This paper seeks to develop understanding of both clinician-patient encounters within sport and Elias’s sociology of knowledge. Premised on a belief that there is a relatively high degree of consensus between figurational and “non-figurational” research on the social organization of sport medicine, and that such a consensus contrasts with the rather acrimonious relations which have characterized similar perspectival relations in the past, a review of literature is undertaken to highlight aspects of implicit agreement. Using a range of Elias’s concepts, this paper argues that there is broad agreement between researchers that clinician-patient relations are fundamentally structured according to mutually coexisting bodies of knowledge, and that there is cross-theoretical acceptance that such bodies of knowledge are shaped by, and make sense within, the distinct social context in which the respective parties are located. In examining aspects of Elias’s theoretical perspective which have hitherto received relatively little attention in the sociology of sport, this paper invites a revision of readings of this theoretical approach within the subdiscipline.
This case study examines the relationship between the “culture of risk” and the negotiation of treatment between sport medicine clinicians and student-athletes at a large Canadian university. The evidence acknowledges that a “culture of risk” was reinforced under certain circumstances during negotiation, but was also tempered by the existence of a “culture of precaution” that worked to resist those influences. The dialectic between the cultures of risk and precaution reveals some of the tensions inherent in negotiations between clinicians and patient-athletes, and helps to complicate the notion of a “culture of risk.” Another aspect (one that has rarely if ever been examined) of the negotiation of treatment is also considered—the promotion of “sensible risks” by clinicians to injured athletes.
Matthew K. Seeley, Ryan P. Sandberg, Joshua F. Chacon, Merrill D. Funk, Neil Nokes and Gary W. Mack
Individuals using traditional axillary crutches to ambulate expend approximately twice as much energy as individuals who perform able-bodied gait. A relatively novel spring-loaded crutch now being marketed may reduce metabolic energy expenditure during crutch ambulation. This idea, however, had not yet been tested.
To determine whether the novel spring-loaded crutch reduces oxygen consumption during crutch ambulation, relative to traditional-crutch ambulation. A secondary purpose was to evaluate the design for subject-perceived comfort and ease of use.
10 able-bodied men and 10 able-bodied women.
The independent variable was crutch design. Each subject ambulated using 3 different crutch designs (traditional, spring-loaded, and modified spring-loaded), in a randomized order.
Main Outcome Measures:
The primary dependent variable was oxygen consumption. Secondary dependent variables were subject-perceived comfort and ease of use, as rated by the subjects using a 100-mm visual analog scale. Dependent variables were compared among the 3 crutch designs using a 1-way repeated-measures ANOVA (α = .05).
Oxygen consumption during spring-loaded-crutch ambulation (17.88 ± 2.13 mL · kg−1 · min−1) was 6.2% greater (P = .015; effect size [ES] = .50) than during traditional axillary-crutch ambulation (16.84 ± 2.08 mL · kg−1 · min−1). There was no statistically significant difference (P = .068; ES = −.45) for oxygen consumption between spring-loaded-crutch ambulation and ambulation using the modified crutch (17.03 ± 1.61 mL · kg−1 · min−1). Subjects perceived the spring-loaded crutch to be more comfortable (P < .001; ES = .56) than the traditional crutch. There was no difference (P = .159; ES = −.09) between the spring-loaded and traditional crutches for subject-perceived ease of use.
Compared with traditional axillary crutches, the novel spring-loaded crutch may be more comfortable but does not appear to benefit subjects via reduced metabolic energy expenditure.
Daniel Martínez-Silván, Jaime Díaz-Ocejo and Andrew Murray
To analyze the influence of training exposure and the utility of self-report questionnaires on predicting overuse injuries in adolescent endurance athletes.
Five adolescent male endurance athletes (15.7 ± 1.4 y) from a full-time sports academy answered 2 questionnaires (Recovery Cue; RC-q and Oslo Sports Trauma Research questionnaire; OSTRC-q) on a weekly basis for 1 season (37 wk) to detect signs of overtraining and underrecovery (RC-q) and early symptoms of lower-limb injuries (OSTRC-q). All overuse injuries were retrospectively analyzed to detect which variations in the questionnaires in the weeks preceding injury were best associated. Overuse incidence rates were calculated based on training exposure.
Lower-limb overuse injuries accounted for 73% of total injuries. The incidence rate for overuse training-related injuries was 10 injuries/1000 h. Strong correlations were observed between individual running exposure and overuse injury incidence (r 2 = .66), number of overuse injuries (r 2 = .69), and days lost (r 2 = .66). A change of 20% or more in the RC-q score in the preceding week was associated with 67% of the lower-limb overuse injuries. Musculoskeletal symptoms were only detected in advance by the OSTRC-q in 27% of the episodes.
Training exposure (especially running exposure) was shown to be related to overuse injuries, suggesting that monitoring training load is a key factor for injury prevention. Worsening scores in the RC-q (but not the OSTRC) may be an indicator of overuse injury in adolescent endurance runners when used longitudinally.
Billy T. Hulin, Tim J. Gabbett, Rich D. Johnston and David G. Jenkins
Purpose: To determine (1) how change-of-direction (COD) workloads influence PlayerLoad (PL) variables when controlling total distance covered and (2) relationships among collision workloads and PL variables during rugby league match play. Methods: Participants completed 3 protocols (crossover design) consisting of 10 repetitions of a 60-m effort in 15 s. The difference between protocols was the COD demands required to complete 1 repetition: no COD (straight line), 1° × 180° COD, or 3° × 180° COD. During rugby league matches, relationships among collision workloads, triaxial vector-magnitude PlayerLoad (PLVM), anteroposterior + mediolateral PL (PL2D), and PLVM accumulated at locomotor velocities below 2 m·s−1 (ie, PLSLOW) were examined using Pearson correlations (r) with coefficients of determination (R 2). Results: Comparing 3° × 180° COD to straight-line drills, PLVM·min−1 (d = 1.50 ± 0.49, large, likelihood = 100%, almost certainly), PL2D·min−1 (d = 1.38 ± 0.53, large, likelihood = 100%, almost certainly), and PLSLOW·min−1 (d = 1.69 ± 0.40, large, likelihood = 100%, almost certainly) were greater. Collisions per minute demonstrated a distinct (ie, R 2 < .50) relationship from PLVM·min−1 (R 2 = .30, r = .55) and PL2D·min−1 (R 2 = .37, r = .61). Total distance per minute demonstrated a very large relationship with PLVM·min−1 (R 2 = .62, r = .79) and PL2D·min−1 (R 2 = .57, r = .76). Conclusions: PL variables demonstrate (1) large increases as COD demands intensify, (2) separate relationships from collision workloads, and (3) moderate to very large relationships with total distance during match play. PL variables should be used with caution to measure collision workloads in team sport.
Akane Yoshimura, Robert Schleip and Norikazu Hirose
Context: Several studies have reported that self-massage using a foam roller (FR) increased joint range of motion (ROM) immediately. However, the mechanism of increasing ROM by the FR intervention has not been elucidated. Objective: To clarify the mechanism by investigating properties and morphological changes of muscles targeted by the FR intervention. Design: An interventional study. Setting: An athletic training laboratory. Participants: Ten male college volunteers with no injuries in their lower limbs (mean [SD]: age 23.8 [3.2] y, height 173.2 [4.9] cm, weight 69.5 [8.6] kg). Intervention: The FR intervention on the right plantar flexors for 3 minutes. Main Outcome Measures: Maximum ankle ROM, muscle hardness, and fascicle length of the gastrocnemius muscle at the neutral (0°), maximum dorsiflexion, and maximum plantar flexion positions. All measurements were conducted before (PRE) and after (POST) the FR intervention. Results: Dorsiflexion ROM increased significantly at POST (PRE: 13.6° [8.0°], POST: 16.6° [8.4°]; P < .001), although plantar flexion ROM did not change significantly between PRE and POST (PRE: 40.0° [6.1°], POST: 41.1° [4.9°]). There was no significant difference in muscle hardness and fascicle length between PRE and POST in any of the angles. Conclusions: Dorsiflexion ROM increased significantly by the FR intervention in the present study; however, muscle hardness and fascicle length did not change. FR may affect not only the muscle but also the fascia, tendon, and muscle-tendon unit. The FR protocol of the present study can be applied in clinical situations, because it was found to be effective to increase ROM.
Steven Nagib and Shelley W. Linens
Clinical Scenario: Every year, millions of people suffer a concussion. A significant portion of these people experience symptoms lasting longer than 10 days and are diagnosed with postconcussion syndrome. Dizziness is the second most reported symptom associated with a concussion and may be a predictor of prolonged recovery. Clinicians are beginning to incorporate vestibular rehabilitation therapy (VRT) in their postconcussion treatment plan, in order to address the dysfunctional inner ear structures that could be causing this dizziness. Focused Clinical Question: Can VRT help postconcussion syndrome patients experiencing prolonged dizziness by improving their perceived disability? Summary of Key Findings: Three studies were included: 1 randomized control trial, 1 retrospective chart review, and 1 exploratory study. The randomized control trial compared cervical spine therapy alone to cervical spine therapy in conjunction with VRT to obtain medical clearance for sport. The chart review explored VRT as a treatment for reducing dizziness and improving balance and gait dysfunction. The exploratory study implemented VRT in conjunction with light aerobic exercise to improve perceived disability associated with dizziness postconcussion. All 3 studies found statistically significant decreases (improvements) in Dizziness Handicap Index scores. Clinical Bottom Line: There is preliminary evidence suggesting that VRT can improve perceived disability in patients with postconcussion syndrome experiencing prolonged dizziness. There is a decrease (improvement) in Dizziness Handicap Index scores across all 3 studies. VRT is a relatively safe treatment option, with no adverse reactions or case reports. Strength of Recommendation: There is level 2 and level 3 evidence supporting the use of VRT to treat patients suffering from dizziness postconcussion.
Rafel Cirer-Sastre, Alejandro Legaz-Arrese, Francisco Corbi, Keith George, Jinlei Nie, Luis Enrique Carranza-García and Joaquim Reverter-Masià
Purpose: The authors evaluated the impact of acute exercise and 24-hour recovery on serum concentration of cardiac troponins T and I (cTnT and cTnI) and N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) in healthy children and adolescents. The authors also determined the proportion of participants exceeding the upper reference limits and acute myocardial infarction cutoff for each assay. Method: Web of Science, SPORTDiscus, MEDLINE, ScienceDirect, and Scopus databases were systematically searched up to November 2017. Studies were screened and quality-assessed; the data was systematically extracted and analyzed. Results: From 751 studies initially identified, 14 met the inclusion criteria for data extraction. All 3 biomarkers were increased significantly after exercise. A decrease from postexercise to 24 hours was noted in cTnT and cTnI, although this decrease was only statistically significant for cTnT. The upper reference limit was exceeded by 76% of participants for cTnT, a 51% for cTnI, and a 13% for NT-proBNP. Furthermore, the cutoff value for acute myocardial infarction was exceeded by 39% for cTnT and a 11% for cTnI. Postexercise peak values of cTnT were associated with duration and intensity (Q (3) = 28.3, P < .001) while NT-proBNP peak values were associated with duration (Q (2) = 11.9, P = .003). Conclusion: Exercise results in the appearance of elevated levels of cTnT, cTnI, and NT-proBNP in children and adolescents. Postexercise elevations of cTnT and NT-proBNP are associated with exercise duration and intensity.