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Open access

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

Context:

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

Objectives:

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.

Design:

Crosssectional, mixed methods.

Setting:

Collegiate athletic training in the United States.

Participants:

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.

Results:

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.

Conclusions:

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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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.

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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Thomas Koesterer, Aaron Blanchard and Patrick Donnelly

Objective:

To present a unique case of meralgia paresthetica.

Background:

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.

Treatment:

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.

Uniqueness:

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.

Conclusions:

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.

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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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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