Key Points • Patients with a lateral ankle sprain often sustain recurrent injuries after return to play. • Impairments and activity limitation persist beyond return to play from a lateral ankle sprain. • It remains unknown how these outcomes contribute to recurrent lateral ankle sprains. Athletic
Ryan McCann, Kyle Kosik, Masafumi Terada and Phillip Gribble
Myles Murphy, Marshall Stockden, Ken Withers, William Breidahl and Jonathon Charlesworth
full recovery of rotator cuff strength does not occur for approximately 6 months postoperatively and suggested that return to play after 6 months may be a better option. However, it has yet to be demonstrated whether postoperative weakness is a direct result of the surgical intervention or due to
Ryan S. McCann, Kyle B. Kosik, Masafumi Terada and Phillip A. Gribble
- and patient-oriented outcomes collected in high school and collegiate athletes. Additionally, the current body of work has not considered the predictive value of these variables relative to return to play (RTP). Some of these outcomes have previously demonstrated limited predictive value for chronic
Nicole Cascia, Tim L. Uhl and Carolyn M. Hettrich
Clinical Scenario Numerous studies have reported on postoperative return to play (RTP) rates, between 66% and 98%, in professional baseball players after ulnar collateral ligament (UCL) reconstruction. 1 – 5 Currently, there is limited evidence following nonoperative management. There has been an
Raymond Chronister, George C. Balazs, Adam Pickett, John-Paul H. Rue and David J. Keblish
Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.
To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.
Case series and review of the literature.
Division I NCAA institution.
Two collegiate athletes who sustained first-time acute lateral patellar dislocations.
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.
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.
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.
Laura C. Reid, Jason R. Cowman, Brian S. Green and Garrett F. Coughlan
Global positioning systems (GPS) are widely used in sport settings to evaluate the physical demands on players in training and competition. The use of these systems in the design and implementation of rehabilitation and return-to-running programs has not yet been elucidated.
To demonstrate the application of GPS technology in the management of return to play in elite-club Rugby Union.
Professional Rugby Union club team.
8 elite Rugby Union players (age 27.86 ± 4.78 y, height 1.85 ± 0.08 m, weight 99.14 ± 9.96 kg).
Players wore GPS devices for the entire duration of a club game.
Main Outcome Measures:
Variables of locomotion speed and distance were measured.
Differences in physical demands between playing positions were observed for all variables.
An analysis of the position-specific physical demands measured by GPS provides key information regarding the level and volume of loads sustained by a player in a game environment. Using this information, sports-medicine practitioners can develop rehabilitation and return-to-running protocols specific to the player position to optimize safe return to play.
Dean Ritchie, Will G. Hopkins, Martin Buchheit, Justin Cordy and Jonathan D. Bartlett
Training volume, intensity, and distribution are important factors during periods of return to play.
To quantify the effect of injury on training load (TL) before and after return to play (RTP) in professional Australian Rules football.
Perceived training load (RPE-TL) for 44 players was obtained for all indoor and outdoor training sessions, while field-based training was monitored via GPS (total distance, high-speed running, mean speed). When a player sustained a competition time-loss injury, weekly TL was quantified for 3 wk before and after RTP. General linear mixed models, with inference about magnitudes standardized by between-players SDs, were used to quantify effects of lower- and upper-body injury on TL compared with the team.
While total RPE-TL was similar to the team 2 wk before RTP, training distribution was different, whereby skills RPE-TL was likely and most likely lower for upper- and lower-body injury, respectively, and most likely replaced with small to very large increases in running and other conditioning load. Weekly total distance and high-speed running were most likely moderately to largely reduced for lower- and upper-body injury until after RTP, at which point total RPE-TL, training distribution, total distance, and high-speed running were similar to the team. Mean speed of field-based training was similar before and after RTP compared with the team.
Despite injured athletes’ obtaining comparable TLs to uninjured players, training distribution is different until after RTP, indicating the importance of monitoring all types of training that athletes complete.
Enda F. Whyte, Nicola Gibbons, Grainne Kerr and Kieran A. Moran
Context: Determination of return to play (RTP) after sport-related concussion (SRC) is critical given the potential consequences of premature RTP. Current RTP guidelines may not identify persistent exercise-induced neurocognitive deficits in asymptomatic athletes after SRC. Therefore, postexercise neurocognitive testing has been recommended to further inform RTP determination. To implement this recommendation, the effect of exercise on neurocognitive function in healthy athletes should be understood. Objective: To examine the acute effects of a high-intensity intermittent-exercise protocol (HIIP) on neurocognitive function assessed by the Symbol Digits Modality Test (SDMT) and Stroop Interference Test. Design: Cohort study. Setting: University laboratory. Participants 40 healthy male athletes (age 21.25 ± 1.29 y, education 16.95 ± 1.37 y). Intervention: Each participant completed the SDMT and Stroop Interference Test at baseline and after random allocation to a condition (HIIP vs control). A mixed between-within-subjects ANOVA assessed time- (pre- vs postcondition) -by-condition interaction effects. Main Outcome Measures: SDMT and Stroop Interference Test scores. Results: There was a significant time-by-condition interaction effect (P < .001, η 2 = .364) for the Stroop Interference Test scores, indicating that the HIIP group scored significantly lower (56.05 ± 9.34) postcondition than the control group (66.39 ± 19.6). There was no significant time-by-condition effect (P = .997, η 2 < .001) for the SDMT, indicating that there was no difference between SDMT scores for the HIIP and control groups (59.95 ± 10.7 vs 58.56 ± 14.02). Conclusions: In healthy athletes, the HIIP results in a reduction in neurocognitive function as assessed by the Stroop Interference Test, with no effect on function as assessed by the SDMT. Testing should also be considered after high-intensity exercise in determining RTP decisions for athletes after SRC in conjunction with the existing recommended RTP protocol. These results may provide an initial reference point for future research investigating the effects of an HIIP on the neurocognitive function of athletes recovering from SRC.
Lindsey Eberman, Leamor Kahanov, Thurman V. Alvey III and Mitch Wasik
Edited by Malissa Martin
Michael F. Bergeron
In contrast to muscle cramps that are brought on by muscle overload or fatigue, exertional heat cramps seem to be prompted by extensive sweating and a significant sweat-induced whole-body sodium deficit. As a result of a consequent contracted interstitial compartment, axon terminals of selected motor neurons can become hyper-excitable and spontaneously discharge. Barely detectable muscle fasciculations or “twitches” in the affected muscles can rapidly progress to debilitating muscle cramps in just 20 to 30 minutes. To aid recovery, salt (NaCl) and water lost from sweating should be sufficiently replaced so as to restore the extracellular volume and interstitial fluid spaces. Sweat sodium, chloride, and fluid losses incurred during training and competition need to be closely matched by daily salt and fluid intake, in order to prevent an excessive sodium deficit, maintain sufficient fluid balance, and avoid exertional heat cramps.