. The orthopedic physician evaluated the athlete and provided a differential diagnosis of right hip fexor strain and hip capsule sprain with numbness, possibly due to meralgia paresthetica. The physician ordered treatment to continue and began a regimen of 600 mg of ibuprofen three times per day and noted the athlete could continue to play.


The athlete did not show any symptoms of meralgia paresthetica for 10 days post initial injury. The meralgia paresthetica was most likely caused by swelling resulting from the hip sprain, in which the swelling compressed the lateral femoral cutaneous nerve (LFCN) against the inguinal ligament.


Meralgia paresthetica may occur as a result of trauma and subsequent swelling of the inguinal region. A thorough evaluation of the hip must be conducted to ensure no motor neuron involvement is associated with the paresthesia symptoms.

Open access

Mark Stanbrough

Coaches play an extremely valuable role in a profession that offers the opportunity to help develop young people. The purpose of this study, which assessed the state of coaching education, was two-fold: 1) to determine coaching education knowledge and skills in meeting the National Coaching Standards, and 2) to determine the application of effective coaching principles in meeting the National Coaching Standards. An email containing a website link for an online survey was sent to all athletic directors in Kansas middle and high schools asking them to forward the website link to all coaches they worked with. A total of 1,414 surveys were returned. The current state of coaching education assessment listed the national coaching standards developed by NASPE and used a Likert scale to ask how prepared and successful the coaches are in meeting the standard. Results of the survey indicated that coaches feel highly prepared and successful in the following coaching standard topics: teaching positive behavior (Standard 2), demonstrating ethical conduct (Standard 4), environmental conditions (Standard 7), positive learning environments (Standard 19), and skills of the sport (standard 27). Coaches indicated that they felt least prepared and least successful in the following standards: coordinated health care program (Standard 10), psychological implications (Standard 11), conditioning based on exercise physiology (Standard 12), teaching proper nutrition (Standard 13), conditioning to return to play after injury (Standard 15), mental skill training (Standard 24), managing human resources (Standard 32), managing fiscal resources (Standard 33) and emergency action plans (Standard 34). Findings from the study can be used to direct coaching education in the areas coaches feel they are less prepared and less successful.

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Megan D. Granquist, Leslie Podlog, Joanna R. Engel and Aubrey Newland


Adherence to sport-injury rehabilitation protocols may be pivotal in ensuring successful rehabilitation and return-to-play outcomes.


To investigate athletic trainers' perspectives related to the degree to which rehabilitation adherence is an issue in collegiate athletic training settings, gain insight from certified athletic trainers regarding the factors contributing to rehabilitation nonadherence (underadherence and overadherence), and ascertain views on the most effective means for promoting adherence.


Crosssectional, mixed methods.


Collegiate athletic training in the United States.


Certified athletic trainers (n = 479; 234 male, 245 female).

Main Outcome Measures:

Online survey consisting of 3 questions regarding rehabilitation adherence, each followed by an open-ended comments section. Descriptive statistics were calculated for quantitative items; hierarchical content analyses were conducted for qualitative items.


Most (98.3%) participants reported poor rehabilitation adherence to be a problem (1.7% = no problem, 29.2% = minor problem, 49.7% = problem, 19.4% = major problem), while most (98.96%) participants reported that they had athletes who exhibited poor rehabilitation adherence (1% = never, 71.4% = occasionally, 22.5% = often, 5% = always). In addition, the majority (97.91%) of participants reported that overadherence (eg, doing too much, failing to comply with activity restrictions, etc) was at least an occasional occurrence (2.1% = never, 69.3% = occasionally, 26.3% = often, 1.9% = always). Hierarchical content analyses regarding the constructs of poor adherence and overadherence revealed 4 major themes: the motivation to adhere, the development of good athletic trainer–athlete rapport and effective communication, athletic trainers' perception of the coaches' role in fostering adherence, and the influence of injury- or individual- (eg, injury severity, sport type, gender) specific characteristics on rehabilitation adherence.


These results suggest that participants believe that underadherence (and to a lesser extent overadherence) is a frequent occurrence in collegiate athletic training settings. Strategies for enhancing rehabilitation adherence rates and preventing overadherence may therefore be important for optimizing rehabilitation outcomes.

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details five ways ATs can limit their liability. Other topics covered in the issue include legal considerations associated with return-to-play decisions and legal concerns related to second impact syndrome. Watch NATA TV Convention Recaps If you were not able to make it to New Orleans for the 69th NATA

Open access

Mary Lynn Manduca and Stephen J. Straub

treatment or rehabilitation program alone • O utcomes: return to play (recovery time duration) Sources of Evidence Searched PubMed, Cochrane Library, CINAHL, SPORTDiscus, ScienceDirect, and SagePub were all searched using keywords PRP injection, hamstring, and hamstring injury. Additional resources were

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Erik A. Wikstrom, Cole Mueller and Mary Spencer Cain

available date until March 2019. Each search used the following combination of keywords: (1) return to sport OR return to play OR return to participation OR return to work OR return to duty and (2) ankle sprain OR lateral ankle sprain OR acute ankle sprain OR acute lateral ankle sprain. Reference lists of

Open access

Nathan Millikan, Dustin R. Grooms, Brett Hoffman and Janet E. Simon

musculoskeletal injury is exponentially higher after a primary injury, highlighting the need for functional testing to determine injury recovery and return to play readiness to mitigate the high reinjury risk. 4 Functional testing comes in numerous forms. Lower-extremity functional testing has focused on agility