JOURNAL OF ATHLETIC TRAINING Official Publication of the National Athletic Trainers’ Association, Inc Volume 48, Number 3, Supplement, 2013 Free Communications Review NATA Foundation Research Robert T. Floyd, EdD, ATC Subcommittee Committee University of West Alabama Jennifer E. Earl-Boehm, PhD, ATC Darin A. Padua, PhD, ATC Vice Chair Chair Craig Garrison, PhD, ATC, PT University of Wisconsin, Milwaukee University of North Carolina, Texas Health Ben Hogan Sports Chapel Hill Medicine Joseph M. Hart, III, PhD, ATC University of Virginia Jennifer E. Earl-Boehm, PhD, ATC M. Susan Guyer, DPE, ATC, LAT Vice Chair for Free Communications Springfield College Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Lisa Jutte, PhD, ATC, LAT University of Wisconsin, Milwaukee Xavior University MaryBeth Horodyski, EdD, ATC Brian G. Ragan, PhD, ATC University of Florida Thomas Kaminski, PhD, ATC, FACSM Vice Chair for Awards University of Delaware Ohio University Scott J. Johnson, MSED, ATC, LAT Old Dominion University Stephanie Mazerolle, PhD, ATC Troy Blackburn University of Connecticut University of North Carolina, Chapel Robert D. Kersey, PhD, ATC Hill California State University– Melanie L. McGrath, PhD, ATC Fullerton University of Nebraska-Omaha Steven P. Broglio, PhD, ATC University of Michigan John Mayes, MS, ATC, LAT Sara Nottingham, EdD, ATC CAEOS Project, Inc Chapman University Michael S. Ferrara, PhD, ATC University of Georgia David H. Perrin, PhD, ATC Darin A. Padua, PhD, ATC University of North Carolina, University of North Carolina, Joseph M. Hart, III, PhD, ATC Greensboro Chapel Hill University of Virginia Richard Ray, EdD, ATC William Pitney, EdD, ATC Tricia Hubbard, PhD, ATC Hope College Northern Illinois University University of North Carolina, Charlotte Robb Rehberg, PhD, ATC, NREMT Brian Ragan, PhD, ATC William Paterson University Student Awards Chair Lennart D. Johns, PhD, ATC Ohio University Quinnipiac University Valerie Rich Moody, PhD, ATC, LAT University of Montana Stephen Straub, PhD, ATC Kristen L. Kucera, PhD, ATC Quinnipiac University Duke University Clark Simpson, MBA, ATC, LAT Middletown, IN Charles A. Thigpen, PhD, ATC, PT Timothy A. McGuine, PhD, ATC Proaxis Therapy University of Wisconsin Health Jeffrey Smith, MS, ATC Sports Medicine Work Center University of Massachusetts, Kavin Tsang, PhD, ATC Amherst California State University, Fullerton NATA Foundation Board of Walter “Kip” Smith, MEd, ATC, LAT Susan Yeargin, PhD, ATC Directors Indiana University University of South Carolina Mark Hoffman, PhD, ATC President Timothy Speicher, PhD, ATC Oregon State University Ogden, UT

Michelle D. Boyd, MS, ATC Patti Tripp, PhD, ATC, LAT Truman State University University of Florida

INDEXES: Currently indexed in PubMed Central, Focus on Sports Science & Medicine (ISI: Institute for Scientific Information), Research Alert (ISI: Institute for Scientific Information), Physical Education Index, SPORT Discus (SIRC: Sport Information Research Centre, Canada), CINAHL (Cumulative Index to Nursing & Allied Health Literature), AMED (The Allied and Alternative Medicine Database), PsycINFO (American Psychological Association), and EMBASE (Elsevier Science). The Journal of Athletic Training (ISSN 1062-6050) is published quarterly ($225 for 1-year subscription, $255 foreign) by The National Athletic Trainers’ Association, Inc, 2952 Stemmons Freeway, Dallas, TX 75247. Periodicals postage paid at Dallas, TX, and at additional mailing offices. POSTMASTER: Send address changes to: Journal of Athletic Training c/o NATA, 2952 Stemmons Freeway, Dallas, TX 75247. CHANGE OF ADDRESS: Request for address change must be received 30 days prior to date of issue with which it is to take effect. Duplicate copies cannot be sent to replace those undelivered as a result of failure to send advance notice. ADVERTISING: Although advertising is screened, acceptance of the advertisement does not imply NATA endorsement of the product or the views expressed. Rates available upon request. The views and opinions in the Journal of Athletic Training are those of the authors and not necessarily of The National Athletic Trainers’ Association, Inc. Copyright 2013 by The National Athletic Trainers’ Association, Inc. All rights reserved. Printed in the U.S.A. Journal of Athletic Training S-1 Take this Supplement to Las Vegas and use it as a guide to the Free Communications Sessions

Dear NATA Members and Friends:

We are pleased to present the annual Supplement to the Journal of Athletic Training. This Supplement contains abstracts presented at the 2013 NATA Annual Meeting & Clinical Symposia in Las Vegas, Nevada as part of the NATA Foundation Free Communications Program. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

The Free Communications Program provides certified athletic trainers, students and other healthcare providers an opportunity to present and learn about the latest in athletic training research. Research is presented in oral and poster formats and includes general research, NATA Foundation-funded research, thematic posters, clinical case reports and our Student Exchange program posters. Abstracts of the research are printed here in the order of presentation at the NATA Annual Meeting in Las Vegas for your convenience. Free Communications presentations represent a wide range of research and clinical interests. In addition, the Clinical Case Reports sessions allow you to test your clinical assessment skills. We encourage you to attend these presentations.

We also urge you to attend the sessions featuring research funded by the NATA Foundation. The NATA Foundation funds research and a variety of educational programs, including summits on issues critical to athletic training, as well as annual scholarships to undergraduate and graduate students of athletic training.

Support from NATA members, corporations, and other affiliated groups make this supplement and all of our programs possible. Please note projects funded by the NATA Foundation and by the generous contributions of our donors are specified in this Supplement. To make an investment in the future of the profession, please contact us today at 800-TRY-NATA, extension 147.

NATA and the NATA Foundation are pleased to offer this supplement as a service to NATA members. We hope that it provides theoretical and practical information you can use to improve your effectiveness as a certified athletic trainer. Thank you for your support!

Sincerely,

Mark A. Hoffman, PhD, ATC James Thornton, MA, ATC President, NATA Research & Education Foundation President, NATA

S-2 Volume 48 • Number 3 (Supplement) May 2013 Dear Colleagues:

On behalf of the National Athletic Trainers’ Association Research & Education Foundation and the Free Communications Sub-Committee, we would like to thank all the authors who submitted abstracts to the Free Communications Program. We are happy to report a record number of submissions again this year with the total exceeding 500 Peer Reviewed and Student Exchange Track submissions, combined. We are excited about this year’s Free Communications Program as we believe it contains

an exciting mix of both high caliber research reports and clinical case studies. Please keep in mind Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 that we consider oral and poster presentations to be equal in terms of caliber and encourage clinicians and researchers to attend both oral and posters sessions.

We would also like to take this opportunity to extend a special thanks to the all of the NATA Foundation staff and especially Patsy Brown; and Rachael Oats, CAE whose attention to detail and dedication makes the Free Communications Program possible. Additionally, many individuals have worked very hard to review submissions, schedule presentations, and produce this Supplement to the Journal of Athletic Training. Therefore, we would like to thank and recognize the efforts of the Free Communications Committee including: Joe Hart, PhD, ATC; Lisa Jutte, PhD, ATC; Tom Kaminski, EdD, ATC; Stephanie Mazerolle, PhD, ATC; Melanie McGrath, PhD, ATC; Sara Nottingham, EdD, ATC; Darin Padua, PhD, ATC; Brian Ragan, PhD, ATC; Stephen Straub, PhD, ATC; Charles Thigpen, PhD, ATC, PT; Kavin Tsang, PhD, ATC and Susan Walker-Yeargin, PhD, ATC for their long hours of abstract reviews and preparation for the Free Communications programming. Lastly, we wish to thank Leslie Neistadt and the staff at the editorial office of the Journal of Athletic Training for making the Supplement possible.

As we move forward, we continually try to improve and make the review process more transparent. Our goal is to be as inclusive as possible while maintaining the high level of scholarship that readers expect of the Journal of Athletic Training. We appreciate the feedback we have received from authors, and suggestions are always welcomed and discussed in committee meetings to further improve the process.

We look forward to seeing you in Las Vegas. Please take the opportunity to attend the Free Communications evidenced-based forums, peer reviewed oral and poster sessions, and the student exchange poster presentations. Please note that projects funded by the NATA Research & Education Foundation are specified in this Supplement. Finally, if you have the opportunity, please offer your thanks to those recognized above.

Sincerely,

Jennifer E. Earl-Boehm, PhD, ATC

Vice Chair for Free Communications, NATA Research & Education Foundation Research Committee

Journal of Athletic Training S-3 JOURNAL OF ATHLETIC TRAINING Official Publication of the National Athletic Trainers’ Association, Inc Volume 48, Number 3, Supplement, 2013 Table of Contents Moderator Page Free Communications: Palm B Tuesday, June 25, 2013 8:00AM-9:15AM ...... Master’s Oral Student Award ...... Finalists ...... Brian Ragan, PhD, ATC ...... S-11

9:30AM-10:45AM ...... Doctoral Oral Student Award Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 ...... Finalists ...... Brian Ragan, PhD, ATC ...... S-15 11:00AM-12:30PM ...... Thematic Poster: Hydration and ...... Cooling Interventions ...... Michelle Cleary, PhD, ATC ...... S-19 12:45PM-2:00PM ...... Thematic Poster: Clinical Assessment of Movement ...... Dysfunctions ...... Anh-Dung Nguyen, PhD, ATC ...... S-25 2:15PM-3:45PM ...... Thematic Poster: Factors that Influence ...... Concussion Assessment ...... Michael Ferrara, PhD, ATC ...... S-30

Wednesday, June 26, 2013 8:00AM-9:00AM ...... Thematic Poster Spitfire: Neuromuscular and Biomechanical Consequences ...... of ACL Reconstruction...... Grace Golden, PhD, ATC, CSCS...... S-36 9:15AM-10:15AM ...... Management of Osteochondral ...... Injuries ...... James Onate, PhD, ATC ...... S-42 10:30AM-11:30AM ..... Knee Evidence-Based Forum ...... S-46

Thursday, June 27, 2013 8:00AM-9:00AM ...... Shoulder Evidence-Based Forum ...... S-47 9:15AM-10:30AM ...... Adaptations and Kinetic Chain ...... in Pitchers ...... Jeffrey Cooper, MS, ATC ...... S-48 11:45PM-12:45PM ...... Thematic Poster Spitfire: Emerging Technologies in ...... Athletic Training ...... Joseph Hart, PhD, ATC...... S-52 3:15PM-4:45PM ...... Thematic Poster: Socialization, Retention and ...... Work-Life Balance ...... Sara Nottingham, EdD, ATC, CSCS ...... S-58

Free Communications: Palm C Tuesday, June 25, 2013 8:00AM-9:00AM ...... Neuromuscular Characteristics of Dance ...... and Warrior Populations ...... Jatin Ambegaonkar, PhD, ATC, OT ...... S-64 9:15AM-10:15AM ...... Knowledge and Perception ...... of Concussions ...... Johna Register-Mihalik, PhD, ATC ...... S-67 10:30AM-11:45PM ...... Various Approaches for Classroom ...... and Clinical Education ...... Jolene Henning, EdD, ATC, LAT ...... S-70 12:00PM-1:00PM ...... Education Evidence-Based Forum ...... S-74 1:15PM-2:30PM ...... Ankle Injury Epidemiology ...... Cathleen Brown-Crowell, PhD, ATC ...... S-75 2:45PM-3:45PM ...... Ankle Evidence-Based Forum...... S-79

S-4 Volume 48 • Number 3 (Supplement) May 2013 Moderator Page

Wednesday, June 26, 2013 8:00AM-8:45AM ...... Abdominal Conditions Case ...... Studies ...... Michael Milligan, MD, CAQSM ...... S-80 9:15AM-10:15AM ...... Impact of Preseason on Exertional ...... Heat Illness...... Kristen Kucera, PhD, ATC ...... S-83

Thursday, June 27, 2013 8:00AM-9:15AM ...... Kinesio Taping Across

...... the Spectrum ...... Mark Merrick, PhD, ATC ...... S-87 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 9:30AM-10:30AM ...... Risk Factors and Management of ...... Patellofemoral Pain ...... Megan Quinlevan, ATC ...... S-91 11:45AM-12:45PM ...... Prospective Clinical Trials ...... in Athletic Training ...... Darin Padua, PhD, ATC ...... S-95 3:00PM-5:00PM ...... Concussion Education and ...... Policy ...... Tricia Kasamatsu, MA, ATC ...... S-99

Free Communications: Palm D Tuesday, June 25, 2013 8:00AM-9:15AM ...... Patient Related Outcome, Correlation to Clinical ...... or Lab Measures ...... Jennifer Earl-Boehm, PhD, ATC ...... S-105 9:30AM-10:45AM ...... Stumped: Differential Diagnosis in Athletic ...... Training ...... Kate Pfile, PhD, ATC ...... S-109 11:00AM-11:45AM ..... Prehospital Care of the ...... Injured Athlete...... Julianne Schmidt, MA, ATC ...... S-114 12:00PM-1:00PM ...... Spine Evidence-Based Forum ...... S-117 1:15PM-2:30PM ...... Emergent Conditions in Athletes ...... (Case Study) ...... Mark Hoffman, PhD, ATC ...... S-118 2:45PM-3:45PM ...... Assessment of the Throwing ...... Athlete ...... Steve Tucker, PhD, ATC ...... S-123

Wednesday, June 26, 2013 8:00AM-9:00AM ...... Manual Therapy ...... Tricia Hubbard Turner, PhD, ATC ...... S-126 9:15AM-10:15AM ...... What Cryotherapy Cannot Do . Jennifer Ostrowski, PhD, ATC ...... S-129 10:30AM-11:30AM ..... Modalities Evidence-Based Forum ...... S-132

Thursday, June 27, 2013

8:00AM-9:00AM ...... Taping/Bracing/Orthotic ...... Interventions ...... Mitchell Cordova, PhD, ATC ...... S-132 12:00PM-12:45PM ...... Elbow Injury Case ...... Ned Bergert, ATC, PTA ...... S-137 3:15pm-4:30pm ...... Non-Mechanical Factors Associated ...... with Injury ...... Brian Pietrosimone, PhD, ATC ...... S-140

Journal of Athletic Training S-5 Page

Free Communications, Poster Presentations: Mandalay Bay South Convention Center

Wednesday, June 26, 2013, 10:00AM-5:00PM

Thursday, June 27, 2013, 10:00AM-5:00PM

Student Exchange Posters: Authors present 10:00AM-10:30AM Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Authors A-L present 10:30AM-11:15AM, Authors M-Z present 11:15AM-12:00PM

Friday, June 28, 2013, 10:00AM-1:00PM

Undergraduate Poster Award Finalists ...... S-133 Master Poster Award Finalists ...... S-137 Doctoral Poster Award Finalists ...... S-141 Lower Extremity Neuromechanics ...... S-145 Psychometrics ...... S-165 Concussion ...... S-176 Ankle Instability ...... S-195 Lower Extremity Injury ...... S-209 Education ...... S-223 Therapeutic Intervention ...... S-230 Case Studies ...... S-250

Awards

The New Investigator Award...... S-7 Freddie H. Fu, MD ...... S-8

The Doctoral Dissertation Award ...... S-9 David H. Perrin, PhD, ATC, FNATA, FACSM ...... S-10

Index

Author Index ...... S-292

Editorial Staff

Editor-in-Chief Business Office Manager Managing Editor Craig R. Denegar, John Honaman, MBA, CFRE Leslie E. Neistadt, ELS PhD, ATC, PT, FNATA National Athletic Saint Louis University University of Connecticut Trainers’Association, Inc St Louis, MO Storrs, CT Dallas, TX Editorial Assistant Erick Richman Columbus, GA

S-6 Volume 48 • Number 3 (Supplement) May 2013 The New Investigator Award Presented in Honor of Freddie H. Fu, MD Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Timothy Butterfield, PhD, ATC University of Kentucky

When Tim Butterfield injured his knee herding cattle at a dairy farm in 1984, he could not have predicted he would one day have his own laboratory, designing new equipment and methods to further athletic training research and practice. Like many athletic trainers, Butterfield only discovered the profession after his injury. “I didn’t realize what sports medicine was,” he says, though he was no stranger to medicine of another sort. Butterfield grew up on a dairy farm and worked for veterinarians since he was 12 years old. His career path changed when his injury led him to Pete Farrell, the head athletic trainer at Potsdam State. Eventually, Butterfield would take over that position from the retiring Farrell. First, however, he had to change direction. Although he was nearly ready to graduate with his biology degree, he delayed graduation to meet the necessary undergraduate requirements to study athletic training as a graduate student. After 2 years of study and an internship at Messiah College, he attended Old Dominion University for his master’s while serving as the head athletic trainer at Virginia Wesleyan College. Butterfield was originally to be 1 of 2 athletic trainers at the school, but when the second person didn’t show, Marty Bradley, the athletic trainer at Old Dominion, told him to go at it alone. Butterfield sees it as the “best experience I could have gotten, to see what being a head athletic trainer was like. I’ve always loved responsibility falling on my shoulders,” he remembers, “and being given enough of a leash or rope to hang myself or do well.” After working as the head football athletic trainer at Mansfield University for 5 years, he was offered the position that inspired him to study athletic training at Potsdam State. Not only did he return to his alma mater, but he also began teaching for the first time. “I liked the opportunity to see a difference in students over time,” he says. After 3 years at Potsdam, Butterfield moved to the University of Calgary to earn his doctorate and then to The Ohio State University to research and teach. There, he found himself specializing in muscle. “Muscle, unlike other tissues, is irritable and activatable, changes its function and form, and does many things we don’t understand to this day.” Butterfield’s interest in muscle manifests in his research, which focuses on the effectiveness of massage. He saw many teams using massage therapy in the athletic training room of the 1996 Atlanta Olympics, despite little actual evidence justifying its use. “What we’re doing now is finding that different loads, durations, frequencies all have a huge impact and difference on how the muscle cell signals to stimulate inflammation, damage, and repair.” He got another “long piece of rope to work with” when Carl Mattacola and Tim Uhl invited him to the University of Kentucky. He was given an empty space on the 4th floor, some start-up money, and free reign. “Five and a half years later, we’re still doing this,” he says. The lab has developed, among other projects, bottle nipples for testing premature infant tongue strength, novel dynamometers, massage devices, and speech therapy tools. Currently, Butterfield is researching manipulation of the immune response after exercise and delaying atrophy though massage. “If we keep finding novel data, we’ll keep writing the grants. I would like to get into some aging work, because we’re all getting older. And the more active we can stay, the more healthy we’ll be.” In addition to Farrell and his family, Butterfield thanks Sandy Bush, ATC; Robert H. Shank, EdD, ATC, EMT-B; Marty Bradley, MS, ATC; Terry Zablocki, ATC, EMT; Scott Johnson, MA, ATC; Thomas Best, MD, PhD; and Walter Herzog, PhD.

Journal of Athletic Training S-7 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Freddie H. Fu, MD

Dr. Freddie H. Fu, a longtime advocate of certified athletic trainers, is a well-respected physician whose work in sports medicine has earned repeated honors.

The 1996 winner of the NATA President’s Challenge Award, Dr. Fu is the David Silver Professor of Orthopaedic Surgery and Chairman of the Department of Orthopedic Surgery at the University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center.

He has been the head team physician for the University of Pittsburgh Department of Athletics since 1986. He also was instrumental in establishing the Sports and Preventive Medicine Institute in 1985. Under his leadership, the facility – now called the UPMC Center for Sports Medicine – has grown into the region’s largest, most comprehensive sports medicine center, regarded among the best in the country.

Dr. Fu holds secondary appointments as Professor of Physical Therapy and Health, Physical and Recreation Education. He was awarded an honorary doctorate of science degree from Point Park University and an honorary doctorate of public service from Chatham College.

Known worldwide for his pioneering surgical techniques to treat sports-related injuries to the knee and shoulder and his extensive research in the biomechanics of such injuries, Dr. Fu performs surgery at UPMC and sees patients at the UPMC Center for Sports Medicine. He also directs the University of Pittsburgh’s Sports Medicine Fellows Society.

Dr. Fu is the editor of 26 major orthopedic textbooks and author of 75 book chapters on managing sports injuries. He has authored or co-authored 180 peer-reviewed articles and has given more than 600 national and international presentations.

Former president of the Pennsylvania Orthopaedic Society, he is a member of 40 other professional and academic medical organizations including the prestigious Herodicus Society. Currently he serves as Second Vice President of the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine and will assume the presidency of ISAKOS in 2009. He is also on the Board of the American Orthopaedic Society for Sports Medicine and the Orthopaedic Research and Education Foundation. Dr. Fu has served as chairman of the board and executive medical director of the UPMC/City of Pittsburgh Marathon, company physician and board member for the Pittsburgh Ballet Theatre, and team physician for Mt. Lebanon High School.

S-8 Volume 48 • Number 3 (Supplement) May 2013 The Doctoral Dissertation Award Presented in Honor of David H. Perrin, PhD, ATC Sponsored by Friends of Dr. Perrin

Dorice Hankemeier, PhD, ATC Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Ball State University

Many high school students ignore their injuries until they’re forgotten, but a young Dorice Hankemeier asked herself, “why is this taking so long to get better?” Nearing the end of her time in high school, Hankemeier decided to seek more information to better understand her experience with injury and recovery. She graduated from Central College (Pella, IA) in 1997 and then went on to earn a MSEd from Old Dominion University in 2003, practicing in various clinical athletic training positions throughout. In 2008, she began her doctoral program at Old Dominion graduating in 2011 with a cognate in curriculum and instruction.

Her research looks empirically at how athletic training students are being taught evidence-based practice and how they are using those lessons. “We’re teaching our students these things, but,” she asks, “clinically, how are they implementing them?” Her dissertation follows the tiered, Scandinavian model, consisting of 3 parts. The first, “Approved Clinical Instructors’ Perspectives on Evidence-Based Practice Implementation Strategies for Students,” was published in the JAT in 2011. The second and third projects, “Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice” and “ Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 1: Perceived Importance, Knowledge, and Confidence” were published recently in JAT. “When I was an undergraduate student, I never would have thought about going on to pursue my doctorate. I was really focused on the clinical aspect of athletic training, but as I progressed through my master’s degree I became more interested in teaching and the educational component of athletic training.”

Currently teaching and researching at Ball State in Muncie, IN, Hankemeier continues to strive for more and recalls that her “mentors saw in me that I could be successful in AT and always pushed me to get better.” Today, she is “always looking for a new way of doing things and not just settling for where I was.” With her colleagues, Hankemeier received an NATA program grant to develop free, online evidence-based practice modules; 15 are now available to the membership on the NATA Web site. Hankemeier sees long-reaching effects of paired research and recommendations. “I think we’re just scratching the surface in some of the areas of outcomes assessment of athletic training programs which will become even more critical as we continue to move athletic training education forward,” as will looking at how athletic trainers fit into the interprofessional team of health care.

“We need the data first,” she says, but predicts a need for “global assessment” of athletic training education that goes beyond comparing BOCpassing rates. Although she hopes her research will help the athletic training profession continue to develop, she also strives to directly inspire her own students and “lead by example, not taking everything at face value but encouraging students to become critical thinkers.”

Hankemeier thanks her undergraduate mentors John Roslien, ATC; Leslie Duinink, ATC; Pam Richards, EdD, for instilling a passion for the profession and challenging her to reach higher; Bonnie Van Lunen, PhD, ATC, for being a strong professional mentor and continually pushing her to new heights and areas of interest; friends Sarah Manspeaker, PhD, ATC; Cailee McCarty, PhD, ATC; and Stacey Gaven, PhD, ATC, for being strong supporters of her research; and her parents, Marv and Sara Hankemeier, who instilled the value of education and showed her what working hard truly meant. Journal of Athletic Training S-9 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

David H. Perrin, PhD, ATC, FNATA, FACSM

David H. Perrin, PhD, ATC, is a respected researcher, educator, mentor and friend of athletic training. This 2003 NATA Hall of Fame inductee is a noted pioneer of terminal degrees in sports medicine, and his dedication to athletic training is making an impact on the profession’s development even today.

Serving as editor-in-chief of the Journal of Athletic Training and founding editor of the Journal of Sport Rehabilitation are only two of Dr. Perrin’s significant achievements. Others include being awarded NATA’s Sayers “Bud” Miller Distinguished Educator Award in 1996, Most Distinguished Athletic Trainer Award in 1998, and All-University Outstanding Teaching Awards from the University of Virginia in 1997 and 1998.

Dr. Perrin has built research education programs at the undergraduate, master’s, and doctoral levels and has fully dedicated himself to mentoring and developing future scholars. Dr. Perrin makes every effort to maximize his students’ potential by offering sound advice and helping them make the most of their educational programs. Many of his students have gone on to bright careers in the profession, as researchers, program directors, clinical supervisors, and award- winning scholars.

Dr. Perrin continues to mentor students and serve as a leader in the profession. He is provost at University of North Carolina at Greensboro. He oversees five academic departments, nearly 75 faculty members and more than 1200 students. The school’s Ph.D. program in the Department of Exercise and Sport Science has been recognized as one of the country’s best programs. Dr. Perrin remains involved in the profession by teaching a class and advising doctoral students who are certified athletic trainers. He also continues to write in athletic training and has recently published three books.

The NATA Foundation Doctoral Dissertation Award, presented in honor of David H. Perrin, recognizes outstanding doctoral student research and is a fitting tribute to a man who has dedicated the duration of his career to mentoring and developing future scholars.

S-10 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Master’s Oral Student Award Finalists 13376MOEMTuesday, June 25, 2013, 8:00AM-9:15AM, Palm B; Moderator: Brian Ragan,13268MODI PhD, ATC

Cold Shower As A Treatment were taken every 5min during Validation Of The Ottawa Ankle For Exercise-Induced treatment. Repeated measures Rules For Acute Foot And Ankle Hyperthermia ANOVAs were utilized to compare Injuries Over Time Buening BJ, McDermott BP, differences between trials. Bonferroni Gray KA, Ragan BG, Starkey C: Bonacci JB, Ganio MS, Kavouras corrections were utilized when Ohio University, Athens, OH SA, Adams JD, Matthews A, appropriate. Alpha was set to d” 0.05.

Tucker MA: University of Results: Tre (CSH: 39.09 ± 0.25°C; Context: The original and Modified Arkansas, Fayetteville, AR CON: 39.04 ± 0.38°C; P=.927) and Ottawa Ankle Rules (MOAR) were HR (CSH: 174 ± 17bpm; CON: 173 ± developed as clinical decision rules Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Exertional heat illnesses are 19bpm; P=.967) were not different (CDRs) for the emergency department common in individuals exercising in throughout exercise for CSH and CON setting to determine the need for the heat. Exertional heat stroke, trials. Thirst (P=.600), thermal radiographs following foot or ankle although not as common as heat (P=.694), perceived exertion injury. However, these CDRs have not exhaustion, is the most severe heat (P=.637) and muscle pain (P=.307) been validated as an immediate sport- illness. Without rapid and effective during exercise were similar between related clinical evaluation tool. treatment, exertional heat stroke can trials. Both Tre and HR significantly Objective: To test the validity of the be fatal. Clinicians sometimes decreased over time during rest, MOAR when applied within 30 min struggle with the feasibility of regardless of treatment (Pd”.001). following sport-related injury. Design accessible cold-water immersion However, decreases in Tre (P=.278) Cross-sectional. Setting: NCAA I (CWI). Experts have recommended and HR (P=.236) over time were athletics, collegiate club sports, and the use of a cold shower (CSH) when not significantly different between high schools. Patients or Other CWI is not feasible. Objective: CSH and CON. However, overall Participants: Thirty-three data Evaluate the efficacy of whole-body cooling rate for CSH was collectors were ATs working with . -1 cooling when hyperthermic 0.069°C min (range: 0.02 – intercollegiate (n = 10), college club . -1 participants are cooled utilizing 0.14°C min ) and was significantly sports (n = 2), and high school (n = continual dousing with CSH. Design: faster than during CON (0.047 ± 21) populations. Data were collected . -1 Randomized, counter-balanced 0.02°C min ; range: 0.013 – using a standardized instrument. Data . -1 controlled study. Setting: Human 0.081°C min ; P=.031). Overall, HR collection occurred for 11 months performance laboratory (33.4 ± 0.9° decreased to a greater extent during during 2011-2012. Interventions: C; 26.3 ± 3.2%RH). Patients or CSH (45 ± 20bpm) compared to CON Following the initial and/or re- Other Participants: 17 participants (27 ± 20bpm; P=.002). Thirst examination of an acute foot or ankle (175.2 ± 6.9cm, 70.4 ± 8.7kg, age (P=.005) and thermal perception injury, the AT completed an inventory range: 19-35yrs.) volunteered. (P<.001) were reduced to a greater identifying the key MOAR diagnostic Interventions: Participants extent with CSH compared to CON findings and clinical diagnosis. Once exercised volitionally for a following exercise. Conclusions: CSH, the patient was cleared for maximum of 90min in a controlled despite perceptual benefits, is not participation, a definitive diagnosis environment on 2 separate clinically supported for the treatment was made, or no further intervention occasions. Exercise mode, duration, of exercise-induced hyperthermia. It was required, the data collector intensity and fluid consumption were could take approximately 2-5 times as submitted the instruments to the matched between trials. Following long to cool a hyperthermic victim with research team. Main Outcome exercise, participants received CSH compared to previous CWI data. Measures: A 2x2 contingency table either CSH (water temperature: 20.8 Clinicians should continue to utilize identified the number of true positive, ± 0.80°C) while seated or sat in a CWI for exertional heat stroke, and true negative, false positive, and false chair (CON) for 15min. All data was should make every effort to have this negative findings. To assess the validity collected in the same available for the rapid treatment of measures of diagnostic accuracy, environmentally controlled room. patients when environmental conditions positive predictive value (PPV), Main Outcome Variables: Rectal increase risk of heat illness. negative predictive value (NPV), temperature (Tre) and heart rate (HR) sensitivity (Sn), specificity (Sp), were recorded every minute during positive likelihood ratio (LR+), and treatment. Thirst and thermal negative likelihood ratio (LR-) were perception, rating of perceived calculated. Results: Eighty-four acute exertion, and muscle pain sensation

Journal of Athletic Training S-11 13106MONE examinations were performed within Anterior Cruciate Ligament corticospinal excitability were 30 min of the initial injury (mean time Reconstruction Participants tested in the injured limb of ACLr between the injury and examination Exhibit Deficits In Quadriceps participants and in a randomly was 6.0 ± 8.4 min). Thirty-three of Strength And Up-Regulation Of assigned limb of healthy controls. the 84 (39.3%) examinations met the Corticospinal Excitability Main Outcome Measures: MOAR criteria, 5 (15.2%) were Clements AE, Lepley AS, Ericksen Quadriceps strength was assessed via positive for a fracture. No fractures HM, Sohn DH, Levine JW, Gribble maximal voluntary isometric were reported in the 51 cases that did PA, Pietrosimone BG: University contractions (MVIC) performed at not meet the MOAR referral of Toledo, Toledo, OH 90° of knee flexion and normalized requirements. In all models to body mass. Quadriceps activation examined the Sn =1.0, NPV = 1.0, Context: Neuromuscular dysfunction was determined by using the central Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and the LR- was zero. The overall all of the quadriceps is a hallmark activation ratio (CAR) obtained accuracy of the MOAR was .67, PPV impairment following anterior through the burst superimposition = .15, Sp = .60, and LR+ = 2.86. cruciate ligament reconstruction technique. Quadriceps spinal-reflex Using only weight bearing status (ACLr), which can include deficits excitability was assessed using yielded an accuracy to .56, PPV = in quadriceps strength and activation, maximal Hoffmann reflexes .12, Sp = .53, and LR+ = 2.14. contributed to by alterations in normalized to maximal muscle Examining only the palpation neural excitability. It is thought that responses (H:M). Quadriceps predictor variables decreased traditional ACLr therapeutic corticospinal excitability was accuracy to .35, PPV = .08, Sp = .30, exercise regimens will regain measured via motor evoked and LR+ = 1.44. Conclusions: normal function of spinal-reflexive potentials (MEP) elicited at 120% Negative findings on the MOAR and corticospinal excitability of active motor threshold and accurately ruled out the need for pathways, yet little is known about normalized to maximal muscle radiographs, but positive findings are how these neuromuscular outcomes responses. Independent t-tests were poorly predictive of the presence of are affected years following ACLr. performed to identify differences a fracture. The pooled findings of Knowing how neuromuscular between groups, and alpha was set a palpation and weight-bearing status deficits are affected will provide priori at P<0.05. Results: ACLr are better predictors than palpation evidence essential to the participants demonstrated signifi- or weight-bearing status alone. The development of improved cantly less strength (ACLr MVIC: absence of false negative findings rehabilitation strategies for ACLr. 2.32Nm/kg±0.72; Healthy MVIC: lends further validity to the MOAR. 3.19Nm/kg±1.1; t = -2.17, p=0.03) Objective: Evaluate differences in 29 quadriceps strength, activation, and higher corticospinal excitability spinal-reflexive excitability and (ACLr MEP: 0.051±0.044; Healthy MEP: 0.023±0.01; t = 2.65, corticospinal excitability between 29 ACLr individuals with high levels of p=0.01) compared to healthy self-reported dysfunction and controls. There were no differences healthy controls. Design: Case- between groups in activation (ACLr control study. Setting: Research CAR: 0.88±0.12; Healthy CAR: 0.92±0.09; t = -0.96, p=0.34) or laboratory. Patients or Other 29 Participants: Nine unilateral ACLr spinal-reflexive excitability (ACLr patients (2M/7F, 21.1±2.2years; H:M: 0.24±0.16; Healthy H:M: 0.20±0.11; t = 0.85, p=0.39). 170.8±11.6cm, 74.6±20.7kg, 29 48.1±29.6 months post-surgery) Conclusions: ACLr participants were compared to twenty-two with IKDC<85 had significantly less healthy controls (7M/15F, 23.0± strength and higher corticospinal 4.0years; 171.1±8.3cm, 71.1± 11.9 excitability than healthy controls; kg). All ACLr patients scored less however, they did not differ from than 85% on the International Knee healthy participants in quadriceps Documentation Committee activation or spinal-reflexive questionnaire (IKDC; 73.5±9.0). excitability. The up-regulation of Interventions: Vastus medialis corticospinal excitability in the ACLr strength, voluntary activation, spinal- group may be a post-injury reflexive excitability and mechanism to maximize quadriceps

S-12 Volume 48 • Number 3 (Supplement) May 2013 13083MOSP activation, explaining similar Patient, Injury, And Assessment concussions, with football accounting activation levels between groups. Characteristics Of Sport- for 49.6% (n=309). Most occurred However, corticospinal up-regulation Related Concussions At Initial during an in-season game (49.4%, alone may not be a sufficient strategy Evaluation: A Report From The n=308) or practice (32.1%, n=200) to develop or maintain quadriceps Athletic Training Practice-Based and the primary mechanism of injury strength. Further research should Research Network was contact (84.1%, n=524). The identify what factors contribute to Kostishak N, Anderson B, Lam initial treatment plan included AT- deficits in quadriceps strength, and KC, Valovich McLeod TC: A. T. initiated treatment (41.7%, n=260) which factors can be clinically Still University, Mesa, AZ and referral to the emergency modified to improve strength. department (5.0%, n=31), team

Context: Most studies describing physician (7.4%, n=46), family Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 concussion assessment practices have physician (13.2%, n=82), and for used self-report surveys and have imaging (1.3%, n=8). A concussion- reported wide variation in practices. specific evaluation form was Understanding real-time concussion completed for 60.4% (n=376) of assessment practices, through a review cases. Loss of consciousness was of medical records, can provide a noted in 4.0% (n=25), post-traumatic better understanding of the initial amnesia in 8.3% (n=52), retrograde clinical presentation and subsequent amnesia in 6.6% (n=41), and aphasia management of the injury. Objective: in 1.4% (n=9) of cases. Pupillary size To describe the patient, injury, and (93.4%, n=351), response (93.9%, assessment characteristics of sport- n=353), and movement (88.6%, related concussion at initial evaluation. n=333) were normal in most patients. Design: A retrospective analysis of Coordination was also normal in most electronic medical records (EMR). patients, whether tested by the heel- Setting: Athletic Training Practice- to-knee (31.6%, n=119), finger-to- Based Research Network (AT-PBRN). nose (66.0%, n=248) or Romberg Patients or Other Participants: 623 (44.9%, n=168) test. Individual cranial patients (392 male, 231 female, nerves were normal in 85.9-90.7% age=17.0±1.8 years) diagnosed with a (n=323-341) of cases. With respect to concussion by an athletic trainer (AT). assessment practices, ATs did not Interventions: Patient records from assess pulse (75.3%, n=283), blood 57 AT-PBRN clinical practice sites pressure (100%, n=376), coordination between October 2009-October 2012 (26.3-64.6%, n=99-243), cranial were reviewed. All records were nerves (8.5%, n=32), range of motion completed by an AT utilizing a web- (9.3%, n=35), or strength (17.1%, based EMR. Concussed patients were n=64) for the indicated percentage of identified by concussion-specific cases. Conclusions: As expected, diagnostic codes (ICD-9: 850.0, many of the clinical tests performed 850.5, 850.9). Main Outcome during an initial concussion evaluation Measures: Frequencies and were normal, ruling out an intracranial descriptive statistics were utilized to injury. Appropriate documentation was describe patient (sex, sport, age), lacking, evident by the difference in the injury (time of injury, mechanism of number of concussions identified injury, initial treatment plan, loss of compared to completed evaluation consciousness, presence of amnesia forms. Furthermore, vitals, and the assessment of cranial nerve coordination, and cranial nerves were function, coordination, range of not tested at initial evaluation, which motion, and strength) and assessment disregards best practices. Clinicians (% of initial evaluation components should improve documentation of completed by ATs) characteristics. concussion assessment to ensure best Results: Generic injury demographic practices and liability protection. forms were completed for 623

Journal of Athletic Training S-13 13430MOSP

Oculomotor Function In concussion screening. The test Collegiate Student-Athletes involves 3 separate cards each with With A Previous History Of a different series of numbers. In Sport-Related Concussion order to effectively study learning Braun PA, Kaminski TW, Swanik effects, a total of two test trials were CB, Knight CA: University of completed. Main Outcome Delaware, Newark, DE Measures: The total time (seconds) to complete the KD Test (all 3 cards) Context: Current clinical tools that was compared between groups diagnose and assess concussed (control vs. experimental). The Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 athletes do not include a component independent variable was the for measuring oculomotor function. participants’ history of concussion. Researchers in optometry and The improvement time (learning neurology have shown that eye effect) was also evaluated between movement deficits in subjects with a the first and second trials across history of acquired brain injury exist, groups. Separate ANOVAs were used but these measurements have not been to compare means between the two implemented utilizing an athletic groups for both total time and population, or a population with a improvement time. Results: No history of sport-related concussion. significant differences existed Objective: The purpose of this study between groups for oculomotor was to determine if sport-related function (F1,168=0.870, p=0.352) or concussion creates lasting deficits in learning effect (F1,166=0.253, oculomotor function and learning, as p=0.615). The control group measured by the King-Devick (KD) revealed a mean completion time of Test. Design: Quasi-experimental, ex 38.21±6.17s as compared to the post facto. Setting: Athletic training experimental group mean time of research laboratory. Patients or 39.12±6.48s. Results from learning Other Participants: Convenience effect scores were very similar as sampling was utilized to evaluate well. The experimental group with no oculomotor function in one hundred previous history of concussion seventy NCAA Division-I collegiate posted a mean improvement time of athletes. Seventy-three (40 males, 2.48±2.87s, while the previously 33 females, age=19.7±1.3 yrs., concussed group had a mean height= 177.4±10.6 cm, mass= improvement of 2.68±2.12s. 79.0±17.2 kg) had a previous history Conclusions: The oculomotor nerve of sport-related concussion (mean can be damaged following sport-related number of concussions =1.5±1.3, concussion, especially with rotational mean recovery time=8.6±12.9 days, impacts. Evidence from this study time since most recent however, suggests that no long-term concussion=28.7±28.0 months). The deficits in oculomotor function or remaining participants (45 males, 52 learning exist in the collegiate student- females, age=19.7± 1.3 yrs., athlete population who has sustained height=175.6±10.2 cm, mass= concussions. These findings help to 77.1±16.3 kg) had no previous strengthen the current concussion history of head injury. definition with regard to the transient Interventions: Objective measure- nature of the associated symptoms. ments were obtained through the use Additional research involving acutely of the KD Test which assesses the concussed athletes studied along a speed of rapid number naming to continuum of recovery is warranted. capture impairments in eye movement and is becoming a widely accepted tool for rapid sideline

S-14 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Doctoral Oral Student Award Finalists 13F10DOBITuesday, June 25, 2013, 9:30AM-10:45AM, Palm B; Moderator: Brian Ragan,13178DOTE PhD, ATC

Predictors Of Frontal Plane (HERMVIC), hip adduction, and knee The Effects Of Two Ankle

Knee Kinematics During A extension (KEXTMVIC) were assessed Destabilization Devices On Single-Leg Squat Task In using a hand-held dynamometer. Main Electromyography Measures Females With Patellofemoral Outcome Measures: Knee abduction During Walking In Patients With Pain (KAB) angle at the time of maximal Chronic Ankle Instability Goto S, Padua DA: Sports knee flexion was averaged across three Donovan L, Hart JM, Hertel J: Medicine Research Laboratory, separate SLS trials. Peak values were University of Virginia, University of North Carolina, averaged across three trials for each Charlottesville, VA Chapel Hill, NC MVIC measure. Separate Pearson Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 product moment correlations were Context: Individuals with chronic Context: Decreased gluteal and thigh performed to identify the association ankle instability (CAI) have been shown muscle strength has been suggested to between KAB angle and each MVIC to have deficits in neuromuscular contribute to altered frontal plane knee measure. A backward stepwise multiple control and altered gait patterns. Ankle kinematics in individuals with regression analysis was performed destabilization devices may improve patellofemoral pain (PFP). using those MVIC variables neuromuscular control by increasing Strengthening of these muscles is significantly associated with KAB to lower extremity muscle activation, often a component of PFP determine the association between the which may improve ankle stability. rehabilitation programs. However, KAB angle and MVIC variables Objective: To compare EMG there is little research investigating the (˜<0.05). Results: We observed activation of lower extremity muscles association between gluteal and thigh significant correlations between KAB during walking gait while wearing 2 muscle strength with frontal plane knee angle with HABMVIC (r=0.56, p=0.029), different ankle destabilization devices. kinematics in those with PFP. and HERMVIC (r=0.548, p=0.034), and Design: Crossover. Setting: Objective: To examine the a trend correlations with HEXTMVIC Laboratory. Patients or Other association between frontal plane knee (r=0.457, p=0.087). Regression Participants: Fifteen young adults kinematics and strength of the gluteal analysis revealed that both HABMVIC with CAI (height=173±11cm and knee extensor musculature in and HERMVIC were predictive of KAB mass=72±14kg age=23±4 sex=M:5 those with PFP. Design: Cross- angle during the SLS in those with PFP F:10) participated. Intervention(s): 2 sectional regression. Setting: (R =0.44, p=0.032). Conclusion: Surface EMG electrodes were placed Research laboratory. Patients or Other Based on these findings, the combination over the anterior tibialis (AT), Participants: Sixteen females with of HABMVIC and HERMVIC predicted peroneus longus (PL), and lateral PFP participated in this study nearly half of the variability in KAB angle gastrocnemius (LG). Subjects walked (Age=25.3±6.1 years; Height= during the SLS in individuals with PFP. shod, with an ankle destabilization 164.5±8.5cm; Mass=61.4±11.1Kg). However, neither HEXTMVIC nor device (ADD), and an ankle Participants with PFP had at least two KEXTMVIC were associated with KAB. destabilization sandal (ADS) in random months of anterior, lateral or retro Less HABMVIC and HERMVIC are associated order. The protocol consisted of 30 patellar pain during walking, running, with greater KAB angle. Increased KAB seconds of treadmill walking at 4.83 stair ascent or descent, squatting, and/ has been suggested to increase contact km/h during each condition. Stance or sitting for an extended period of pressure at the patellofemoral joint, time was determined with foot time, no other lower extremity injuries which leads to cause pain. These findings switches. Main Outcome Measures: within six months prior to the testing, suggest that exercises focused on Normalized amplitudes (100ms pre- and negative findings on examination improving HABMVIC and HERMVIC may be and 200ms post-initial contact) and of ligaments and menisci. effective for decreasing KAB during time of onset activation relative to Interventions: Knee abduction angle functional tasks in PFP patients. initial contact were analyzed for 9 was assessed using a seven-camera steps. Muscle activation was infrared optical motion capture system determined for each muscle if the while participants performed three amplitude was 10 SD over the mean separate single-leg squat (SLS) tasks amplitude during quiet standing. A at a standardized speed. Three separate negative value for time of onset maximum voluntary isometric represents muscle activation prior to contraction (MVIC) trials during hip initial contact. Percent of activation abduction (HABMVIC), hip extension was calculated as the proportion of the

(HEXTMVIC), hip external rotation total time across the stride cycle that

Journal of Athletic Training S-15 13257DONE the amplitude was greater than the Instrumented Anterior between each trial. Data was previously described threshold. Each Mobilization Of The Ankle collected at 1000Hz. Main dependent variable was compared Joint Increases Contralateral Outcome Measures: Event- using a repeated measures ANOVA and Somatosensory Cortex related desynchronization (ERD, post-hoc t-tests as appropriate. The Activation In Healthy Subjects %) in upper Alpha Frequency (10- level of significance was set a priori Needle AR, Baumeister J, 12Hz) was used to detect changes at Pd”0.05. Results: The pre-contact Schubert M, Reinecke K, in maximal ERD amplitude from a amplitudes of the PL and LG were Higginson JS, Swanik CB: period of baseline (BASE, -2000 to significantly greater in the ADD (PL University of Delaware, Newark, -1000 ms prior to loading), and 0.34±0.18, p=0.003; LG 0.22±0.15 the first 2000ms of load DE, and University of Paderborn, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 p=0.003) and ADS (PL 0.30±0.11, Paderborn, Germany application (LOAD1=0 to 1000ms; p=0.003; LG: 0.18±0.15, p=0.028) LOAD2=1000 to 2000ms) for the conditions when compared to shod Context: Ankle joint loading and joint CP3 electrode position, which (PL 0.20±0.10; LG 0.09±0.05). The mobilization have been demonstrated represents the contralateral post-contact amplitude of the AT was to affect the nervous system at multiple somatosensory area of the cortex. significantly lower in the ADD levels, resulting in increased joint Bonferroni corrected T-tests were (2.17±1.95, p=0.031) and the ADS sensation and tied closely to the used to compare ERD changes (2.24±2.14, p=0.015) conditions magnitude of motor responses. between BASE, LOAD1 and LOAD2 when compared to shod (3.02±2.92). While previous research has conditions. Results: Ankle load The post-contact amplitude of the PL quantified changes in peripheral causes a significant increase in was significantly greater in the ADD afferent traffic as well as reflexive ERD in the contralateral hemisphere (1.62±0.97, p=0.001) and the ADS motor activity, it remains unknown from BASE (0.6±0.7%) to LOAD1 (1.33±0.64, p<0.001) conditions whether activation can be measured (36.8 ±16.6%, p<0.0001) as well as when compared to shod (0.76±0.37). in the somatosensory cortex from BASE to LOAD2 (LOAD2 The AT was activated significantly during joint loading. This data =33.4±15.2%, p<0.0001). No later in the ADD (-0.23±0.13ms, would provide initial evidence significant difference could be p=0.003) and the ADS (- regarding how sensory integration demonstrated between LOAD 0.30±0.14ms, p=0.009) conditions of joint loading is occurring in the conditions. Conclusions: when compared to shod (- central nervous system, even at Anterior joint mobilization at the 0.36±0.17ms). The AT, PL and LG minimal force levels such as those ankle increases upper Alpha ERD were activated significantly longer provided during joint mobilization. during the first 2000ms of joint across the stride cycle in the ADD Objective: To investigate the effect loading and suggests an activation (AT 61.1±30.3%, p<0.028; PL of anterior joint mobilizations at of the contralateral somato- 48.8±11.9%, p=0.001; LG 31.4 the ankle joint on contralateral sensory cortex while load is ±17.4%, p=0.05) condition, but only somatosensory cortex activity using applied. This data is the first to the AT and PL were higher in the ADS electroencephalography (EEG). detect alterations in cortical (AT 60.9±28.8%, p=0.001; PL Design: Single group post-test only. activity during in-vivo joint 44.4±12.7%, p=0.005) condition Setting: University laboratory. loading, and lends support to a when compared to shod (AT Patients or Other Participants: significant role of the brain during 53.1±26.7%; PL 36.0±10.3%; LG Nine subjects (2 male, 7 female, ankle joint mobilizations, even at 21.1±12.2%). Conclusions: Both 21.0±2.6yrs, 165.0±9.0cm, 62.2 relatively small loads. This ankle destabilization devices caused ± 13.2kg) with no history of injury approach could improve our substantial alterations in muscle to the ankle joint participated in understanding of sensory inte- activity during walking. The this study. All subjects were right gration that must occur between destabilization devices may be leg dominant. Interventions: the sensation of injurious loads useful adjuncts for use in Subjects were fitted with an EEG and the formation of a reflexive rehabilitation programs for CAI. cap following international response. Future investigations standards (impedance<5k˜) and using this methodology may target ask to lay supine on a treatment how somatosensory cortex table as a modified ankle activation is affected among arthrometer was used to load the pathologic populations, and across ankle from -30N to 125N. A total various treatments. of 50 trials were performed on the dominant leg, with 5 seconds

S-16 Volume 48 • Number 3 (Supplement) May 2013 13F09DOSP 13168DOSP

Long-Term Upper Extremity t-tests and Cohen’s d was calculated as Effects Of Exercise On Motor Performance Following a measure of effect size. Significance Measures Of Cerebral Blood Concussion: A Preliminary was noted when p<0.05. Results: Flow Integrity Using The Brain Investigation Significantly slower responses Acoustic Monitor In Healthy Martini DN, Scott SM, Weindorf (concussed vs controls) to the lighted Individuals JH, Hudson SR, Broglio SP: targets were recorded by those with a Acocello S, Broshek D, Cooke A, Neurotrauma Research previous concussion for the average Saliba S: University of Virginia; Laboratory, University of time between targets on all conditions Charlottesville, VA, and Active Michigan, Ann Arbor, MI (0.71s+0.10 vs 0.63s+0.09, d=0.79, Signal Technologies, Inc, p=0.05) and the average time between Baltimore, MD Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Sport related concussion has horizontal targets for the left hand historically been viewed as a transient (0.60s+0.04 vs 0.54s+0.07, d=0.91, Context: Standard assessment of injury void of long term consequences. p=0.03). Non-significant differences concussion does not currently include Emerging evidence however, suggests with large effects sizes were seen for measurements of physiological changes to gait and balance can persist the average time between horizontal deficits, such as cerebral blood flow, years after symptoms resolution. targets for the right hand (0.62s+0.08 immediately post-injury. A new device, Investigations into upper extremity vs 0.58s+0.05, d=.63, p=0.11) and the Brain Acoustic Monitor (BAM), is motor performance have not been average times between horizontal and purported to detect cerebral blood conducted. Objective: The purpose vertical targets for the right hand flow changes that occur after mild of this investigation is to evaluate for (0.76s+0.06 vs 0.71s+0.08, d=0.74, traumatic brain injury through the differences in upper extremity motor p=0.07) and left hand (0.74s+0.05 vs amplification and comparison of sound performance between previously 0.70s+0.08, d=0.68, p=0.09). waves created by cerebral arteries and concussed and unconcussed young Conclusions: These data are the first a reference artery in a peripheral limb. adults. We hypothesize that the to demonstrate long-term changes to Were clinicians to begin using this previously concussed participants will motor performance in the upper device in an athletic population as an demonstrate impaired motor extremity in those with a concussion assessment tool immediately performance. Design: Cross- history. These findings parallel following injury, it is necessary to sectional study design. Setting: previous work indicating lower examine what effect exercise has on Research laboratory. Patients or extremity deficits in a similar cohort. the stability of BAM measures. Other Participants: A total of 27 How these deficits may manifest in Objective: To determine the effect of young adults (20.6yrs, 71.6kg, later life is not clear, but the deficits exercise on outcomes associated with 174.3cm) with (n=14; 20.1yrs, 72.3kg, to recognition and response to the the Brain Acoustic Monitor. Design: 174.5cm, 2.0 concussions, 3.1years lighted targets may have implications Repeated-measures pretest-posttest. prior) and without (n=13; 21.1yrs, to sport performance. This project Setting: Laboratory. Participants: 70.7kg, 174.1cm) a history of was funded by the Rackham 20 healthy, recreationally active diagnosed concussions volunteered Graduate School and the National individuals (10 males and 10 females; for this investigation. Interventions: Athletic Trainers’ Association – age: 23.4±4.3years, height: Each participant completed a single, 15 Research and Education Foundation 173.4±10.9cm, mass: 69.1±14.2kg) minute evaluation of upper extremity volunteered. Interventions: Ten 10- motor performance on the ULTrA second BAM measurements were Board. The evaluation consisted of obtained every 15 minutes for one hour unilateral and bilateral responses to prior to and following (T1= lighted targets in the vertical and immediate, T2 = 15min post; T3 = horizontal planes. Main Outcome 30min post; T4 = 45min post, T5 = Measures: The primary variables 60min post) completion of a 20 evaluated were average time between minute treadmill program. The targets on all conditions; average times treadmill program consisted of a 5 between horizontal targets for the right minute warm-up period and 15 minutes and left hands; average times between of sustained submaximal exercise. horizontal and vertical targets for the Subjects were asked to maintain a pace right and left hands. The average that would equate to a Borg Rating of response times between targets were Perceived Exertion of 14 out of 20. compared using independent samples Speed was manipulated by the subject

Journal of Athletic Training S-17 to maintain this level of exertion. Main Outcome Measures: The outcome measures associated with the Brain Acoustic Monitor are left brain (LB) and right brain (RB) ratio and divergence (measured in voltage). Ratio is a measure of the positive to negative acoustic signal deflection given by the cerebral arteries. Divergence is the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 difference in component frequencies between the brain signal and the peripheral arterial reference. The three best measures taken at the time point immediately prior to exercise and at each time interval following (T1, T2, T3, T4, T5) were averaged and analyzed using a 4 separate 6- factor ANOVAs. Results: Pretest measures (3.75 ± 0.89V) of LB ratio were significantly greater than those obtained at T1 (2.74 ± 0.64V; t=3.65, p=0.002), T2 (3.03 ± 0.61V; t=2.52, p=0.021), and T3 (3.17 ± 0.60V; t=2.37, p=0.03). No other time points were significantly different for LB Ratio, RB Ratio (F(5,15)=2.25, p=0.103), LB Divergence

(F(5,15)=1.65, p=0.208), or RB

Divergence (F(5,15)=0.609, p=0.70). Conclusions: These results indicate that minimal alteration in BAM measures of cerebral blood flow occurs following 20 minutes of aerobic exercise. Some change in LB ratio was seen but this change was not found in RB ratio measures. This suggests that during clinical use, a 30 to 45 minute waiting period may be indicated before accurate measurements of cerebral blood flow integrity can be obtained using the BAM.

S-18 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Thematic Poster Presentations: Hydration and Cooling Interventions 13245SOEXTuesday, June 25, 2013, 11:00AM-12:30AM, Palm B; Moderator: Michelle Cleary, PhD, ATC

Influence Of Cold Water level was set a priori at 0.05. Hedges’ potential effects of CWI on return to Immersion On Recovery Of g effect sizes were calculated. PRE values past 40h was not possible. Elite Triathletes In The Results: CWI group (n=12; IL6 and CORT returned to similar PRE Ironman World Championships height=175.8±6.4cm; percent body values by 40h. Thus, one bout of CWI Stearns RL, Casa DJ, DeMartini fat=11.3±4.7%; finish time immediately following an ironman JK, Huggins RA, Munõz CX, (hr:min)=10:30±00:50h) was similar race did not affect markers of muscle (p>0.05) to CON (n=21; height=

Pagnotta KD, Volk BM, Kupchak damage or inflammation up to 40h Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 BR, Maresh CM: Korey Stringer 173.5±8.4cm; percent body post race compared to CON. Institute, Department of fat=11.5±4.4%; finish time= Kinesiology, University of 11:21±1:33h) except for age Connecticut, Storrs, CT (CWI=34±11y vs CON=43±10y; p=0.020). There was no significant Context: Ironman Triathlons impose difference between CWI and CON for intense physiological stresses. Cold- any variable across time (CK, MYO, water immersion has been debated to IL6, CORT, CRP, DOMS). However, an improve recovery, however, no study overall effect of time occurred for all has examined its effect following an variables. CK, MYO, CRP, and DOMS Ironman. Objective: Examine the were significantly elevated POST impact of cold-water immersion on (637±298IU/L(p<0.001), recovery following an Ironman 43±15nmol/L (p<0.001), 24.76± Triathlon. Design: Observational field 15.24nmol/L (p=0.025), 76.8± study. Setting: 2011 Ironman World 13.3mm (p<0.001), respectively) and Championships in Kona, Hawaii remained elevated through 40h (28.9°C, 71% relative humidity). (706±559IU/L (p<0.001), 4±4nmol/L Patients or Other Participants: 33 (p=0.016), 2.34±1.16mg/dL 222.86 subjects (n=22 males, 11 females) ±110.48nmol/L (p<0.001), 63.2± entered in the Ironman World 24.8mm (p<0.001), respectively). IL6 Championships (Mean±SD: age= significantly increased POST 40±11y; height=174.5±9.1cm; 0.67±0.18pg/dl; (p<0.001) however, percent body fat=11.4±4.1%). Inter- returned to similar PRE values at 40h ventions: Ten minutes of cold-water (0.004±0.003pg/dL). CORT was immersion to the sternal notch significantly elevated at POST (10.4±0.2°C) immediately upon race (3461±658nmol/L; (p<0.001). finish. Subjects were randomized post Moderate effect sizes occurred for race into a control group (CON) or MYO at 16h (0.40), while small effect intervention group (CWI). Data sizes occurred at POST for CORT (- collection occurred prior to (PRE), 0.29), CK (0.28), and IL6 (-0.30). IL6 immediately post (POST), 16 hours was correlated with finish time at 16h (16h) and 40 hours (40h) post race. (r=0.378, p=0.30) and %B (r=0.454, Main Outcome Measures: Myo- p=0.008) at POST. %R was correlated globin (MYO), creatine kinase (CK), with CK at 16h (r=0.349, p-0.047) and interleukin-6 (IL6), cortisol (CORT), 40h (r=0.365, p=0.37). Conclusions: C-reactive protein (CRP) and delayed The Ironman resulted in significantly onset muscle soreness (DOMS). A elevated muscle damage and two-way mixed model ANOVA inflammatory markers. No effect of examined differences across time and CWI vs CON was observed within the between groups. Pearson’s bivariate examined time frame. However, correlations compared finishing time indices for muscle damage and DOMS and percent of time spent during bike remained elevated through the 40h (%B) and run (%R) sections. Alpha time point, therefore observation of

Journal of Athletic Training S-19 13465DOEX 13377FOEX

Thermoregulatory Responses In finish time. Results: Mean finish Body Temperature In Baseball Triathletes During A Competitive time was 790.26 ± 87.01min. Mean Umpires Wearing Cooling Vests

Ironman Race In A Warm Tgi at PRE (n=27), T1 (n=16), T2 During Activity Environment (n=25), and POST (n=27) were McDermott BP, Erickson SM, DeMartini JK, Casa DJ, Stearns 37.39 ± 0.34°C, 38.06 ± 0.42°C, Sroufe AM, Letendre MA: RL, Creighton BC, Muñoz CX, 38.27 ± 0.28°C, and 38.42 ± 0.55°C, University of Arkansas,

Apicella JM, Huggins RA: Korey respectively. Tgi was significantly Fayetteville, AR; Umpire Medical Stringer Institute, Department of higher from PRE to POST race (1.03 Services, Major League Baseball,

Kinesiology, University of ± 0.6°C; p<0.001). Additionally, Tgi New York, NY; Jasper County was significantly elevated at T1 and Hospital, Rensselaer, IN Connecticut, Storrs, CT Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 T2 compared to PRE (p<0.001), while T was also significantly Context: The unique stress of an gi Context: Exertional heat illness Ironman triathlon involving a 2.4 mile higher at POST compared to T1 remains a potential for those employed swim, 112 mile bike, and 26.2 mile run (p=0.037). Pearson correlation in environmental extremes. Baseball leads to extreme yet variable revealed no significant interaction umpires have attempted external between ˜T and finish time (r= physiological and biochemical stress. gi mechanisms to assist body Thermoregulatory responses during -0.17, p>0.05) Conclusions: temperature maintenance during ultra-endurance exercise are often Ironman competitors are a unique activity. Previous research on limited to measurements before and cohort of athletes who are exposed preventive cooling vests (CV) and after exercise, warranting further to extreme physiological demands thermoregulation have focused on investigation of repeated monitoring due to the ultra-endurance nature of moderate to severe temperature of the thermoregulatory demands their sport. In-race monitoring differences at the modality-skin imposed on the body during this event. provided an enhanced understanding interface. Objective: Determine Objective: Observe the response of of the thermoregulatory response to effectiveness of CV that creates a gastrointestinal temperature (T ) in the Ironman race. The Ironman event minor thermal gradient at the gi resulted in a significantly higher T triathletes during a full Ironman gi modality-skin interface on body distance triathlon race. Design: at all time points compared to pre- temperature and thermal sensation race measurements, while T was not Observational field study. Setting: gi responses in baseball umpires during 2012 Lake Placid Ironman Triathlon correlated to finish time. work. Design: Observational field (WBGT= 22.1 ± 2.0°C). Patients Additionally, likely due to the study. Setting: Single Arizona fall or Other Participants: Ironman intense biomechanical nature and league baseball season (92.6 ± 3.5°F, triathletes participating in the 2012 prolonged exposure to 13 ± 7%RH). Patients or Other Lake Placid Ironman (n=27; environmental conditions, the Participants: 12 baseball umpires age=39.9 ± 8.0y; height=174 ± combined bike and run portions of (183.9 ± 6.5cm, 95.5 ± 9.6kg, 23.8 11cm; body mass=73.1 ± 9.6kg; the race resulted in a further increase ± 4.7 % body fat) rotated coverage in T . However, despite being body fat=15.13 ± 6.19%). gi between 3 stadiums and voluntarily Interventions: All participants took exposed to physical, environmental, participated. Interventions: an ingestible temperature sensor the nutritional, and biochemical Participants were randomly assigned stressors that resulted in mild to wear a CV (HTFx, Inc., evening before the Ironman race. Tgi was recorded via handheld receiver hyperthermia, the participants were Melbourne, FL) that changes phase able to avoid a detrimental rise in T before the race (PRE), during the gi at 50°F or no vest (NV) under normal swim-to-bike transition (T1), during and potential of a subsequent heat padding and uniform umpiring. the bike-to-run transition (T2), and illness that is commonly seen in Subjects took an ingestible immediately following the race higher intensity exercise. thermistor to quantify gastro-

(POST). Data were analyzed via one- intestinal temperature (TGI) at least way ANOVA and are presented as 5 hours prior to data collection. mean ± standard deviation. Umpires reported to a researcher Additionally, a Pearson correlation located near a dugout every ½-inning was performed to examine the for TGI and thermal sensation relationship between delta (POST- assessment. Data collection PRE) thermoregulatory response included 20 total games and analysis was run on 18 plate umpire (PUM) (˜Tgi) and finish time. Significance level was set a priori at p<0.05. and 48 field umpire (FUM) games.

Main Outcome Measures: Tgi, S-20 Volume 48 • Number 3 (Supplement) May 2013 13296FOEX

volume consumed(L), SR(L/hr), urine Main Outcome Measures: TGI, Comparison Of Practice Versus thermal sensation, and average Game Hydration Behaviors In specific gravity(Usg) via clinical refractometer, urine color (U ) via increase in TGI for every ½-inning. Collegiate Women’s Soccer col Repeated measures ANOVAs were Yeargin SW, Minton DM, Torres- color chart, and BML(kg). One way used to analyze treatment McGehee TM, Rosehart S, Paper ANOVA was conducted for fluid differences. Independent t-tests S, Whittington E, Sutton K, consumed, SR, and hydration status were used to identify differences in Emerson CC: University of South variables. Post hoc paired t-tests were conducted for hydration status average TGI increases. Alpha was set Carolina, Columbia, SC variables. Results: Players consumed a priori at d”0.05. Results: TGI was significantly increased compared to more fluids during games than Context: Time constraints during Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 pre-game at every time point after soccer games and team dynamics practices(1.7±0.7L vs. 0.8±0.5L; 1.5 innings in PUM (pd”.042) and during practices provide challenging P<0.001).Participants consumed more water during games than FUM (pd”.001). TGI was consistently circumstances to optimize hydration lower, although not significantly strategies. Previous research has practices(1.1±0.7L vs.0.5±0.4L; (p=.469), with CV (100.40 ± examined hydration behaviors in P<0.001) as well as CEB (0.6±0.5L 0.19°F) compared to NV (100.59 ± collegiate women’s soccer players vs. 0.5±0.3L; P=0.79), respectively. 0.19°F) in PUM. Similarly, FUM during preseason practices. However, SR were greater during games than practices(1.6±0.5L/hr vs. 0.8±0.3L/hr; demonstrated non-significant TGI behavior difference between practices differences (CV: 100.13 ± .12°F; and games has not yet been explored. P<0.001). Activity time was longer in NV: 100.27 ± 0.13°F; p=.428). On Objective: To observe and compare practices than games(1.6±0.3hrs vs. 1.4±0.4hrs; P=0.039). Players arrived average, TGI was 0.19°F and 0.14°F hydration status and fluid intake during less with CV than NV for PUM and games and practices. Design: to games hydrated(1.014±0.007μG, FUM, respectively. There was a Observational crossover design. 3±1) compared (P<0.001) to minimal significant attenuation in the average Setting: Outdoor soccer field during dehydration for practices (1.020± 0.008μG, 4±1). BML during games and increase in TGI in PUM with CV August environmental conditions. versus NV (p=.038), but not FUM Patients or Other Participants: Ten practices(0.7±1.0kg vs 0.6±0.7kg) (p=.236). Thermal sensation was (19±1yo, 171.6±4.3cm, 65.6±9.6kg) were similar. Practice hydration status increased pre to post for U significantly increased after 5.5 DI collegiate women’s soccer players, sg innings compared to pre-game in representing a variety of positions. (1.020±0.008 μG vs 1.022±0.012, P=0.336) and U (4±1vs 4±1; PUM (pd”.025), and after 0.5 innings Participants attended an informational col in FUM (pd”.001). Thermal meeting and signed a consent form P=0.020;) respectively. Game sensation was significantly prior to participating. Interventions: hydration status also increased pre to post for U (1.013±0.006 μG decreased with CV in FUM (CV: The independent variable was playing sg 5.2 ± 0.1; NV: 5.6 ± 0.1;p=.032), activity with two levels- game and vs 1.024±0.008, P<0.001) and U (3±1vs 5±1; P<0.001) but not PUM (CV: 5.1 ± 0.2; NV: practice. Players participated in both col 5.6 ± 0.2; p=.150), despite a larger conditions. Five practices and 3 games respectively. Conclusions: Despite mean difference (PUM: 0.5 were observed within 10 days. For pre time constraints during games, vs. FUM: 0.4). Conclusions: and post practices and games, players players employed hydration strategies CV provided favorable results arrived to the locker room and that took advantage of the time, resulting in greater consumption in preventing a rise in TGI in PUM. provided a urine sample and a semi- FUM demonstrated positive, but nude weight, which calculated body of fluids compared to practice. Even not significant advantages. Future mass loss(BML) and sweat rates(SR). with the significant consumption of research is warranted using CV on To record fluid consumed during fluids, the higher intensity of games participants engaging in more intense practice, each player was provided two resulted in higher sweat rates and fluid exercise and with greater thermo- fluid bottles, one containing a losses, ultimately eliciting greater regulatory challenge to determine carbohydrate-electrolyte beverage changes in hydration status. Activity clinical applicability of CV. (CEB) and one water. Playing/activity time was increased during practices, time was recorded for each player however break opportunities were during games and for groups during anecdotally more frequent, and practices via an activity log. decreased fluid consumption was Researchers did not intervene in any offset by lower sweat rates. other manner. Main Outcome Measures: Dependent variables included practice/game activity time,

Journal of Athletic Training S-21 13156DOEX 13342DOEX

Individualized Rehydration Main Outcome Measures: Percent Hydration Measures Of Division Protocol Resulted In Greater body mass (BM) loss, heart rate (HR), I Collegiate Female Soccer

Relative Fluid Replacement gastrointestinal temperature (TGI), Goalkeepers And Field Players Than Ad Libitum Hydration time, plasma volume (PV) shifts, urine Minton DM, Torres-McGehee TM,

During A 20-km Trail Race In osmolality (Uosm), and serum Yeargin SW, Rosehart S, Paper S,

The Heat electrolytes. Results: HR and TGI Whittington E, Sutton K, Emerson Lopez RM, Casa DJ, Jensen K, responses were similar between CC: University of South Carolina, Bailey B, Ballard K, DeMartini conditions. Subjects drank only 32 ± Columbia, SC JK, Kupchak B, Lee E, Pagnotta 13% of their water losses in AL and 66 ± 13% of their water losses in the K, Roti M, Stearns RL, Volk BM, Context: Much of the hydration Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Yamamoto LM, Armstrong LE, IR trial (P<0.001). Concordantly, AL research within competitive soccer has Maresh CM: University of experienced greater BM losses (-2.6 utilized male athletes; additionally, Connecticut, Storrs, CT, and ± 0.5%) compared to IR (-1.3 ± 0.5%; goalkeepers (GK) are often excluded University of South Florida, P<0.001). A relative hydration deficit from research studies. Although GK Tampa, FL in AL vs. IR hydrated participants was do not cover as much distance during further corroborated by Uosm practices as field players (FP), they Context: Proper hydration is differences between pre- and post- are required to perform high intensity, imperative for athletes striving for race (-273 ± 146mOsm (AL) vs. -145 short duration activities requiring peak physical performance and ideal ± 215mOsm (IR), P=0.032), and strength, speed, and agility. Objective: physiological training responses. changes in %PV in AL (-4.9 ± 5.5%) To determine hydration measures Although laboratory research has vs. IR (-1.0 ± 4.6%; P= 0.013). Pre- among female GK and FP during 11 shown that hydration significantly to post-race changes in serum days of pre-season practice. Design: + - affects an athlete’s physical electrolytes (Na and Cl ) were also Observational cohort study. Setting: performance and physiological greater in AL than IR (P<0.001). Practice facility of a Division I responses, an optimal method of fluid Overall race times between groups collegiate female soccer team in the replacement in the field setting were similar. Conclusions: An Southeastern United States. Patients remains undefined. Objective: To individualized rehydration protocol or Other Participants: Participants investigate how two distinct hydration replaced double the amount of fluid were 17 (3 GK and 14 FP) female protocols affect physiological loss than ad libitum drinking during a collegiate soccer players (age = responses and performance during a 20-km trail race. Differences in fluid 19+1yrs, height = 168.2+5.9cm, 20-km trail running race. Design: consumption negatively affected and weight = 63.8+7.0kg.) Players Randomized, counter-balanced, several hydration indices with AL represented all education levels and crossover design. Setting: Field compared to the IR protocol. Despite FP represented all positions. setting (trails) in a warm environment a clear, quantitative difference in Intervention(s): All hydration (Mean±SD: WBGT 28.3 ± 1.9°C) hydration level, AL and IR did not measures were assessed for 11 differ in HR, T , or race performance. Participants: Well-trained male GI days (14 practices) during pre- (n=8) and female (n=5) runners While IR did not completely replace season training. Participants (39±1y; 175 ± 9cm; 67.5 ± 11.1kg; 13.4 sweat losses, it is recommended that provided a urine sample and weighed ± 4.6% body fat) volunteered for study athletic trainers utilize individual pre- and post-practice. Urine was participation. Intervention: sweat rates when designing fluid measured for urine specific gravity replacement protocols. A more Participants completed two 20-km (Usg) and urine color (Ucol). Weight trail races (5 x 4-km loop) with 2 accurate method of individualizing was measured semi-nude. Volume fluid intake prescription would likely different hydration protocols: (1) ad of fluid consumed (Vfluid) during libitum (AL) condition and (2) result in greater than 66% activity was measured for individualized rehydration (IR) replacement of body water loss and each player by providing condition. At nine water stations, AL perhaps more favorable performance individualized water and carbo- participants drank as much fluid as they benefits in future studies. hydrate-electrolyte beverage (CEB) chose and IR participants drank a bottles. Practice time was recorded prescribed volume of water to replace for each practice, from the beginning their pre-determined, estimated sweat of warm-up to the end of the cool- losses. Data were analyzed using down session. Sweat rate (SR) was repeated measures ANOVA (post hoc calculated by using change in body paired t-tests, significance at Pd”0.05). mass and Vfluid. Main Outcome

S-22 Volume 48 • Number 3 (Supplement) May 2013 13347SOEX

each of the refractometer models and Measure(s): Usg, Ucol, percent change Validity And Reliability Of Two U . Bland-Altman analysis was used in body mass (%˜BM), SR, Vfluid, and Digital Refractometers To A col practice time. Repeated measures Manual Refractometer And Urine to determine mean estimation bias and ANOVAs were used to determine Color direction and 95% limits of agreement differences in all dependent variables Emerson CC, Minton DM, Torres- among refractometers. Results: A between GK and FPs over the 14 McGehee TM, Yeargin SW: total of 714 urine samples were

practices. Results: GK practiced University of South Carolina, utilized for comparisons. Mean Usg for significantly more than FP Columbia, SC MAN = 1.021+0.008˜G, DIP = (1.87+0.5hrs vs. 1.69+0.4hrs, P = 1.020+0.007˜G, and PIP = 0.003). GK consumed similar V 1.019+0.007˜G. Mean U = 5+2. fluid Context: Monitoring athletes’ urine col Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (total = 1.1+0.6L; water = 0.5+0.4L, Strong, significant, correlations were specific gravity (Usg) is recommended CEB = 0.7+0.5L) compared to FP by the National Athletic Trainers’ found between each of the (total =1.1+0.6L; water = 0.7+0.6L, Association to prevent heat illness and refractometer models (MAN-DIP: r CEB = 0.6+0.4L). SR was also similar improve performance. Refractometry =0.98; MAN-PIP: r =0.97; and DIP- for both GK and FP (0.7+0.4L/hr and is considered the gold standard for PIP: r =0.97; P<0.001). Ucol was also 0.8+0.5L/hr, respectively). There were significantly correlated, albeit measuring Usg; however, the use of no significant differences between GK manual refractometers can be time- moderately, to each of the refractometers (r =0.60, P<0.001). and FP for %˜BM, Usg, or Ucol. Mean consuming and subject to user error. Bland-Altman analysis revealed a pre-practice Usg = 1.020+0.001μG Digital refractometers are time- and did not significantly increase post- efficient and reduce subjectivity, mean error of 0.001+0.002 ˜G for practice (1.021+0.002μG). Mean however limited research has DIP and 0.002+0.002 ˜G for PIP. A %˜BM = -0.5+0.5%. Conclusion: examined the validity and reliability of greater percentage of samples with While GK practiced longer, they digital refractometers and no studies measurement error e”0.005˜G was consumed similar amounts of fluid have examined this in an athletic found for PIP (61/741, 8.5%) than DIP during practice and hydration measures population. Objective: To determine (26/741, 3.6%). PIP and DIP both were not significantly different than the the validity and reliability of two had a trend to underestimate Usg FP. Overall, players reported euhydrated commonly used digital refractometer compared to the MAN. and maintained this status. An models to a manual refractometer Misclassification as euhydrated explanation for these results may be the when the MAN indicated (MAN) and urine color (Ucol). Design: continuous education and pre-season Descriptive study. Setting: Division I hypohydrated (defined as Usg hydration measures (e.g., pre-post body collegiate female soccer team >1.021˜G) occurred more mass measures) by the team’s athletic practice facility. Patients or Other frequently with PIP samples (8.5%, trainer, potentially impacting our results Participants: Participants were 26 61/714) than DIP (5.0%, 36/714). and supporting the role of athletic female collegiate soccer players Conclusion: DIP and PIP trainers in hydration education. Despite (19+1yrs, 168.6+3.0cm, 65.1+ measurements of Usg were similar differences in practice time, GK and FP 8.6kg). Intervention(s): As part of a to MAN, however tended to are similar in SR and hydration measures larger study, participants provided pre- underestimate Usg and were more during pre-season practice. Athletic and post-activity urine samples over 19 likely to classify samples as trainers should be aware of days (23 practices and 3 games). Urine euhydrated when MAN classified these similarities to minimize risk was analyzed by a MAN, a “pen-like” those samples as hypohydrated. of dehydration. Future research should digital refractometer requiring the Athletic trainers should be aware examine female soccer players prism to be dipped into the sample of potential error when using at different competitive levels (DIP), and a second digital digital refractometers to monitor and during the season. refractometer requiring ~3ml of Usg. Future research is needed to sample to be pipetted on to the prism examine the validity of digital refractometers compared to (PIP). Ucol was assessed using a Ucol chart. Calibration was ensured prior to plasma hydration measures. each data flight for each instrument.

Main Outcome Measure(s): Usg, measured by MAN, DIP, and PIP, and

Ucol. Pearson r correlations were used to determine the relationship between

Journal of Athletic Training S-23 13119UC

Reoccurring Exertional physician and team physician with an aware of the clinical features of Rhabdomyolysis In A Division II understanding that he would report any exertional rhabdomyolysis to ensure Collegiate Football Athlete: A recognized symptoms upon initial athletes are not undiagnosed as the Case Report development. Since this episode, he clinical features often mimic those of Bennett CC, Eley DM, Berry DC: experienced six additional bouts of muscle cramping and heat-related Saginaw Valley State University, exertional rhabdomyolysis (over a 5- illnesses. Evaluating clinicians must University Center, MI year period), two events, which perform a thorough history and occurred during preseason practices focused exam, in addition to ordering Background: The purpose of this needing, advanced medical attention. a serum CK and urinalysis. In this case report is to document the Normally, the athlete was treated for clinical setting, a CK equal to or Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 treatment and outcome of reoccurring dehydration, myalgia, and muscle greater than five times normal or a exertional rhabdomyolysis in a 22- cramping. Treatment included urine dipstick testing positive for year-old male Division II collegiate increased clear liquid intake, NSAIDS, blood with no demonstrable red blood football player (mass=92.9kg, and hot compresses until symptoms cells upon microscopic assessment height=180.3cm). The athlete first had subsided. The athlete was educated confirms the diagnosis. A urine or began experiencing symptoms when on his condition and possible serum myoglobin is more definitive he was 15-years-old playing high outcomes if symptoms were left when expeditiously available. After school (sophomore) football. It was untreated. He continues to participate treatment for exertional rhab- not until he was 18-years-old and began with physician clearance. domyolysis, athletic trainers and participating in collegiate football that Uniqueness: Exertional rhab- physicians must risk-stratify athletes his condition was diagnosed. During a domyolysis is a common form of for risk of recurrence, consider further strenuous preseason football practice, rhabdomyolysis, affecting individuals testing, and make the decision on he began experiencing full body participating in novel and intense when, if, and under what conditions the muscle cramping with a burning exercise to which they are athlete can safely return to play. sensation in his abdomen. The athletic unaccustomed. This athlete was not training staff treated the athlete for new to the sport and supposedly severe cramping using cold-water understood the sport’s physical immersion and oral fluids. Unable to demands, but still experienced control the cramping, the athlete was subsequent episodes while transported via EMS to the emergency participating in collegiate football. department (ED). Evaluated at the ED, Even with education and constant diagnostic testing (CBC and urinalysis) reminding, he managed to suffer two were positive for abnormal values of more episodes needing emergent Creatine (1.66 mg/dl), Creatine Kinase medical care. Both episodes occurred (9,277 U/L), Bilirubin (2.5 mg/dl), during preseason where the athlete Aspartate Aminotransferase (122 U/ experienced periods of intense L), and hematuria suggesting a training. However, prior to being diagnosis of exertional rhab- diagnosed and educated, he freely domyolysis. Differential Diagnosis: admitted he would have continued to Dehydration, electrolyte imbalance, exert himself further past his maximal potassium deficiency, myalgia, threshold, which could have had fatal inflammatory myositis, exertional consequences. Conclusions: Athletic heat-related illnesses. Treatment: The trainers are well trained in the athlete was admitted to the hospital for management of musculoskeletal 4-days where he received intravenous injuries, environmental illnesses, and fluids (3-days) while undergoing in medical emergencies. However, additional CBC and urinalysis testing. exertional rhabdomyolysis, as Once his CK levels decreased to near presented in this case, may be a normal (males=38-174 U/L), he was condition that commonly goes discharged. Due to the lack of undiagnosed because of the standardized care for exertional commonality of symptoms rhabdomyolysis, the athlete was experienced in other injuries and cleared to return to play by his family illnesses. Athletic trainers need to be

S-24 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Clinical Assessment of Movement Dysfunctions Tuesday,13434MOIN June 25, 2013, 12:45PM-2:00PM, Palm B; Moderator: Anh-Dung13103FOIN Nguyen, PhD, ATC

Investigation Of The scoring criteria, evaluating both the Functional Measures And Body Measurement Properties Of The individual tests and total score. Mass Index As Predictors Of Functional Movement Screen™ Reliability of the test scores was Lower Extremity Injury Among In High School Athletes calculated using intra-class Collegiate Football Players Monfreda AM, Anderson B, correlation coefficients [ICC, (2,1)]. Gribble PA, Ford A, Morrell M, Neumann M, Valovich McLeod TC: Main Outcome Measures: The Pietrosimone BG: University of Athletic Training Program, A.T. Still dependent variable was the research Toledo, Toledo, OH University, Mesa, AZ scoring criteria, including both Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 individual test scores and the total Context: Researchers and clinicians Context: Functional movement is an score. Results: The intra-rater often seek ways to predict and prevent essential component to any athletic reliability of the FMS research lower extremity injury. The star activity. The Functional Movement scoring criteria total score was excursion balance test (SEBT) and the Screen (FMS) consists of seven tests ICC=.83 The following tests Functional Movement Screen (FMS) used to evaluate fundamental demonstrated good reliability have been suggested as tools for movement patterns. The reliability of (ICC>.75): HS total, SM right, SM predicting acute lower extremity (LE) the clinical scoring system has been total, ASLR left, TSPU, RS left. Tests injury. However, the injury prediction published, however there is minimal with ICC’s below .75 included: DS, capability of the SEBT and FMS for research investigating the reliability of HS right, HS left, ILL right, ILL left, collegiate football athletes is not the research scoring criteria in high ILL total, SM left, ASLR right, ASLR established. Body mass index (BMI) school athletes. Objective: To total, RS right, and RS total. Inter- may be another potential predictor of investigate the intra- and inter-rater rater reliability of the research injury, but has had little application reliability of the FMS research scoring scoring total score was ICC=.87. among collegiate football athletes. By criteria in high school athletes. Individual tests resulting in ICCs>.75, utilizing these screening tools, Design: Inter- and Intra-rater including: HS right, SM right, SM clinicians may be able to identify reliability. Setting: Local high left, SM total, ASLR right, ASLR left, athletes at risk for LE injury and schools and outpatient physical therapy ASLR total, and TSPU. The following recommend proper preventative facilities. Patients or Other tests demonstrated poor-moderate intervention strategies. Objective: To Participants: Convenience sample of reliability with ICCs <.75: DS, HS determine the capability of the SEBT, 30 high school athletes (15 females, 15 left, HS total, ILL right, ILL left, ILL FMS and BMI to predict acute ankle males; age 15.8±1.4 years, height total, RS right, RS left, and, RS total. and knee injury in collegiate football 181.4±39.1cm, mass 67.4±6.9kg). Conclusions: The reliability of the players. Design: Prospective cohort. Interventions: Each subject research total score for both intra- and Setting: Athletic training facility. completed the FMS while being inter-rater reliability was good. Patients or Other Participants: One videotaped from an anterior and lateral However, the reliability of the hundred eighty, NCAA Division I view. Tests included: deep squat (DS), individual test scores varied, football players (19.79± 1.38 hurdle step (HS), in-line lunge (ILL), indicating the need for more research yrs;1.86±0.07m,102.29±18.92kg) shoulder mobility (SM), active straight assessing the degree of agreement volunteered to participate. leg raise (ALSR), trunk stability push- between individual tests. It is Interventions: Prior to the 2010- up (TSPU), and rotary stability (RS). recommended for clinicians to obtain 2011 and 2011-2012 football seasons, Videos were imported and edited, prior appropriate training to improve the participants completed a single to video scoring. The primary potential for increased reliability, session in which height and mass, the researcher scored both live and video especially of the individual tests. It anterior reach of the SEBT (A-SEBT) versions on two separate occasions, also seems to be more advantageous and all seven stations of the FMS (deep with the secondary and tertiary to score the FMS live, which allows squat, hurdle step, in-line lunge, researchers scoring videos only. It three-dimensional views of the tests. shoulder mobility, active straight leg should be noted each researcher had raise, trunk stability push-up, and various levels of training with the FMS, rotary stability) were evaluated. Main with wide individual experience. Outcome Measures: Dynamic Descriptive statistics and ICC’s were postural control was measured calculated for the FMS research bilaterally using A-SEBT. The mean of three reaches (cm), expressed as a

Journal of Athletic Training S-25 13410MOMU percentage of the stance limb length Functional Movement Screen and FMS task were tabulated into (cm), was used. Each station of the And Beighton And Horan Joint composite scores. Main Outcome FMS is scored on a 0-3 scale, with a Mobility Index Scores Between Measures: The dependent variables total possible composite score of 21 Levels Of Pubescence In were BHJMI and FMS composite points indicating a perfect Athletes scores. The independent variables were performance. The lowest score of Paszkewicz JR, McCarty CW, maturation stage (3) and gender (2). three attempts in each station was used Van Lunen BL: Old Dominion Between and with-in group differences to create the total score. BMI was University, Norfolk, VA, and A.T. were calculated using separate 2x3 calculated with the following equation: Still University, Mesa, AZ factorial ANOVAs (Pd”0.05) for each 2

weight (kg)/[height (m)] . Certified dependent variable. In the presence of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Athletic Trainers tracked and reported Context: The pubertal growth spurt an interaction or main effect, Fisher’s traumatic ankle and knee injuries. may cause alterations in joint LSD post-hoc comparisons were After the competition season, athletes flexibility, joint laxity, muscular calculated. A Spearman Rho (r) were placed in an injured (traumatic strength, balance, and coordination, analysis of correlation was utilized to ankle or knee injury; n=33) or which could result in an increased assess relationships between FMS and uninjured (n=147) group. Sensitivity incidence of musculoskeletal injuries. BHJMI composite scores. Results: and specificity were used to create The Functional Movement ScreenTM There was a significant increase in positive and negative likelihood ratios, (FMS) and the Beighton and Horan FMS scores (P=0.032) but not BHJMI from which diagnostic odds ratios Joint Mobility Index (BHJMI) may be scores (PRE=2.69±0.40, PUB=1.96 (DOR) were created separately for good clinical tools to identify these ±0.40, POST=3.13±0.43, P=0.131) each outcome measure. Results For changes that occur during across pubertal stages. POST subjects the A-SEBT, a normalized reach adolescence. While the BHJMI has (15.91±0.47) had significantly greater distance of 70.84% was associated been shown to identify differences in FMS scores (P=0.008) than the PRE with strong sensitivity (0.79) and joint laxity in the adolescent subjects (14.28±0.44) and PUB moderate specificity (0.55), with a population, there is no evidence subjects (14.55±0.44; P=0.039). No DOR of 4.63. For the FMS, a score of whether the FMS can identify such differences were identified between 15.5 was associated with low- differences among children. gender and FMS scores moderate sensitivity (0.42) and strong Objective: To compare FMS and (males=15.16±0.38, females =14.67 specificity (0.74), with a DOR of 2.08. BHJMI scores between gender and ±0.35, P=0.351) or BHJMI scores For BMI, a score of 28.97 was pubertal maturation in 8-14 year old (males=2.36±0.35, females= 2.83± associated with moderate sensitivity athletes. Design: Cross-Sectional. 0.32, P=0.321). No significant (0.58) and specificity (0.63), with a Setting: Various athletic facilities. interactions were found between DOR of 2.34. Conclusions: Specific Participants: Sixty-six youth athletes gender and pubescence regarding the SEBT, FMS and BMI measures actively participating on an organized BHJMI composite scores (P=0.503) suggested a LE injury was 2-5 times athletic team (29 females, 37 males, or FMS composite scores (P=0.216). more likely to occur during the 11.45±1.98 years, 151.16±12.67cm, There was no correlation between season. Clinicians and researchers 41.90±12.86kg). Participants were FMS composite scores and BHJMI should continue to examine what categorized into three maturational composite scores (P=0.89) [r(s)=- combination of screening measures categories [pre-pubescent (PRE), 0.017] Conclusions: Our results are the most efficient to implement. early-pubescent (PUB), post- suggest that the FMS may be a good pubescent (POST)] based on the clinical tool for assessing Pubertal Maturation Observational musculoskeletal alterations that occur Scale that was completed by the as a result of the pubertal growth spurt participants’ parent or legal guardian since it can discriminate between prior to participation. Interventions: maturation stages whereas the BHJMI Participants performed each BHJMI may not. A prospective extension of test (9) once, each FMS task (7) a this study to include follow-up of maximum of three times (highest injured participants appears score was documented as task score), worthwhile to determine if the FMS and the three FMS clearing tests. If the can suitably predict injury in clearing test was positive, zero was the adolescent population. scored for the corresponding FMS task. The scores of each BHJMI test

S-26 Volume 48 • Number 3 (Supplement) May 2013 13113MOMU 13057DOBI

Functional Movement Screen™ injury risk. Mann-Whitney U tests Kinematic Differences Between Differences Exist Between Male were used to determine sex Those With And Without Medial and Female Adolescent Athletes differences in individual and total Knee Displacement During A Neumann M, Anderson BL, Huxel composite and research scores. Single Leg Squat Bliven KC: A. T. Still University, Results: Females scored significantly Mauntel TC, Begalle RL, Cram TR, Mesa, AZ lower on the following individual FMS Frank BS, Hirth CJ, Blackburn JT, tests: hurdle step (Composite: Padua DA: Sports Medicine Context: Injury prevention and females=0.2±0.4 pts vs. males= Research Laboratory; University athletic performance are reliant upon 0.45±0.5 pts, P=0.046), in-line lunge of North Carolina, Chapel Hill, NC (Composite: females=2.2±0.7 pts vs. integration of adequate mobility, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 stability, and neuromuscular control to males=2.6±0.5 pts, P<0.001; Context: Knee valgus is described as produce fundamental movement Research: females=13.9±4.8 pts vs. a risk factor for lower extremity (LE) patterns, including squatting and males=17.1±2.9 pts, P=0.009), and injuries, such as ACL rupture. Clinical lunging. Several movement screens trunk stability push-up (Composite: movement assessments are an exist to assess the quality of functional females=2.2±0.7 pts vs. males= important aspect of injury prevention movement and ultimately determine 2.6±0.5 pts, P=0.043; Research: screening and program development, injury risk. The Functional Movement females=13.9±4.8 pts vs. males as laboratory based motion analysis Screen™ (FMS) is a commonly used =17.1±2.9 pts, P=0.009). Females testing for knee valgus motion is not tool, and evidence suggests that also scored significantly lower than clinically feasible. Identifying medial athletes who score <14 points on the males on both the composite knee displacement (MKD) as a marker FMS are at increased risk for injury. [females=13.8±1.8 pts, 95% of knee valgus motion is described However, there is minimal research C.I.(13.2, 14.5), males=15.3±2.1 pts, during clinical movement investigating FMS score differences 95% C.I.(14.5, 16.0), ES=0.82, assessments; however, the validity of and injury risk between healthy male P=0.004] and research total scores MKD as an indicator of valgus motion and female athletes. Objective: To [females=53.2±10.7 pts, 95% has yet to be determined. Objective: investigate sex differences in FMS C.I.(49.2, 57.3), males=63.1±12.5 pts, To compare frontal and transverse individual test and total scores of 95% C.I.(58.5, 67.7), ES=0.91, plane knee and hip angles between healthy adolescent athletes. Design: P=0.001]. Conclusions: Healthy participants who display visual MKD Cross-sectional. Patients or Other female athletes did not perform as (MKD group) during a single leg squat Participants: Sixty healthy well as healthy male athletes on the (SLS) to those who do not (CON adolescent athletes (Male=31, FMS, as indicated by lower group). Design: Cross-sectional. age=16.0±1.1 yrs, height=177.1±8.1 individual test and total scores. Setting: Research laboratory. cm, weight=75.1±11.0 kg; Female The individual tests (hurdle step, Participants: Forty, healthy, =29, age=15.9±1.3 yrs, height= in-line lunge, and trunk stability physically active adults volunteered to 166.5±7.8 cm, weight= 61.8 ±7.4 kg) push-up) that females scored lower participate in this study (CON: n=20, of convenience were tested. than males incorporate components age=20.2±1.5yr, height= 173.1± Interventions: Participants of core stability, balance, postural 10.1cm, mass= 71.0±14.6kg; MKD: performed the FMS, which comprises control, and strength. These results n=20, age=20.2±1.8yr, height= 7 functional movement tests, indicate that females may be at 173.8± 8.8cm, mass=71.8±14.7kg). including: deep squat, hurdle step, in- a higher risk for injury than males, MKD members displayed medial line lunge, shoulder mobility, active possibly due to deficits in core displacement of the patella relative to straight leg raise, trunk stability push stabilization, neuromuscular control, the great toe on at least three of five up, rotary stability and 3 clearance and coordinated movement patterns. SLS trials, whereas the CON members tests. Main Outcome Measures: The Clinicians should be aware of maintained neutral patellar alignment. dependent variables were FMS these sex differences when using the Interventions: Participants individual test scores and total score FMS and developing injury completed five SLS trials to 60- for composite (individual test score prevention programs to address degrees of knee flexion with their range=0-3 pts, total=21pts) and potential injury risk factors. Further dominant leg foot flat on the ground, research (individual test score research is warranted regarding toes pointed forward, and non- range=0-8, 0-12, 0-18, or 0-20 pts, sex differences, and interventions dominant leg flexed at the hip and total=100 pts) scoring methods. to improve FMS scores. knee. An electromagnetic motion Lower scores indicate functional tracking system was used to quantify movement deficits and increased knee and hip joint angles during the

Journal of Athletic Training S-27 13028DOBI descent phase (initiation of knee Medial Knee Displacement Is between age-groups. Odds ratios (OR) flexion to peak knee flexion). Main Associated With Youth Soccer were calculated if a significant (P Outcome Measures: Peak frontal and Player Sex And Age <0.05) association was observed. transverse plane knee and hip joint Frank BF, DiStefano LJ, Padua Results: Overall, there was a angles were averaged across five trials. DA: The University of North significant association between sex A single MANOVA was performed to Carolina at Chapel Hill, Chapel Hill, and MKD frequency (X2 (1, N= 214)= compare peak frontal and transverse NC, and The University of 11.90, P <0.001); females plane knee and hip joint angles between Connecticut, Storrs, CT demonstrated greater MKD frequency groups. Follow-up one-way ANOVAs compared to males (OR= 3.69, 95% were performed as post-hoc analyses. CI= 1.70, 7.99). There was no Context: Sex differences in lower Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Results: A significant difference was extremity injury biomechanics may association between sex and MKD identified between the MKD and CON influence the greater incidence of ACL frequency in the middle school age- group kinematics (Wilks’ injury in female youth soccer athletes. group (X2 (1, N= 92)= 1.01, P= Lambda=.575, F7,32=3.130, P=.012, However, it is not clear when sex 0.315). However, an association 2 ˜ =.406). Follow-up one-way differences in lower extremity between sex and MKD was observed ANOVAs revealed significantly biomechanics, such as medial knee in the high school age-group (X2 (1, greater peak knee valgus displacement (MKD) emerge during N= 122)= 13.42, P <0.001); females (F1,38=15.263, P<.001) in the MKD maturation. Objective: The purpose demonstrated a greater MKD (-12.79±5.62) compared to the CON of this study was two-fold: 1) frequency compared to males (OR= (-6.08±5.23). There were no other Determine if there is a relationship 8.24, 95% CI= 2.31, 29.45). significant differences between groups between sex and MKD frequency, 2) Conclusions: The sex difference in for peak knee flexion (P=.320, effect Determine if there is a difference in MKD prevalence appears to be driven size=.459), knee external (P=.905, MKD prevalence between females and by age, as there was no sex difference effect size=.038) or internal rotation males across age-groups. Design: in the prevalence of MKD between (P=.486, effect size=.222), hip Cross-Sectional. Setting: Field middle school-aged soccer athletes. adduction (P=.497, effect size=.217), laboratory. Patients or Other However, high school-aged female or hip external (P=.877, effect Participants: Elite-level club soccer soccer athletes had over 8 times size=.049) or internal rotation athletes (n= 214) in middle school greater odds of MKD compared (P=.416, effect size=.260) (˜ d”.05). (11-13 year old age-group) (44 males, to their male counterparts. MKD Conclusions: Visual observation of 48 females; age= 12 ±1 yrs, height= is commonly observed during ACL MKD is a biomechanically valid 153.4 ±7.7 cm, mass= 40.4 ±6.2 Kg) injury episodes. The higher prevalence clinical assessment of peak knee and high school (14-18 year old age- of MKD in high school female soccer valgus angle during a SLS. On average, group) (66 males, 56 females; age= 16 athletes may help explain the rise there was 6-degrees more peak knee ±1 yrs, height= 169.9 ±8.1 cm, mass= in ACL injury risk in females from valgus in the MKD compared to the 59.7 ±8.6 Kg) volunteered for this middle school to high school. CON group, which represents a large study. Interventions: Participants Acknowledgements: Funding provided difference between groups (effect performed 3 jump-landings from a 30- by the National Academy of Sports size=1.24). In contrast, the presence cm high box at a distance half of each Medicine and the National Basketball of MKD does not appear to be individual’s height from a white line Athletic Trainers Association. indicative of increased knee rotation, marked on the ground in front of the hip rotation, or hip adduction. While box. Participants were instructed to the presence of MKD is a valid jump from the box, land forward of the indicator of increased knee valgus line, then immediately jump for motion, the relationship between maximum height. Main Outcome MKD and increased risk of LE injury Measure: Participants were requires further study. videotaped and evaluated for the presence of MKD (at least one instance of the center of the patella displaced medial to, or in-line with the great toe) during ground contact. Chi- square tests of association were conducted to determine if MKD frequency was associated with sex

S-28 Volume 48 • Number 3 (Supplement) May 2013 13128MOIN

Landing Error Scoring System errors (Excellent), 4-5 (Good), 6 (LESS) Differences Between (Moderate), and 7 or more (Poor). The Single-Sport And Multi-Sport 3 scored trials were then averaged Female High School Athletes before a t-test was utilized to test Beese ME, Joy EA, Switzler CL, statistical significance between Hicks-Little CA: University of groups. Alpha was set a priori at 0.05. Utah, Salt Lake City, UT Results: Mean scores for SSS group were 6.84 (SD ± 1.81) while the mean Context: The prevalence of single scores for the M-S group were 6.07 (SD ± 1.93). T-value = 1.309 (P>.05) sport specialization (SSS) is becoming Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 more popular in youth sports. Deficits Conclusions: These results indicate in functional movement have been that participation in soccer alone, shown to predispose athletes to injury. compared to participation in multiple With this increase in early SSS, it is sports does not significantly impact unclear whether there is a link between LESS scores in adolescent female SSS and an increased risk of knee soccer players. However, the LESS injury. Objective: The purpose of this scores indicate that the majority of study was to identify functional athletes are at moderate risk for a knee movement deficits between SSS injury regardless of the number of athletes and multi-sport (M-S) sports played (mean LESS score in the athletes. The study goal was to identify moderate to poor range). Adolescent associations that would aid in the athletes should participate in training development of specialized training that works to correct these deficits in programs that could be implemented order to reduce injury risk. More throughout the year to reduce the risk research is needed to identify what of injury. Design: Observational interventions would be most study. Setting: A soccer practice field successful at reducing these risks. and sports medicine research laboratory. Patients or Other Participants: Forty (n = 21 SSS, n = 19 M-S) female high school athlete volunteers, ages 14-18 (Mean age 15.18 SD+/- 1.12) were recruited through local soccer clubs and an Olympic Development Program (ODP). All single sport athletes played soccer. Interventions: All participants completed 3 trials of the standard LESS jump landing task which was recorded and then analyzed at a later date. The subjects performed a double-leg jump from a 30cm platform, landing on a rubber mat at a distance of half their body height. Upon landing, the subjects immediately performed a maximum vertical jump. Main Outcome Measures: Values were assigned to each trial using the LESS scoring criteria. The LESS score is a count of “errors” on a range of easily observable items of movement with a total of 17 scored items. Scores range from 0-3

Journal of Athletic Training S-29 Free Communications, Thematic Poster Presentations: Factors that Influence Concussion Assessment Tuesday, June 25, 2013, 2:15PM-3:45PM; Palm B; Moderator: Michael Ferrara, PhD, ATC 13239MOSP

Predicting Clinical Concussion time, complex attention, cognitive tained via a demographic question- Measures At Baseline Based On flexibility, processing speed, naire prior to baseline testing. Academic Profile And Motivation executive functioning, and reasoning. Trinidad KJ, Schmidt JD, The composite equilibrium score was Register-Mihalik JK, Groff D, Goto used from the SOT as a criterion S, Guskiewicz KM: University of variable for balance. Ten separate

North Carolina at Chapel Hill, multivariate regression models were Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Chapel Hill, NC; Select Physical used with SAT, hsGPA, and motivation Therapy, Durham, NC; WakeMed as predictors (a priori alpha =0.05). Health and Hospitals, Raleigh, NC Results: hsGPA was a significant predictor of the processing speed Context: Baseline concussion standard score (103.73±15.57, 2 measures may be influenced by an F3,82=3.73, p = 0.014; R =0.12). SAT athlete’s academic abilities. Likewise, score was a significant predictor of the previous research suggest that an complex attention standard score athlete’s level of motivation at the time (95.07±36.40, F3,82=3.32, p = 0.024; of testing influences baseline testing R2=0.11) and the SOT composite score performance. Objective: To (76.90±7.07, F3,78=6.31, p = <0.001; determine if unweighted high school R2=0.20). However, these models grade point average (hsGPA), explained only 12% of the variance Scholastic Assessment Test (SAT) in the processing speed standard scores, and motivation scores predict score, 11% of the variance in the neurocognitive and postural control complex attention standard score, performance at baseline. Design: and 20% of the variance in the SOT Cross-sectional study. Setting: Composite score. We did not observe Clinical-Research Center. Parti- any other significant predictors. cipants: 88 NCAA Division 1 Conclusions: Baseline motivation, incoming student-athletes for which all SAT score, and hsGPA explained some predictor variables were available to of variance in baseline measures of the researchers (age: 18.58±0.52 cognitive flexibility, processing speed, years, height: 175.67±12.75 cm, and postural control. However, our mass: 15.85±20.28 kg). Participants model does not explain enough of reported for baseline testing prior to the variance in these scores to be able their playing season. Interventions: to accurately estimate an athlete’s Participants completed a com- baseline performance. Further puterized neurocognitive test (CNS research is necessary to identify other Vital Signs), a balance exam (Sensory factors that might help clinicians Organization Test: SOT), and a measure better assess the validity of an athletes’ of test-taking motivation (Rey’s Dot neurocognitive and postural control Counting Test). Motivation was measures relative to their individual assessed following completion of the capabilities. We suggest that clinicians baseline concussion assessment. SAT continue to consider motivation and hsGPA were obtained from the and academic profile when interpreting university admissions and registrar baseline and post-concussion offices. Main Outcome Measures: measures in the clinical decision The following domains standard scores making process as some of were taken from the neurocognitive the variance was explained with these test battery and used as criterion variables. Academic profile variables: verbal memory, visual information can also be easily ob- memory, psychomotor speed, reaction

S-30 Volume 48 • Number 3 (Supplement) May 2013 13231FOSP 13222DOSP

The Acute Effect Of Stimulant Interventions: Subjects were The Number Of Words And Ingestion On ImPACT Test assessed at the same time of day under Word Choice Can Improve The Performance three conditions, treatment, placebo Standardized Assessment Of Power ME: Marist College, and control with each separated by a Concussion Scores Poughkeepsie, NY period of one week. During the Mc Elhiney DS, Ragan BG: Ohio treatment condition, subjects ingested University, Division of Athletic Context: The management of mild 5.5 g of a supplement (Jacked 3D™, Training, Athens, OH traumatic brain injury (MTBI) has USPlabs) containing a proprietary become an area of great concern and blend that included caffeine and 1,3- Context: The Standardized controversy in the athletic setting. dimethylamylamine (DMAA) in Assessment of Concussion (SAC) is a Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Numerous states have adopted capsule form with water. The placebo common concussion-screening tool legislation mandating evaluation condition consisted of 5.5 g of used to assess the effects of sport- procedures and return to play criteria dextrose in identical capsule form. related concussions. The baseline-post for interscholastic athletics, while Main Outcome Measures: injury comparison recommended by other sport governing bodies have ImPACT™ composite scores for the National Athletic Trainers’ adopted similar policies. Many of verbal and visual memory, visual motor Association (NATA) is an individual- these recommend neurocognitive tests speed, reaction time, impulse control centered approach that emphasizes the like Immediate Post-Concussion and a cognitive efficiency index (CEI) validity and accuracy of baseline test Assessment and Cognitive Testing were compared under each of the three scores. The validity of the SAC (ImPACT™) as a management tool. conditions and were assessed 30 min baseline memory scores has been Due to the restrictive nature of current after ingestion. Results: A significant questioned with because many of the management plans, anecdotal difference was observed (F2,22=4.31, memory items not do meet acceptable concerns have been raised regarding p=.026) when comparing reaction psychometric thresholds, mostly athletes trying to cheat the assessment time, as the subjects reacted faster because the items are “too easy.” and return to play sooner. Various during the treatment condition Objective: To create 5 alternative stimulants have been shown to improve (.535±.03 s) as compared to the version of the immediate and delayed reaction time, visual information placebo (.553±.03 s) and control memory section and then compare the processing and working memory, (.554±.03 s) conditions. A significant original version to the 5 alternative difference (F =4.07, p=.031) was which are similar to the tasks used 2,22 memory versions using Rasch during ImPACT™. Thus, it is possible also observed for the CEI, as the modeling. Design: Observational that stimulant use could improve subjects scored higher during the design. Setting: Laboratory. performance during neurocognitive treatment condition (.486±.09) as Participants: Six hundred twenty-five testing for MTBI. Objective: The compared to the placebo (.415±.10) participants with no history of purpose of this investigation was to and control (.409±.12) conditions. concussion in the previous 6 months examine the effects of a nutritional Conclusions: The results suggest (aged 21.38 ± 1.77 yrs; n = 282 men, supplement containing stimulants on that stimulant ingestion 30 min prior n = 343 women) volunteered for this ImPACT™ performance. Design: A to test administration results in study. Intervention: Participants were randomized and counterbalanced improved reaction time, visual given 1 of 6 different versions of the double blind cross over design was processing speed and memory. SAC. Each version had a different used. Setting: ImPACT™ was However, the question of clinical memory subset (S1 = Original SAC, performed on a desktop computer in a significance remains, as it is unclear S2 = All words from the original 3 quiet, fully enclosed and illuminated if this would result in an earlier versions (5items) given in one list, S3 room at normal room temperature. return to play decision. = 10 new words, S4 = 10 new words, Participants: Health males and S5 = 10 new words, and S6 = S3+8 females (age=20.6±1.2 y, height= news words+8 new words). Common 168.5±10.7 cm, mass= 67.6 ±15.2 kg) items (orientation and concentration with no history of physician diagnosed items) were used to anchor the 6 head injury, learning disability or any versions so the all memory items form of attention deficit disorder would be placed on the common volunteered. Potential subjects were metric in relative position. Main excluded if they were prescribed any Outcome Measures: The Rasch- type of stimulant or monoamine calibrated item difficulties for the oxidase inhibitor for regular use.

Journal of Athletic Training S-31 13311MOSP memory items for the 6 SAC versions. Rasch Model Fit Indices May represent how well the examinees’ A one-way ANOVA with post-hoc Help Identify Effort With responses match the expected analysis was performed to assess if Baseline Concussion Testing responses from the model. The there were any differences across the LaFevor ME, McElhiney DS, advantage of the Rasch model is that it memory items for the 6 versions (˜ = Ragan BG: Ohio University, is highly unlikely an examinee would 0.05). Descriptive statistics of the Division of Athletic Training, know which items to respond participants’ abilities were examined. Athens, OH positively to, thus increasing the Results: Mean item difficulty, number of abnormal responses standard deviation and range for each Context: One major problem facing resulting in an elevated fit index. version: (mean ± SD; Range): S1 (-2.05 pre-season concussion testing is the Thresholds below 1.5 and 2.0 were Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 ± 1.88; -4.86 to 1.38 logits), S2 (0.61 assumption that athletes give 100 used to identify participants giving full ± 1.15; -1.96 to 2.01 logits), S3 (0.17 percent effort, forcing scores to effort. Data were analyzed with ± 1.32; -4.01 to 1.75 logits), S4 (0.54 reflect current “true” ability to make Winsteps 3.75.0. Any person with fit ± 1.03; -2.01 to 2.13 logits), S5 (0.59 post-injury comparisons possible. It is indices greater than the thresholds was ± 1.00; -2.36 to 3.26 logits), and S6 all too common that professional considered to be misfit. Main (0.85 ± 1.28; -4.86 to 3.26 logits). athletes indicate that they deliberately Outcome Measures: The dependent There was a significant difference in do poorly on the baseline test to avoid variables were the number of people mean difficulty between versions not playing after scoring poorly on the with fit indices greater than the (F(5,196) = 29.8; P = 0.05). S1 was second test following a concussion. threshold. The smaller the number of significantly different than the other This intentional deceit represents a full-effort people that fall outside the 5 versions. Mean person abilities for major problem in concussion testing. threshold, the better the performance each version were S1 (0.79 ± 0.89 While some concussion-testing of the threshold. Results: Using the logits), S2 (0.13 ± 0.53 logits), S3 programs attempt to identify abnormal 1.5-fit threshold, 15/625 (2.4%) of (0.03 ± 0.54 logits), S4 (0.25 ± 0.76 performance, they are severely limited participants were identified by the infit logits), S5 (0.25 ± 0.53 logits), and S6 in capability. There is a need to develop statistic, 33/625 (5.3%) by the outfit, (0.33 ± 0.41 logits). Conclusions: methodology to identify abnormal and 40/625 (6.4%) by either infit Our results show that increasing the responses associated with sub- or outfit. Using the 2.0 threshold, amount of words and word difficulty maximal effort in concussion testing. 0/625 (0%) participants were can improve the precision of baseline Objective: To examine various Rasch- identified by the infit statistic, 20/625 scores. Even though 6 different based person fit indices and thresholds (3.2%) by the outfit, and 20/625 versions were administered, Rasch for operationalize a participant giving (3.2%) by either infit or outfit. modeling allows for person’s ability to full effort. Design: Observational Conclusions: Effort is essential to be placed on the same scale. design. Setting: Laboratory. Patients ensure validity during concussion or Other Participants: Six hundred testing. Both thresholds performed and twenty-five participants with no well in classifying participants as full history of concussion in the previous effort. These results support the 6 months (mean ± sd: aged 21.38 ± examination of these thresholds in a 1.86 years; n= 282 men, n= 343 large diagnostic accuracy study. women) volunteered for this study. Because participants had no reason to not want to do well on the baseline test, it is assumed that all participants gave full effort. Interventions: Participants were administered 1 of 6 versions of the Standardized Assessment of Concussion. Data from all 6 versions were calibrated using the Rasch model using common items (orientation and concentration) as anchor items and model data fit was good. Person ability estimates were calculated with appropriate infit and outfit statistics. These fit statistics

S-32 Volume 48 • Number 3 (Supplement) May 2013 13173MOSP

Influences On Annual subsequent baseline test scores. controlled, it is recommended that Computerized Neurocognitive Results: Regression analyses reassessment of collegiate student- Baseline Test Performance In revealed various predictors among athletes occur annually. Collegiate Student-Athletes composite scores. Initial baseline Beidler E, Acocello S, Hertel J, score was a significant predictor of Broshek DK, Saliba S: University all composites (Test 2: CRT, of Virginia, Charlottesville, VA r 2˜=0.303,p<0.001; SRT, r2˜= 0.232,p<0.001; PS, r2˜ =0.495, Context: Baseline neurocognitive p<0.001; Test 3: CRT, r2˜ 2 testing aids clinicians in the =0.05,p<0.001; SRT, r ˜ =0.078, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 management of sport-related p<0.001; PS, r2˜=0.034,p<0.001; concussions, but no universal Test 4: CRT, r2˜=0.027,p=0.03; PS, guidelines have been determined for r 2˜=0.02,p=0.004; Test 5: SRT, frequency of reassessment. Research r2˜=0.234,p=0.006) except Test 4 has shown significant change over time SRT (r2˜=0.348,p=0.226) and Test in high school student-athletes’ scores 5 CRT (r2˜=0.491,p=0.169) and PS warranting annual reassessments, but (r2˜=0.681,p=0.48). Most recent it is unknown if collegiate student- baseline score was a significant athletes should be similarly tested. predictor of all composites on all Objective: To determine which tests taken (Test 3: CRT, r2˜=0.298; factors significantly predict SRT, r2˜=0.32; PS, r2˜=0.593; Test Concussion Resolution Index (CRI) 4: CRT, r2˜=0.552; SRT, r2˜=0.289; baseline measurements. Design: PS, r2˜=0.801; Test 5: CRT, Retrospective Case Series Setting: r2˜=0.491; SRT, r2˜=0.393; PS, Sports Medicine Clinic Patients or r 2˜=0.681; p<0.005 for all). Other Participants: 450 Division I Additionally, CRT was predicted by varsity student-athletes (274 males/ gender, showing females performed 176 females; age: 19±1years) better than males (Test 2, Interventions: A retrospective r2˜=0.18,p=0.001) and age, showing analysis was completed on CRI an improvement in score as age baseline tests administered between increased (Test 3, r2˜= 0.016, August 2006 and December 2011. p=0.044). SRT was predicted by Main Outcome Measures: CRI sport (Test 3, r2˜=0.019,p=0.021) composite scores: complex reaction and history of concussion (Test 4, time (CRT), simple reaction r 2˜=0.059,p=0.011). PS was time(SRT), and processing speed(PS) significantly predicted by gender were collected for repeated baseline (Test 2, r2˜=0.018,pˆ0.001). tests. Prediction variables included Conclusions: These results show age, gender, history of concussion, that initial and most recent baseline history of learning disorder, time tests are the most useful in predicting between baseline tests, performance subsequent CRI performance. There on initial baseline test, performance was, however, no consistency in a on most recent baseline test, and sport. single demographic or self-report Grouping was performed using number variable as a predictor of of consecutive tests taken and analysis neurocognitive function. This could of predictors for each test (2nd, 3rd, 4th, indicate influence of some unknown, and 5th baselines) included only those unmeasured factors such as subjects who had taken the maturation, sport type (i.e. collision corresponding number of tests (i.e. all vs. non-collision), duration/level of subjects did not complete 5 participation, testing environment consecutive tests). Step-wise linear and frequency of testing. Until these regression models were fit to factors are investigated and can be determine which factors predicted

Journal of Athletic Training S-33 13157DOSP 13248UOSP

Baseline Factors Affecting processing speed, executive function, The Effect Of The Environment Neurocognitive Performance On psychomotor speed, reaction time, On Sport Concussion A Concussion Assessment Test complex attention and cognitive Assessment Tool 2 (SCAT2) Littleton AC, Guskiewicz KM: flexibility. Results: The HX group Scores University of North Carolina at demonstrated significantly lower Smith DH, Bowman TG, Bradney Chapel Hill, Chapel Hill, NC scores, indicating worse performance DA, Cowden NE: Old Dominion on 4 of the 8 CNSVS domains University, Norfolk, VA, and Context: Baseline concussion testing analyzed, including verbal memory Lynchburg College, Lynchburg, of all athletes has been recommended, (94.59±19.72 vs. 100.98±17.95, VA p=0.009), executive function so that measures of athletes’ pre- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 injury performance can be used as an (95.12±18.922 vs. 100.54±15.00, Context: With the incidence of accurate comparison post-injury. p=0.015), complex attention concussion in sport on the rise, it is Widespread baseline testing is not (85.16±68.99 vs. 100.99±26.42, crucial that the concussion always feasible and recent literature p=0.018) and cognitive flexibility assessment tools utilized by health has shown that comparison to (93.71±20.07 vs. 100.25±15.27, care professionals be accurately normative data agrees with comparison p=0.005). There were no significant administered. It may be important to to individualized baselines for the differences observed between the consider the environment of test majority of neurocognitive domains. groups on visual memory, processing administration between baseline and However, certain individuals, such as speed, psychomotor speed, or reaction post-concussion assessment to allow those with learning disabilities and a time. Conclusion: Certain college appropriate examination and return to history of concussion may benefit athletes, including those with a history play decisions. Previous work has from individualized base- of one or more previous concussions, found that the testing environment lines. Objective: To determine the a learning disability, ADHD, alters Balance Error Scoring System effect of previous concussion history, psychiatric disorder and/or a total scores. However, there is limited presence of learning disability, baseline symptom score of 5 or more research on the effect of testing psychiatric disorder and baseline total may perform worse than a normative environment on Sport Concussion symptom score on neurocognitive sample on select neurocognitive Assessment Tool 2 (SCAT2) scores performance. Design: Cross- domains. Therefore, baseline testing is although it is the recommended sectional. Setting: Clinical research essential for individuals with a examination tool for concussion. center. Patients or Other Parti- significant history. Additionally, if Objective: To determine if testing cipants: Two-hundred forty Division individuals with a significant history environment has an effect on SCAT2 I college athletes (age: 19.41±1.21, sustain a concussion and do not have a scores in healthy collegiate club height: 70.01±4.90 in, weight: baseline test, their post-injury scores athletes. Design: Experimental, 78.12±18.03 kg). Individuals should be interpreted carefully. randomized controlled clinical trial. identified with a previous concussion, Setting: Uncontrolled sideline of an learning disability, attention deficit athletic field during a practice and a hyperactivity disorder (ADHD) or quiet controlled classroom. Patients psychiatric disorder and/or a total or Other Participants: A total of 18 baseline symptom score of 5 or more healthy male club lacrosse players were placed into a significant history (age=20.39±1.46 years, height group (HX, n=121), all other =180.17±6.92 cm, mass=81.89±8.92 individuals were placed into a control kg) and 15 healthy female club soccer group (CON, n=119). Inter- players (age=19.41±1.24 years, ventions: Subjects were administered height=158.53±6.81 cm, mass= the computerized neurocognitive test 58.85±7.53 kg) with no history of head CNS Vital Signs (CNSVS), including injury within the last 12 months, no a baseline symptom checklist and a lower extremity injuries reported history questionnaire. The main within the past 2 months, and no outcome measures of the HX and CON history of Attention Deficit Disorder group were compared using or Attention Deficit Hyperactivity independent t-tests. Main Outcome Disorder volunteered to participate. Measures: CNSVS standard scores Interventions: Participants for verbal memory, visual memory, completed the SCAT2 test in 2

S-34 Volume 48 • Number 3 (Supplement) May 2013 13355 environments, controlled quiet Psychometric Evaluation Of The correlation. National Commission for classroom and uncontrolled sideline, Standardized Assessment Of Certifying Agencies (NCCA) in 2 testing sessions approximately Concussion In High School standards were used to evaluate which 8.05±1.63 days apart. We counter- Student-Athletes item statistics were appropriate. balanced the testing sessions to reduce Haley JT, Mc Elhiney DS, Ragan Acceptable item difficulty ranged from a practice effect altering the results. BG, Kang M: Middle Tennessee 0.10 to 0.92. Acceptable item Main Outcome Measures: The State University, Murfreesboro, discrimination was a point-biserial SCAT2 is a written standardized TN, and Division of Athletic correlation of >0.10. Based on the concussion test comprised of eight Training, Ohio University, Athens, acceptable item difficulty and components: symptom score, physical OH acceptable item discrimination, an Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 signs score, Glasgow coma scale, item determination was determined to Maddocks score, cognitive Context: The Standardized decide whether or not the item was assessment, balance examination, Assessment of Concussion (SAC) is a acceptable. Results: All three coordination examination, and concussion screening tool used to versions of the SAC had unacceptable cognitive assessment. We used a identify concussions by comparing a items (A = 50%, B = 60%, C = MANOVA to examine the differences baseline score with a post-injury score. 63.33%). The vast majority of the between testing environments for the Previous studies have examined the unacceptable items were in the 8 component scores and the total validity and reliability of the SAC test; orientation and immediate memory score of the SCAT2. Results: We however, one of the most fundamental sections. All five orientation items found statistically significant group evaluations, classic item analysis were considered unacceptable in the mean differences between testing which evaluates the psychometric three versions. Of the 15 items in the environments in the combined properties (i.e., item difficulty and immediate memory section of dependent variables for males discrimination) of the items, has not versions A, B, and C, there were 10, (multivariate F =6.759, P<0.001, 1- 7,28 been examined in high school student- 12, and 14 unacceptable items, 2 ˜=0.998, ˜ =0.628), females athletes Objective: The purpose of respectively. Conclusions: This (multivariate F =8.306, P<0.001, 1- 6,23 this study was to perform an classic study demonstrates that some items on 2 ˜=0.999, ˜ =0.684), and a item analysis on the SAC in order to the SAC are too easy in the high school combination of both sexes examine its validity as a baseline population, which produces a ceiling (multivariate F =11.098, P<0.001, 7,58 measurement for use in high school effect. Increasing number of 2 1-˜=1.000, ˜ =0.573). The modified student-athletes. Design: Observa- acceptable items in the current SAC BESS was most affected by the tional design. Setting: Athletic Trainer is important to ensure the safety of environmental differences in males administered the SAC in a quiet room athletes returning to play following (F =17.118, P<0.001, 1-˜=0.981, 1,34 away from distractions. Patients or concussion. Future research should ˜ 2=0.311), females (F =23.805, 1,28 Other Participants: One Hundred focus on altering the SAC (i.e., 2 P<0.001, 1-˜=0.997, ˜ =0.432), and forty-two high school student-athletes modifying existing items or testing both sexes combined (F =36.767, 1,64 (89=M, 53=F; mean age = 16.13 SD new items) in order to improve the 2 P<0.001, 1-˜=1.00, ˜ =0.351). = 1.18) with no history of concussion item psychometrics of the SAC. Conclusions: SCAT2 scores were within the previous 6 months were impaired when we tested participants recruited for this study. in a sideline environment compared Interventions: The SAC test is with a quiet clinical environment. An comprised of 4 sections assessing outside, uncontrolled environment orientation, immediate memory, can potentially alter SCAT2 scores concentration, and delayed memory. significantly from an inside, Three versions of the SAC, reported controlled environment potentially as equivalent, were counterbalanced due to several factors including and given to each participant. Main noise level, weather, playing surface, Outcome Measures: Iteman software or interference from coaches and (V 3.6) was used to calculate item teammates. We recommend baseline difficulty and item discrimination. SCAT2 testing be administered in an Item difficulty (P) is reported as a environment in which testing after proportion of those who answered an injury will most likely be conducted. item correctly. Item discrimination

(rpb) is reported as a point biserial

Journal of Athletic Training S-35 Free Communications, Thematic Spitfire Session: Neuromuscular and Biomechanical Consequences of ACL Reconstruction 13107DONEWednesday, June 26, 2013, 8:00AM-9:00AM; Palm B; Moderator: Grace Golden, PhD, ATC, CSCS

Quadriceps Activation And tested in the injured limb in a random essential in generating quadriceps Spinal-Reflexive Excitability order. Main Outcome Measures: strength in ACLr patients. Predicts Quadriceps Strength Quadriceps strength was assessed via Interventions targeting neural Following Anterior Cruciate maximal voluntary isometric pathways may be beneficial Ligament Reconstruction contractions (MVIC) normalized to to restore optimal quadriceps Lepley AS, Clements AE, Ericksen body mass (Nm/kg) and performed strength following surgery and

HM, Sohn DH, Levine JW, Gribble at 90° of knee flexion in an potentially improve function. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 PA, Pietrosimone BG: University isokinetic dynamometer. Quadriceps of Toledo, Toledo, OH activation was determined by using the central activation ratio (CAR) Context: Quadriceps weakness is obtained through the burst common following anterior cruciate superimposition technique. ligament reconstruction (ACLr) and Quadriceps spinal-reflexive often persists long after patients excitability was assessed using resume normal activity. Neural maximal Hoffmann reflexes inhibition of the quadriceps may normalized to maximal muscle contribute to this ongoing weakness, responses (H:M). Simple Pearson which could lead to prolonged Product correlations were disability within this population. performed to determine if spinal- New rehabilitative strategies that reflex excitability and voluntary attempt to overcome neural activation had a higher relation to inhibition by increasing voluntary strength. Both voluntary activation activation through stimulation of and spinal-reflexive excitability were neural pathways have been proposed hierarchically added into a multiple to improve muscle strength. Linear Regression to determine Understanding how neural their ability to predict quadriceps 2 excitability and voluntary activation strength. The change in R to the contribute to muscle strength is model from the addition of each critical in developing new predictor variable was also analyzed. therapeutic techniques that will Alpha was set a priori at P<0.05. ultimately improve function Results: H:M (r = 0.528; P<0.01) following injury. Objective: To had slightly higher relation to MVIC evaluate the ability of quadriceps than CAR (r = 0.525; P<0.01). The activation and spinal-reflexive overall multiple regression model excitability to predict quadriceps significantly predicted 45% of the 2 strength in patients with ACLr. variance in quadriceps strength (R Design: Descriptive laboratory = 0.451, P=0.01; MVIC= 1.85H:M study. Setting: Research laboratory. +2.55CAR - 0.081). Initial imputation Patients or Other Participants: of H:M into the model accounted for 2 Twenty-five patients with a history of 27.8% (R =0.278, P<0.01) of the ACLr (17 Female, 8 Male; age: 21.5 variance in MVIC. The subsequent ± 3.9years; height: 171±10.5cm; addition of CAR accounted for a 2 weight: 71.8±17.1kg; 49.9±37.8 significant increase of 17.3% (˜R months post-surgery) who had been = 0.173, P=0.01) in the prediction medically cleared for full capability of the model. participation in physical activity Conclusions: Quadriceps activation were included in this study. and spinal-reflexive excitability Interventions: Vastus medialis predicted nearly half of the variance strength, voluntary activation and in quadriceps strength of ACLr spinal-reflexive excitability were patients. This may be interpreted as evidence that neural pathways are

S-36 Volume 48 • Number 3 (Supplement) May 2013 13031DONE 13018DOBI

Preoperative Quadriceps dynamometer at 60°/second were Anterior Cruciate Ligament Activation Is Associated With averaged and normalized to subject Injury Causes Biomechanical Postoperative Quadriceps body mass (Nm/kg) to quantify Alterations In Both The Injured Activation, Not Strength, quadriceps strength. Main Outcome And Non-Injured Leg: The JUMP Following Anterior Cruciate Measures: Linear regressions were ACL Study Ligament Reconstruction used to examine the relationship Goerger BM, Marshall SW, Beutler Lepley LK, Palmieri-Smith RM: between 1) preoperative and AI, Blackburn JT, Wilckens JH, University of Michigan, Ann Arbor, postoperative activation, 2) Padua DA: George Mason MI preoperative activation and University, Manassas, VA; The postoperative strength and 3) University of North Carolina at Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: It is well accepted that preoperative and postoperative Chapel Hill, Chapel Hill, NC; greater preoperative quadriceps strength. Results: Preoperative Uniformed Services University of strength leads to a better recovery of quadriceps activation was found to be the Health Sciences, Bethesda, strength following anterior cruciate associated with postoperative MD; Johns Hopkins University, 2 ligament (ACL) reconstruction. activation (R =0.169, b=0.412, Baltimore, MD 2 Although quadriceps activation failure P=0.009), but not strength (R =0.018, is considered to contribute to the b=-0.134, P=0.416). Preoperative Context: Those with anterior cruciate quadriceps weakness that lingers strength was associated with ligament (ACL) injury and 2 following ACL reconstruction, the postoperative strength (R =0.268, reconstruction (ACLR) display lower impact of preoperative quadriceps b=0.518, P=0.001). Conclusions: extremity biomechanics that may activation on postoperative quadriceps ACL patients with better preoperative predispose them to subsequent ACL strength and activation is less quadriceps activation and strength injury and osteoarthritis. There is understood. It seems plausible that recovered quadriceps activation and limited evidence regarding whether better preoperative quadriceps strength better than those with lower these factors are induced by ACLR or activation can help improve the preoperative quadriceps function. existed prior to injury. Objective: To recovery of quadriceps function post- Because previous research has determine the effect of ACL injury and surgery. Understanding the factors that demonstrated a relationship between ACLR on lower extremity contribute to the best postoperative quadriceps activation and strength in biomechanics. Design: Repeated quadriceps function could help healthy individuals, we had anticipated measures, case-cohort Setting: clinicians design more effective that preoperative quadriceps activation Research laboratory Participants: preoperative interventions. would affect postoperative quadriceps Seventy participants of the JUMP ACL Objective: Determine if quadriceps strength. However, our data indicates study, a multi-year prospective study activation and strength prior to ACL that preoperative quadriceps activation conducted at the United States service reconstruction are related to is not a good predictor of academies to identify risk factors for postoperative quadriceps function. postoperative strength. Preoperative noncontact ACL injury, completed Design: Descriptive laboratory study. activation may be mediated by other testing for this analysis, 31 who Setting: University Laboratory. factors such as pain and effusion. suffered an ACL injury (Cases) and 39 Patients or Other Participants: Rehabilitation programs for ACL who did not. Because unilateral Thirty-nine individuals post-ACL patients should focus on maximizing biomechanics were collected during injury (18 male, 21 female; age quadriceps activation and strength initial testing, Cases were divided into 19.21±5.0 yrs; height 1.74±0.01 m; prior to surgery to optimize these those that injured the tested limb mass 72.89±16.1 kg) reported for measurements of quadriceps function (ACLR-INJ: n=12 (8 males, 4 testing on two occasions: post-ACL postoperatively. Supported by NIH females), Age=21.42±0.79 years, injury (2.47±2.4 months) and post- Grant K08 AR053152-01A2 Height=174.29±7.56 cm, Mass= ACL surgery once they returned to 76.25±9.95 kg) and those that injured activity (7.35±1.1 months). the non-tested limb (ACLR-NINJ: Interventions: Quadriceps activation n=19 (9 males, 10 females), Age= was assessed using the burst 21.47±0.77 years, Height= 170.05 superimposition technique, and ±9.13 cm, Mass=72.87±12.78 kg). quantified by averaging three trials of Participants who never suffered an the central activation ratio. Three ACL injury (CON: n=39 (20 males, 19 maximal knee extension trials females), Age=20.98±0.73 years, collected via an isokinetic Height:172.73±8.99 cm, Mass=

Journal of Athletic Training S-37 13190DONE

73.11±13.16 kg) were matched for 0.04 Nm/BH*BW), peak hip flexion Gender Differences In Lower cohort year, academy, and gender. moment (F(2,66)=3.847, p=0.026) Extremity Neuromuscular Interventions: Three-dimensional (ACLR-INJ: Baseline=-0.26± Function Following 30 Minutes lower extremity kinematics and 0.10 Nm/BH*BW, Follow-Up= Of Sub-Maximal Exercise In ACL kinetics were collected during a -0.14±0.07 Nm/BH* BW), and ATSF Reconstructed Individuals double-leg jump landing during initial (F(2,66)=4.530, p=0.014) (ACLR-INJ: Kuenze C, Hertel J, Hart JM: enrollment in the JUMP ACL study Baseline =1.25±0.32 N/BW, Follow- University of Virginia, prior to ACL injury and ACLR Up=0.92±0.25 N/BW). The Charlottesville, VA (Baseline) and following ACL injury CON group only demonstrated an and ACLR (Follow-Up). Main increase in peak internal knee Context: Return to physical activity Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Outcome Measures: Joint angles at rotation angle during LP is the primary goal of many patients initial ground contact (IGC), peak (F(2,66)=4.204, p=0.019) (CON: following ACL reconstruction. The values during the landing phase (LP), Baseline=9.18°±8.66°, Follow- effects of a return to exercise in the and normalized internal joint Up=17.10°±8.23°). Conclusions: presence of lower extremity moments, vertical ground reaction ACL injury and ACLR causes neuromuscular dysfunction remain force (VGRF), and anterior tibial alterations in hip and knee unclear however; those who return to shear force (ATSF) were recorded kinematics for both the injured a higher level a physical activity appear during LP. Mixed model (Time: and non-injured limb, and may be to be at a higher risk for knee joint Baseline, Follow-Up; Group: ACLR- related to continued avoidance of osteoarthritis (OA). Female patients INJ, ACLR-NINJ, CON) analyses of loading the injured limb. have been shown to be less likely to covariance (Gender) were performed return to high levels of physical for each dependent variable. Results: activity as well as more likely to ACL injury and ACLR caused an develop post-traumatic knee joint OA increase in hip adduction over time. Objective: To compare (F =3.773, p=0.028) and knee (2,66) quadriceps neuromuscular function valgus angles (F =3.957, (2,66) after exercise between males and p=0.024) at IGC for both ACLR-INJ females with ACL reconstructed (Hip Adduction: Baseline=- knees. Design: Descriptive laboratory 11.12°±6.64°, Follow-Up= 0.02° study. Setting: Laboratory. Patients ±9.65°; Knee Valgus: Baseline or Other Participants: Twenty-six =2.61°±6.54°, Follow-Up=-4.22°± recreationally active persons (13M/ 5.78°) and ACLR-NINJ (Hip 13F: age=24.1±4.4yrs, height Adduction: Baseline=-9.00°±6.61°, =179.1±9.8cm, mass=80.1±9.4kg, Follow-Up=0.41°±9.61°; Knee time since surgery= 43.5±37.0mo; Valgus: Baseline=1.33°±6.51°, age=24.2±5.6yrs, height =163.0 Follow-Up=-4.84°±5.76°) groups. ±5.9cm, mass =62.3 ±8.3kg, time Both groups demonstrated a since surgery= 45.8±42.7mo) with a decrease in peak knee varus angle history of unilateral, primary ACL during LP (F =5.198, p=0.008) (2, 66) reconstruction at least 6 months prior (ACLR-INJ: Baseline=7.48°±7.48°, to testing. Interventions: 30 minutes Follow-Up=1.28°±7.14° ; ACLR- of continuous exercise comprised of NINJ: Baseline=9.27°±7.44°, repeated bouts of 5 minutes of uphill Follow-Up=0.55°±7.11°). The walking and 1 minute of body weight ACLR-NINJ group demonstrated an squatting and step-ups. Main increase in peak knee valgus angle Outcome Measures: Normalized during LP (F =3.768, p=0.028) (2,66) knee extension maximal voluntary (ACLR-INJ: Baseline=-5.26° isometric contraction (MVIC) torque, ±8.19°, Follow-Up=-11.61°±7.74°). quadriceps central activation ratio The ACLR-INJ group demonstrated (CAR) before and after exercise. a decrease in peak knee extension While participants performed maximal moment (F =4.509, p=0.015) (2,66) isometric knee extension, an electrical (ACLR-INJ: Baseline=-0.23±0.06 stimulus was triggered causing a Nm/BH*BW, Follow-Up=-0.17± transient increase in torque (SIB). CAR

S-38 Volume 48 • Number 3 (Supplement) May 2013 13184MONE

was calculated as (MVIC/SIB)*100. Unipedal Postural Control After COPAP-SD, and COPArea were analyzed Separate 2 (gender: male, female) x 2 Exercise In Individuals With ACL using nonparametric statistics. Group (time: baseline, pre-exercise) repeated Reconstructed Knees differences at baseline and post- measures ANOVAs were performed Goetschius J, Kuenze C, Saliba S, exercise were assessed using Mann- for knee extension torque, Hart JM: University of Virginia, Whitney U tests, and baseline to post- superimposed burst torque, and Charlottesville, VA exercise changes in groups were quadriceps CAR. Separate independent assessed using Wilcoxin Signed Ranks. samples t-tests were performed to Context: Returning to exercise and COPVel was analyzed using parametric compare pre- to post-exercise change sport is a common goal for patients statistics; effects of group and in knee extension torque, exercise were assessed using a 2x2 following anterior cruciate ligament Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 superimposed burst torque, and reconstruction (ACL-R). ANOVA with repeated measures. quadriceps CAR between genders. Sensorimotor deficits may impede on Results: COPML-SD, COPAP-SD, or Results: There was a significant group patients ability to return to pre-injury COPArea was no different between x time interaction for knee extension levels of activity. The effects of groups at baseline or post-exercise. torque (F = 4.72, P=0.04) with (1,24) exercise in patients with ACL-R may Exercise had no effect on COPML-SD in females (pre-exercise=2.56±0.70 provide information about the ACL-R group (1.10[0.93, 1.20] to Nm/kg; post-exercise=2.28±0.65 Nm/ sensorimotor changes experienced in 1.15[0.93,1.38], p=0.530), but kg) experiencing a decline in knee this population as they return to significantly increased COPML-SD in the extension torque while males (pre- physical activity. Objective: To control group (1.15[0.93, 1.28] to exercise=2.63±0.68 Nm/kg; post- compare the effects of 36-minutes of 1.20[1.10, 1.30], p=0.040). Exercise exercise=2.62±0.55 Nm/kg) did not. continuous exercise on unipedal significantly increased COPAP-SD in the There was no significant group x time postural control in ACL-R individuals ACL-R (1.15[1.00, 1.38] to 1.40[1.10, interaction for quadriceps CAR and healthy controls. Design: 2 1.68], p=0.007) and control (1.20 (F =4.02, P=0.06) however, there (1,24) (Group: ACL-R, control) x 2 (Time: [1.00, 1.58] to 1.45[1.20, 1.90], was a significant time main effect baseline, post-exercise) descriptive p<0.001) groups. Exercise (P=0.02, pre-exercise=75.2±13.4%; laboratory study. Setting: Laboratory. significantly increased COPArea in post-exercise=71.2±13.2%) for Patients or Other Participants: the ACL-R (22.65[19.20, 26.35] quadriceps CAR with participants Forty recreationally active volunteers: to 29.90[18.65, 39.60], p=0.014) and experiencing a reduction in quadriceps Twenty (sex= 10F/10M, age= control (24.55[16.73, 32.98] to activation following exercise 25.5±5.5yrs, height= 1.8±0.1m, 32.85[25.08, 47.35, p=0.023) groups. regardless of group. The percent mass= 76.7±14.4kg, time-from- On average, COPVel significantly reduction in knee extension MVIC surgery: 5.0±4.3yrs) with a history of increased (p=0.013) from baseline torque (t =2.60, P=0.02) and (24) primary, non-complicated ACL-R at (ACL-R=8.81±2.24, quadriceps CAR (t =2.27, P=0.03) (24) least 6 months prior and twenty healthy control=9.92±2.73) to post-exercise experienced by male participants controls (sex= 10F/10M, age= (ACL-R=9.69±2.44, (CAR=-1.45±9.45%, 24.6±5.0yrs, height= 1.7±0.1m, control=10.87±2.97), but there were MVIC=1.94±12.17%) was smaller mass= 65.2±12.1kg). Interventions: no significant group (p=0.081) than those measured in female A series of 6 repeated cycles (each or group x time (p=0.415) effects. participants (CAR=-8.69±6.59%, lasting 6-minutes, total=36 minutes), Conclusions: ACL-R does not effect MVIC=-10.32±11.84%). Each cycle included 5-minutes of postural control in a rested state. Conclusions: Female participants inclined treadmill walking and 1- An exercise-induced increase in experienced reductions in isometric minute of jumping exercises. Heart COP measures suggests individuals knee extension torque and quadriceps rate, rating of perceived exertion were must adjust to the constraints central activation ratio following monitored prevent exhaustion. Main of exercise by broadening 30 minutes of exercise. The reduced Outcome Measures: Three 10- sensorimotor strategies. ACL-R fatigability seen in male participants second trials of static, unipedal stance patients may be limited in their ability may be indicative of compensatory with eyes closed and arms crossed to properly adapt to the constraints strategies developed following were assessed using a force plate and of exercise. This may place them ACL reconstruction in order to cope center of pressure (COP) excursions. at greater risk for functional joint with continuous exercise by problems when attempting to return Medial-lateral (COPML-SD) and anterior decreasing the demand on the posterior (COP ) standard to sport and exercise. quadriceps during exercise. AP-SD deviations, velocity (COPVel), and area

(COPArea) were calculated. COPML-SD,

Journal of Athletic Training S-39 13176MONE 13141MOBI

Quadriceps Function After a significant group by time interaction Fatigue Alters Hip Biomechanics Repeated Bouts Of Exercise In found for knee extension torque in the And Postural Stability In Patients With ACL reconstructed side limbs Females With Anterior Cruciate

Reconstruction (F3,48=4.64,P=.006). On day 1, ACL- Ligament Reconstruction Chang EW, Kim KM, Hart JM, R (2.85±.33 Nm/kg) were significantly Gilsdorf CM, Frank BF, Goerger Hertel J: Oregon State University, weaker compared to healthy at BM, Prentice WE, Padua DA: The Corvallis, OR; Texas State baseline(3.84±.30 Nm/kg, P=0.01). University of North Carolina at University, San Marcos, TX; Knee extension torque significantly Chapel Hill, Chapel Hill, NC, and University of Virginia, decreased approximately 21% George Mason University, following exercise(P=0.01) in the

Charlottesville, VA Manassas, VA Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 healthy group whereas the ACL-R Context: Quadriceps activation group only experienced on average a Context: Females with a history of failure and weakness have been 9% reduction(P=0.13). On day 2, the ACL injury and subsequent surgical reported in patients with anterior knee extension torques of the healthy reconstruction (ACLR) are at high risk cruciate ligament reconstructions group before exercise were for future ACL injury. Fatigue may (ACL-R). Limited information is significantly lower than pre-exercise influence the increased risk of future available regarding the quadriceps torques on day 1(P=0.03), indicating injury in these individuals by altering response after exercise in people with lack of full recovery of quadriceps lower extremity (LE) biomechanics or ACL-R. Objective: To compare strength 24 hours after exercise. In balance. However, there is limited neuromuscular function of the contrast, the pre-exercise knee research investigating the effects of quadriceps following repeated bouts of extension torques of the ACL-R group fatigue in females with ACLR. exercise between individuals with and were not different between day 1 and Objective: To determine the effect of without a history of ACL-R. Design: 2(P=0.73). For a group comparison fatigue on hip and knee biomechanics Case-control. Setting: Laboratory. of pre-exercise torques on Day 2, the and balance in females with ACLR. Patients or Other Participants: ACL-R group tended to have lower Design: Cross-sectional, repeated Eight subjects with unilateral ACL-R knee extension torque compared measures. Setting: Research (age=24.8±5.1yrs, height =176.7± to healthy controls, but the difference laboratory. Patients or Other 14.2cm, mass=82.9±17.9kg) and 10 was not statistically significant Participants: Fourteen physically healthy subjects (age=26.9±5.3yrs, (P=0.07). Following exercise the active females with ACLR height=173.8±8.5cm, extension torques significantly (age=19.64±1.5 years; height= mass=70.2±12.4kg) participated. decreased in both groups: 163.52±6.18 cm; weight=62.6±13.97 Interventions: All subjects performed approximately 15% reduction found in kg) volunteered for this study. 30 minutes of exercise on two the healthy group(P<0.001) Interventions: Participants consecutive days. In each 30-min and approximately 11% reduction performed a fatigue protocol exercise, there were 5 repeated cycles found in the ACL-R group(P=0.03) consisting of repeated, weighted squats of aerobic and nonaerobic exercise, Conclusions: ACL-R patients are (30% bodyweight) from 0° to 60° of each of which consisted of 5-mintue weaker and less activated than healthy knee flexion at a rate of 25 squat incremental treadmill walking and 1- controls. ACL-R patients respond cycles per minute. The fatigue minute of jumping exercises. Main to exercise differently and appear protocol was terminated when Outcome Measures: Knee extension to experience less deterioration participants fell four squat cycles torque and CAR were measured during of quadriceps strength after a single behind the set rate or failed to a knee extension maximal voluntary bout of exercise, but not after 2 complete two sequential squat cycles. isometric contraction (MVIC). CAR bouts of daily exercise. LE biomechanics were assessed was measured as the ratio between during five jump-landing trials. The MVIC and the peak torque generated jump-landing task consisted of by an electrical stimulation delivered participants jumping forward to the thigh superimposed during the (distance=50% of body height) from MVIC test. Outcomes were recorded a box (height=30 cm) onto a force 4 times: before and after exercise on plate. Balance was assessed as the first and second day of exercise and participants stood on their involved compared with a 2X4 repeated limb with their eyes closed (3 trials, measures ANOVA and post hoc testing 20 sec each trial) while on a force where appropriate. Results: There was plate. All measures were performed

S-40 Volume 48 • Number 3 (Supplement) May 2013 before and after the fatigue protocol on the ACLR limb. Paired t-tests were performed to compare LE biomechanics and balance variables before and after the fatigue protocol. Main Outcome Measures: LE biomechanical variables were defined as three-dimensional hip and knee joint displacements (degrees) and peak joint moments (normalized to body weight Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 * height). These variables were averaged across 5-trials during the loading phase (time from initial contact to peak knee flexion). Balance was quantified as the sway path (cm), averaged across 3-trials. Results: Hip flexion displacement (t=2.23, P=0.044; pre-fatigue=45.19±14.10, post-fatigue=47.48±14.21) and moment (t=2.14; P=0.052; pre- fatigue=1.66±0.68, post-fatigue= 1.91±0.62) were significantly increased from pre- to post-fatigue. No other LE biomechanical variables were altered after fatigue (P>0.05). Sway path was also significantly increased after the fatigue protocol (t=3.925; P=0.002; pre-fatigue =102.54±19.36 cm, post-fatigue =124±34.51 cm). Conclusions: We observed increased hip flexion displacement and moment during a jump-landing and decreased single-leg balance in females ACLR limb after fatigue. Increased hip flexion is described during ACL injury mechanisms and decreased balance is associated with increased risk of future ACL injury in those with ACLR. Thus, fatigue in ACLR females may partially explain the high risk of future ACL injury in these individuals. Future research examining the relationship between fatigue and risk of future ACL injury in those with ACLR is warranted.

Journal of Athletic Training S-41 Free Communications, Oral Presentations: Management of Osteochondral Injuries 13398DOMUWednesday, June 26, 2013, 9:15AM-10:15AM; Palm B; Moderator: James Onate, PhD, ATC

Differences In Self-Reported and subjects were classified according with CPC-III BBL reported greater Pain And Function For Patients to their most severe BBL (CPC-II: difficulty in performing sport related With Anterior Cruciate Ligament n=28; CPC-III: n=22). Main activities and lower quality of life Injury When Compared Outcome Measures: Three patient scores compared to the CPC-II group. According To Bone Bruise reported outcome measures were Our findings support the impact of Lesion Severity completed (Knee Injury and concomitant BBL on patient reported Hoch JM, Mattacola CG, Bush HM, Osteoarthritis Outcome Score outcomes in patients with ACL injury Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Gonzalez L, Hewett TE, Medina (KOOS)), International Knee and the use of a severity classification McKeon JM, Lattermann C: Documentation Committee (IKDC), system for future research studies University of Kentucky, Lexington, and the Short-Form 12 (SF-12). The investigating BBL outcomes. KY; Old Dominion University, dependent variables (DV) were scores Norfolk, VA; Appalachian State on the KOOS subscales: KOOS-Pain, University, Boone, NC; Ohio State KOOS-Function, KOOS-Activities of University, Columbus, OH Daily Living, KOOS-Quality of Life (QOL), KOOS-Sport, the IKDC score Context: There is inconsistent and the SF-12 Physical and Mental evidence regarding differences in self- components. An ANCOVA was reported pain and function in patients employed to determine if differences following anterior cruciate ligament in the DV are present when subjects (ACL) injury when compared are compared according to differing according to the presence or absence BBL severities (CPC-II and CPC-III). of bone bruise lesions (BBL). Covariates included age, total number Classifying individuals based on the of BBL, total BBL volume and time severity of the BBL is more specific elapsed from injury to data collection. and may provide better criteria for Alpha was set a priori at p<0.05. stratifying self-reported pain and Adjusted means and associated 95% function in ACL-injured patients. confidence intervals (95%CI) are Objective: To determine if presented for significant differences. differences in self-reported pain and Results: While controlling for function would be observed for confounding variables, the results patients with differing BBL severities indicated patients with CPC-III BBL (Costa-Paz (CPC) I, II, or III). Design: reported lower scores on the KOOS- Cross-sectional. Setting: Ortho- Sport (9.6, 95%CI:2.0-17.2) paedic clinic. Patients or Other compared to patients with CPC-II BBL Participants: A convenience sample (21.5, 95%CI:14.7-28.3, p=0.03). In of 51 subjects participated. Only one addition, while controlling for subject was classified as CPC-I; confounding variables, the results therefore, the final analysis includes indicated patients with CPC-III BBL only patients with CPC-II and CPC-III reported lower scores on the KOOS- BBL (CPC-II: 15males, 13females, QOL (23.9, 95%CI:17.1-30.8) age:21.8+9.2years, height: 172.7+ compared to patients with CPC-II BBL 8.2cm, mass:74.5 +19.7kg, CPC-III: (34.6, 95%CI:28.5-40.7, p=0.03). 11males, 11 females, age:20.3 There were no other significant +8.8years, height: 174.8+9.3cm, differences between the two groups mass: 78.1+ 19.5kg). Subjects had an for all other DVs (p>0.05). MRI documenting ACL injury and Conclusions: The severity of BBL concomitant BBL, and an evaluation by influences several patient reported orthopaedic physician within 4 weeks outcomes including the KOOS-Sport following injury. Interventions: The and KOOS-QOL. When confounding severity of each BBL was determined variables are controlled for, subjects

S-42 Volume 48 • Number 3 (Supplement) May 2013 13287OC

Bilateral Knee Osteochondritis osteochondritis dissecans (OCD), symptomatic OCD lesions of bilateral Dissecans In An Adolescent synovial chondromatosis, infection/ MFC’s. Surgery was recommended in Male Athlete osteomyelitis, meniscal pathology, hope of decreasing likelihood of Wood JM, Hackett TR, Ashton JM: rheumatoid arthritis, slipped capital progression to an unstable OCD and The Steadman Clinic, Vail, CO femoral epiphysis (SCFE). potential loose body. OCD that Treatment: Radiographs and MRI of become unstable can lead to Background: This case presents a 17- left knee showed evidence of 15 mm degenerative joint problems year-old male student-athlete who OCD lesion involving the including osteoarthritis. OCD is a participates in football, basketball and weightbearing MFC with intact rare disease in the general weight lifting. Patient presented with overlying cartilage. Based on imaging, population, an important cause of chief complaint of sharp pain and physical examination, and failure of joint pain in physically active Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 weakness of the left knee. Initial injury conservative management, a left knee adolescents, and proper diagnosis occurred seven months earlier when arthroscopy and retrograde drilling of and treatment of a young athlete by the patient twisted his left knee landing MFC with chondroplasty was sports medicine professional is a jump. Initially left knee was stiff but performed. Postoperatively treatment pertinent to joint preservation. not painful. He finished football and included pain medications, knee brace, basketball season but discomfort crutches, and physical therapy. Patient progressively increased. Resting was extremely satisfied with left knee alleviated symptoms while activity procedure outcome at one year exacerbated his pain, weakness and follow-up and had returned to sport discomfort. Patient had no prior without recurrent symptoms. history of left knee pathology. Radiographs and MRI of right knee Examination revealed mild left knee revealed similar OCD lesion involving effusion. Patient had point tenderness the inferior lateral aspect of the MFC over the distal medial femoral condyle and evidence of open growth plates. (MFC) and medial joint line. Left knee Conservative treatment trial was ROM was 0ˆ-120ˆ; right knee was recommended prior to any additional 0ˆ-140ˆ. A slight increase in pain surgical procedures. Uniqueness: noted with McMurray’s testing, Symptomatic OCD lesions are rare negative Wilson’s test was present. and can be commonly overlooked on Radiographs and magnetic resonance radiographic studies. Bilateral lesions imaging (MRI) of the left knee were are even more uncommon (only 15- obtained prior to surgical intervention. 30% of cases). Etiology of OCD At the patient’s one year follow-up his lesions remains unclear, but has been chief complaint was persistent knee linked to repetitive trauma. OCD pain of the contralateral knee with lesions classically involve lateral insidious onset. Symptoms included aspect of MFC (51% of cases). OCD right knee popping, catching and lesions in skeletally immature patients clicking with running and walking, and are most likely to heal with or without change in his gait pattern. Patient was surgical intervention. In this case, tender to palpation over right medial surgical intervention stimulated joint line and MFC. Right knee ROM healing of OCD lesion after skeletal was 0ˆ-120ˆ with pain at terminal maturity. OCD lesions that fail to heal flexion. ROM of left knee was 0ˆ-130 are commonly treated with cartilage without pain. Patient had right knee restoration procedures (including pain with valgus stress. Radiographs autograft or allograft mosaicplasty/ and MRI of right knee were then OATS). OCD lesions originate prior to obtained. Differential Diagnosis: skeletal maturity and should not be Spontaneous osetonecrosis of the confused with osteochondral defects, knee, medial collateral ligament which are traumatic in origin and injury, insufficiency fracture, commonly occur after skeletal chondroblastoma, osteosarcoma, maturity. Conclusions: The patient is chondral fracture/stress fracture, an adolescent athlete diagnosed with

Journal of Athletic Training S-43 13380FC

Osteochondral Allograft participate until season’s end. When no intercollegiate basketball for the Transplantation In A NCAA symptomatic relief was provided by 2012-13 season. She has experienced Division Ii Intercollegiate the injection, a second opinion was no setbacks. This case highlights the Women’s Basketball Athlete sought from another orthopedic conundrum of evidenced based Gruber DM, Sefcik N, Peterson K: surgeon. Following this evaluation in treatment and rehabilitation algorithms Ashland University, Ashland, OH November 2010, the patient underwent for athletic trainers managing an abrasion chondroplasty of the osteochondral defects, particularly on Background: A 20-year-old female patella and removal of loose bodies. the patellofemoral surface. Very little intercollegiate basketball player The patient did not return to basketball RCTs exist for younger and active experienced pain and effusion of an activities during the 2010-11 season. populations. Athletic trainers would Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 insidious onset during preseason Two months following this surgery, benefit from the knowledge of workouts in September of 2010. The symptoms returned. At this point, a surgical protocol, graft failure rates, patient’s chief complaints were pain conservative approach of non weight osteochondral hypertrophy, and and stiffness along the medial bearing activity and isometric quad osteoarthritis are all complications patellofemoral border and joint line. strengthening was instructed from the that are byproducts of surgery. The patient also stated she felt a physician to reduce symptoms. In May palpable soft tissue mass along the 2011, the patient began experiencing medial patellofemoral border increasing pain and effusion upon all following workouts. During weight bearing activity. She was then examination, the athletic trainer referred to another orthopedic found no signs of trauma other than specialist for an osteochondral superior and medial joint effusion allograft transplantation. During this indicative of intra articular injury to visit, June 2011, a final course of the knee. Ligamentous and functional action was detailed for the patient in testing provided little evidence as to order to resume her intercollegiate the causation of the effusion. The athletics career. Initially, a surgery to patient was referred to the Team debride the patella and removed loose Physician for further evaluation bodies was performed. Visco- following two weeks of minimal supplementation was then utilized progression with symptomatic during the Fall of 2011 to allow the interventions of NSAIDs, inter- patient to participate in basketball for mittent compression, and quad the 2011-12 season. Following the strengthening. Differential basketball season in March 2012, a Diagnosis: Patellar Tendinitis, DeNovo allograft cartilage Medial Retinacular Sprain, transplantation was performed. Chondramalacia, Symptomatic Uniqueness: Evidenced based Synovial Plica, Patellofemoral outcomes of allograft cartilage Pain Syndrome, Patellofemoral transplantation in young and active Instability. Treatment: Following patient populations are limited. Along examination by the Team Physician, with this, multiple factors such as an MRI was ordered to rule out BMI, defect size, pre-existing structural deformities and identify conditions, and length of elapsed time the palpable soft tissue mass. before the transplantation confound Results of the MRI concluded a full the problem for athletic trainers as they thickness chondral injury to the advise patients, parents, and coaches patella along with a separated on courses of action for return to fragment from the inferior pole. The activity. Conclusions: The allograft individual was referred to a local transplantation was the only option orthopedic for follow up. At this time, available to allow the athlete to return the orthopedic felt an injection of 2cc to play prior to her eligibility to Kenalog and a patellofemoral J brace expire. As of this submission, the would allow the individual to patient has been cleared to return to

S-44 Volume 48 • Number 3 (Supplement) May 2013 13393FOMU

Comparison Of The Occurrence used to evaluate response-shift in the Of Response-Shift Among following patient reported Sporting And Non-Sporting outcomes(PROs) – the SF-36 Autologous Chondrocyte Physical Component Scale(SF- Implantation(ACI) Patients 36PCS), the IKDC Subjective Knee Howard JS, Mattacola CG, Evaluation Form, and the Lysholm Lattermann C: University of Knee Scale. Each PRO was completed Kentucky, Lexington, KY pre-ACI and 6 and 12 months post- surgery. At 6 and 12 months an

Context: Response-shift is the additional “then” version of each PRO Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 phenomenon by which an individual’s was also completed. The “then” standards for evaluation change over version was identical to the original time due to a change in internal except that patients were instructed to standards, values, or construct assess how they were pre-ACI. It is definition. Response-shift has been theorized that by completing the then- observed in a variety of populations test and post-test PROs at the same including knee arthroplasty and time point the same frame-of- cartilage patients. Failure to account reference is utilized.Main Outcome for response-shift may result in over Measures: Response-Shift (RS=then- or under-reporting treatment effects score – pre-score) and Response-Shift on health related quality of Magnitude (RSM=|then-score – pre- life(HRQL). The capacity to score|) were calculated at 6 and 12 participate in sports greatly influences months. Independent t-tests were used athletes’ perceived HRQL. Whether to compare RS and RSM values athletes are more prone to response- between groups at 6 and 12 months. shift following interventions that Results: There were no differences restrict physical activity has not been between groups for age, BMI, or defect previously explored. Objective: Our size. There were no differences in RS purpose was to determine if patients at 6 or 12 months or in RSM at 6 undergoing ACI who reported high months for any of the PROs. RSM at levels of sports participation 12 months was greater in the sporting experienced greater response-shift than non-sporting group for the IKDC following ACI than non/low-level (15.80±13.26 vs. 6.06±5.42, sports participants. It was p=0.005), SF-36PCS (10.33±8.04 vs. hypothesized that those individuals 5.72±4.90, p=0.046), and Lysholm who prospectively self-identified (16±14 vs. 8±5, p=0.029). themselves as sporting would Conclusions: These results suggest experience more response-shift due to that sporting patients may recalibrate, the physical limitations imposed reprioritize, or reconceptualize their following ACI (restrictions in weight personal definition of physical bearing, physical activity, etc.). function during the first year following Design: Case-control Setting: ACI. The failure to find a difference Orthopaedic Clinic Patients: in RS values suggests that the Individuals undergoing ACI who self- response-shift experienced is identified as non-sporting (n=25, not uniform in direction and varies 34.6±7.1yrs, 92.6kg, 173cm) or as from patient-to-patient. Future sporting (n=22, 35.6±9.2yrs, 92.0kg, research is needed to determine if this 189.2cm). Intervention: All patients variability in direction may be underwent ACI for the repair of associated with expectations for symptomatic articular cartilage surgery or intent to return to sports. defects. The “Then-Test” method was

Journal of Athletic Training S-45 Knee Evidence-Based Forum Wednesday, June 26, 2013, 10:30AM-11:30AM; Palm B; Moderators: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

S-46 Volume 48 • Number 3 (Supplement) May 2013 Shoulder Evidence-Based Forum Thursday, June 27, 2013, 8:00AM-9:00AM; Palm B; Moderators: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Journal of Athletic Training S-47 Free Communications, Oral Presentations: Adaptations and Kinetic Chain in Pitchers 13134FONEThursday, June 27, 2013, 9:15AM-10:30AM; Palm B; Moderator: Jeffrey13109FOTE Cooper, MS, ATC

Excessive Glenoid Retroversion independent variable consisted of four The Acute Effects Of Hold-Relax Is Associated With Increased levels based on quartile cut points for Proprioceptive Neuromuscular Rotator Cuff Strength In The the degree of glenoid retroversion. Facilitation With Vibration Shoulder Four separate one-way ANOVAs, along Therapy On Glenohumeral Owens BD, Campbell SE, Peck with Scheffe post-hoc tests, were used Internal Rotation Deficit KY, Westrick RB, Cameron KL: to examine mean between group Tucker WS, Slone SW: University

Keller Army Hospital, United States differences in rotator cuff strength of Central Arkansas, Conway, AR, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Military Academy, West Point, NY with shoulder as the unit of analysis. and Lindenwood University - Results: We observed significant Belleville, Belleville, IL Context: The rotator cuff muscles are main effects for internal critical secondary stabilizers in the (F3,1144=11.79, p<0.001) rotation Context: Glenohumeral internal shoulder. Increased glenoid strength in neutral. Scheffe post-hoc rotation deficit (GIRD) is believed to retroversion has been associated with analyses demonstrated that internal be a strong contributing factor to the risk of posterior shoulder rotation strength was significantly shoulder injuries in overhead throwing instability; however, the impact of higher in subjects in the upper quartile athletes. Clinicians use various increased glenoid retroversion on (4Q:53.65±13.99) for glenoid stretching techniques to prevent the rotator cuff strength remains unclear. retroversion when compared to those onset of and treat GIRD. It is unknown Objective: To examine the in the lower three quartiles which stretching technique is the most association between glenoid (3Q:49.98±14.47, 2Q:49.09±13.04, effective treatment for GIRD. retroversion and rotator cuff strength 1Q:46.93±13.16), respectively. Objective: To compare the acute in the shoulder. Design and Setting: Similar main effects were observed effects of hold-relax proprioceptive This study represents a cross-sectional for external (F3,1144=9.62, p<0.001) neuromuscular facilitation (PNF) with analysis of baseline data from a rotation strength in neutral and internal and without vibration therapy on prospective cohort study conducted at (F=13.663,1144, df=3, p<0.001) and glenohumeral internal rotation in a US Service Academy. Participants: external (F3,1144=15.70, p<0.001) individuals with GIRD. Design: Two- 574 college freshmen with no history rotation strength in 45º of abduction within (stretch x time) comparison. of glenohumeral joint instability at and post-hoc analyses demonstrated Setting: Controlled laboratory. baseline or during the 4 year follow- that all rotator cuff strength measures Patients or Other Participants: up period were included in the current were significantly higher in subjects Eleven male overhead and former study. The average age, height, and in the upper quartile for glenoid overhead athletes (19.8±1.4 years, weight of participants was 18.77±0.97 retroversion when compared to 184.5±4.5 cm, 91.8±11.6 kg) years, 176.81±8.48 cm, and those in the lower three quartiles. presenting with GIRD. Interventions: 73.80±12.45 kg, respectively. No other significant between group Participants reported for three Intervention/Methods: Baseline data differences were observed. separate sessions with a minimum of collected upon entry into the study Conclusions: Increased glenoid seven days between sessions. At each included bilateral MRI assessments of retroversion has been previously session, three pretest maximum glenoid version. All measures of associated with acute posterior passive glenohumeral internal rotation glenoid version were performed by a shoulder instability. The increased measurements were taken and musculoskeletal radiologist blinded to rotator cuff strength observed averaged on the throwing dominant all other baseline data. Rotator cuff in those in the upper quartile shoulder with a digital protractor. There strength was also assessed at baseline for glenoid retroversion in was a 60 second rest between each using a hand held dynamometer. the current study may represent an pretest measurement. At each session, Internal and external rotation strength acquired compensatory mechanism participants performed one of three was assessed with the glenohumeral in these secondary stabilizers of randomly assigned stretches: hold- joint positioned in neutral and in 45º the glenohumeral joint. relax PNF (PNF), hold-relax PNF in of abduction. Main Outcome combination with a whole body Measures: The primary dependent vibration unit set at 30 Hz (PNF-V) and variables of interest were the four static stretch (SS). All stretches measures of rotator cuff strength. The involved a 30 second static stretch,

S-48 Volume 48 • Number 3 (Supplement) May 2013 13021FOBI while the PNF and PNF-V stretches The Relationship Between external rotation torque and maximum included a six second isometric Clinically Measured Hip shoulder horizontal adduction motion contraction prior to the static stretch. Rotational Motion And Shoulder during the throwing motion. Results: Three trials were performed for each Biomechanics During The The averages and standard deviations stretch with a 60 second rest between Pitching Motion for shoulder external rotation torque trials. Immediately after each trial, Laudner K, Wong R, Onuki T, and shoulder horizontal adduction posttest maximum passive Meister K, Lynall R: Illinois State during the throwing motion were glenohumeral internal rotation University, Normal, IL, and Texas 5.1±1.0 % body weight x height and measurements were taken and Metroplex Institute for Sports 21.0º±8.1º. The clinically measured averaged with a digital protractor. The Medicine and Orthopedics, lead leg internal, external, and total arc independent variables were stretch Arlington, TX of rotational ROM were 27.7º±5.9º, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (PNF, PNF-V and SS) and time (pretest 35.8º±3.4º, and 63.4º±7.0º. Trail leg and posttest). Main Outcome Context: Throwing a baseball has been internal, external, and total arc of Measures: The dependent variables described as a kinetic chain of events rotational ROM were 28.9º±7.2º, were the mean glenohumeral internal that begins with the development of 35.4º±6.2º, and 64.2º±8.4º. Multiple rotation measurements taken at the power in the lower extremity, which regression analyses showed that the pretest and posttest. The influence of is then transmitted through the core total hip rotational motion of the lead stretch and time on mean and finally to the upper extremity prior leg measured clinically had a glenohumeral internal rotation was to ball release. Although, many significant relationship with shoulder compared using a 3x2 factorial clinicians have hypothesized that external rotation torque (r=.56, ANOVA with repeated measures on altered motion at one segment in this P=.003) during the throwing motion. both variables (Pd”0.05). Tukey post chain can affect the forces placed on Both lead leg hip external rotation (r=- hoc testing was applied in the event of distal segments, little research has .39, P=.02) and internal rotation a significant interaction. Results: explored these relationships. (r=.42, P=.009) ROM made There was a stretch-by-time Objective: To determine if alterations significant individual contributions to interaction (F =34.697; P<0.001). this relationship. Lead leg external 2,20 in hip rotational motion affect the Post hoc testing revealed that the PNF amount of external rotation torque or rotation ROM had a significant posttest (73.0±10.4°) was greater than horizontal adduction of the dominant negative relationship with shoulder the PNF pretest (60.0±11.8°), the shoulder developed during the horizontal adduction during the PNF-V posttest (74.7±10.0°) was throwing motion. Design: Cross- throwing motion (r=-.36, P=.04). The greater than the PNF-V pretest sectional. Setting: Athletic training total rotational motion of the trail leg (57.4±10.4°), and the SS posttest room. Participants: Thirty-four, had a significant relationship with (67.0±10.7°) was greater than the SS asymptomatic, NCAA Division I shoulder horizontal adduction motion pretest (60.1±9.4°). When baseball pitchers (age=20±1.3 years; (r=.43, P=.04). However, trail leg comparing the posttest values, height=187.2±5.8 cm; mass=86.9±6.8 external rotation was the only the PNF-V posttest was greater than kg) participated. Interventions: We significant contributor to this the SS posttest. Conclusions: All three measured bilateral hip rotational ROM relationship (r=-.35, P=.04). No stretches (PNF, PNF-V and SS) in a prone position using a digital other significant relationships were resulted in acute increases in inclinometer. We measured external noted (r<.37, P>.11). Conclusions: glenohumeral internal rotation in rotation torque and maximum Our results demonstrate that altered individuals presenting with GIRD. The horizontal adduction motion of the hip rotational ROM measured PNF-V stretch resulted in the greatest throwing shoulder using a three- clinically has a direct effect on the increase in glenohumeral internal dimension, high speed video capture amount of dominant shoulder external rotation and was significantly more system. Separate multiple regression rotation torque and horizontal than the SS stretch. Utilization of analyses were used to determine if adduction during the throwing motion. hold-relax PNF with vibration therapy relationships existed between hip Because of these relationships may be clinically beneficial for external rotation ROM and external clinicians should consider utilizing individuals with GIRD. Future research rotation torque produced at the stretches, which target hip rotation investigating the long-term effectiveness throwing shoulder, as well as maximum ROM, in an effort to minimize the of these stretching techniques on shoulder horizontal adduction motion kinetic forces and excessive motion glenohumeral internal rotation is warranted. during the throwing motion (p<.05). placed on the throwing shoulder. Main Outcome Measures: Dependent variables included shoulder

Journal of Athletic Training S-49 13233DOBI

Improper Trunk Rotation time from stride foot contact to ball without a motion capture system, and Sequence Is Associated With release), maximal shoulder external to correct the improper technique need to Increased Maximal Shoulder rotation angle (MaxER), elbow be investigated in order to apply this External Rotation Angle And extension angle at ball release observation to prevention of pitching- Shoulder Joint Force During (ElbEXT), peak shoulder proximal related upper extremity injuries. Baseball Pitching force, shoulder internal rotation Oyama S, Yu B, Padua DA, moment, and elbow varus moment Blackburn JT, Li L, Myers JB: were calculated from the marker Department of Health and coordinate data. Subjects were

Kinesiology, University of Texas considered to have a proper vs. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 San Antonio, San Antonio, TX, improper trunk rotation sequence and Department of Exercise when the peak pelvis rotation velocity and Sport Science, University reached before vs. after the peak upper of North Carolina at Chapel torso rotation velocity beyond the Hill, Chapel Hill, NC margin of standard error of measurement (±3.7% pitching time), Context: In a coordinated throwing respectively. Subjects in whom the motion, peak pelvis rotation velocity difference in timing of peak pelvis and is reached before the peak upper torso upper torso velocities was within the rotation velocity, so that angular margin of error were excluded. momentum can be transferred Dependent variables were compared effectively from the proximal (pelvis) between groups using independent t- to distal (upper torso) segment. tests (˜<.05). Results: Subjects with Despite the fact that upper extremity improper trunk rotation sequence kinematics and kinetics during (n=33) demonstrated greater MaxER throwing are highly influenced by trunk (mean difference=7.2°±2.9°, 95%CI =1.39°-13.0°, t =2.5, p=.016) and kinematics, the effects of proper vs. 54 improper trunk rotation sequence on greater shoulder proximal force (mean baseball pitching performance (ball difference=9.2±3.9%body weight, 95%CI=1.4-16.9%, t =2.4, p=.021) speed) and upper extremity 54 biomechanics linked to common compared to those with proper trunk pitching-related upper extremity rotation sequence (n=23). There were injuries have not been investigated. no group differences in ElbEXT, ball Objective: To investigate the effects speed, or the other joint kinetic of trunk rotation sequence on ball variables (p>.05). Conclusions: No speed and upper extremity kinematics significant difference observed in ball and kinetics linked to injuries in high speed or joint moments suggest that school baseball pitchers. Design: other factors may have a larger Cross-sectional study. Setting: influence on these variables. Biomechanics laboratory. Patients or Anatomically, the greater MaxER is Other Participants: Seventy-three associated with increased risk of healthy high school baseball pitchers posterior impingement and superior (dominance=57-right/16-left, labral anterior-posterior lesion. age=15.5±1.2years, height =179.3± Additionally, increased shoulder 7.3cm,mass=72.7±9.8kg). proximal force that resists distraction Interventions: Three-dimensional of the shoulder during arm- kinematics of the pitching motion were acceleration is linked to increased captured using a motion capture tensile stress on the rotator cuff and system. The pitches were performed biceps-labral complex. Therefore, until at least 3 strike-pitches were improper trunk rotation sequence may captured. Main Outcome Measures: be harmful to the throwing shoulder. Timings of peak pelvis and upper torso Methods to identify pitchers with rotation velocity (% pitching time = improper trunk rotation sequence

S-50 Volume 48 • Number 3 (Supplement) May 2013 13246FONE

Effects Of A Sport Specific assigned to one of two training groups Training Program Targeting for 7 weeks; a traditional endurance The Pelvis, Spine And Trunk training group (ET) (n=21) or a power On Throwing Velocity And training group (PT) (n=25). Muscular Power And Endurance Interventions: The ET group performed Measures In College Throwing a traditional endurance progression Athletes relative to the number of repetitions Palmer TG, Mattacola CG, Uhl TL, and time incorporating static and linear Hewett TE, Howell D, Viele K : exercise movements of the pelvis,

University of Cincinnati, spine and trunk. The PT group received Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Cincinnati, OH; University of undulating blocked periodization Kentucky, Lexington, KY; Ohio consisting of endurance, strength and State University, Columbus, OH; power movements specific to Eastern Kentucky University, throwing. Main Outcome Measures: Richmond, KY; Berry Consultants, Peak throwing velocity (km/h) Austin, TX normalized for body weight (kg), muscular endurance prone plank tests (seconds) and power output from a Context: The ability to stabilize and one-repetition maximum chop test actively control the pelvis, spine and (watts/Kg body weight) were trunk, has been reported to influence measured pre- and post- intervention. sport performance yet there is limited Student’s independent t-tests were evidence supporting that used to compare differences between improvements in sport result from the change score for all dependent changes in the muscles supporting the variables with alpha level set at pd”.05. pelvis, spine and trunk. Traditional Results: The peak throwing velocity interventions lack sport specific change score was significantly faster methods which target both the by 6±2% in the PT group (ET= .01±.1 muscular power and endurance km/h/kg of body weight, PT= .08±.03 capabilities of the pelvis, spine, and km/h/kg of body weight, p< .001) at trunk. Objective: To investigate the post-intervention compared to the ET effect a traditional endurance training group. Muscular endurance was not program and a sport specific power different between groups (ET= 154 training program have on throwing ±54, PT= 151±42, p= .901). The velocity, muscular endurance and power chop test improved in PT group power measures of the proximal (105 ±68 watts) compared to the ET segments. We hypothesized there group (20 ±78 watts) (p<.001) would be a significant difference (p CONCLUSION: This is the first study d•.05) in change scores for throwing to demonstrate improvements velocity, muscular power and muscular in muscle performance for the endurance between groups. Design: A proximal segments simultaneously randomized clinical trial with blocked with a sport performance measure in stratification for sex and position was throwing velocity. Sport specific implemented with a pre- to post- training that targets the pelvis, spine intervention design. Setting: Field and and trunk is beneficial to muscular research laboratory. Patients or Other power measures and throwing Participants: Forty-six healthy (mean performance. KEYWORDS: Spinal age = 20 ± 1.3 years, height = 175.7 ± Stability; Core Stability, Exercise 8.7 cm, weight = 79 ± 13.9 Kg), Training, Performance Assessment Division III collegiate female softball (n=17) and male baseball (n=29) players from the same institution volunteered and were randomly

Journal of Athletic Training S-51 Free Communications, Thematic Spitfire Session: Emerging Technologies in Athletic Training 13265UOMUThursday, June 27, 2013, 11:45AM-12:45PM; Palm B; Moderator: Joseph13121UOMU Hart, PhD, ATC

Inter-Rater Reliability Of The Outcome Measures: The 11 MAPS Comparison Of Standard Movement And Activity In system variables were total physical Goniometry Versus An Iphone Physical Space activity counts (TPAC), total physical Goniometry Accelerometer (MAPS) System: Geospatial activity counts at home (TPACH), total Application To Measure Knee Functional Outcome Measures physical activity counts at locations Flexion And Extension Warner KD, David SL, Ragan BG: other than home (TPACL), total step Eley DM, Tomczyk KM, Berry DC: counts (TSC), total step counts at home Saginaw Valley State University, Ohio University, Division of Athletic Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Training, Athens, OH (TSCH), total step counts at locations University Center, MI other than home (TSCL), total time at Context: Functional outcome home (TTH), total time at locations Context: Measuring range of motion measures are critically important for other than home (TTL), total number (ROM) is standard practice when evaluating the effectiveness of clinical of trips away from home (TL), total conducting an injury evaluation. ROM treatments and tracking disease number of instrumental trips (IT), and is quantified using a standard progression. The measures currently total number of discretional trips (DT). goniometer (SG); but due to used in clinical settings are unable to Each team examined the same 6 days technological advances, alternative account for factors, such as of unprocessed MAPS data and methods using iPhone applications environment, that can influence calculated each of the MAPS system may offer clinicians a quick, more function. In an attempt to address this variables for each day. Inter-rater efficient tool. Objective: To compare measurement issue, we have developed reliability was examined by calculating the relationship between knee flexion and validated the Movement and interclass correlation coefficients (KF) and extension (KE) active ROM Activity in Physical Space (MAPS) (ICC 3,1) for each of the 11 variables. (AROM) using SG and the iPhone system, which combines physical An ICC of .7 was considered application, Goniometer (App). activity and geospatial data, providing acceptable and an ICC of .8 or greater Design: Quasi-experimental. an assessment of real-world function considered good. Results: The ICCs Setting: Athletic training laboratory. across multiple days. Objective: To for most of the MAPS variables were Participants: Forty-one participants, examine the inter-rater reliability of considered good with TPAC=.98; 16 males and 25 females (age the MAPS system variables. Design: TPAL=.99; TPAH=.96; TSC=1.0; =20.5±1.1; height =171.4 cm±8.4cm; Observational. Setting: Laboratory. TSL=.99; TSH=.97; TTL=.78; mass= 73.9kg±16.51) free of lower Participants: Two teams of 2 raters, TTH=.74; TL=.98; IT=.92; DT=.82. extremity injuries, surgery or pain for all trained in MAPS processing and Conclusions: Overall, the rating 6 months to the dominant limb currently using MAPS system in other teams produced very good inter-rater participated. Interventions: projects, volunteered for this study. reliability for 9 MAPS variables with Participants were placed supine for a Interventions: The raters processed acceptable ICCs for TTH and TTL. single session measurement of KF and 6 days of MAPS data from a past These time variables are related to KE AROM by two independent raters project. The 6 days of unprocessed one another and future procedural using the dominant limb (used to kick MAPS data were chosen from 3 work should be done to reduce the a ball). To control measurement error, individuals for data processing based error. The results support multiple a polyvinyl chloride (PVC) frame was on the difficulty and complexity in rating teams to be able process placed at the pelvis to maintain a 90° processing with 2 days simple/light and combine data, which will allow hip angle. Measurements were travel, 2 moderate days, and 2 for larger MAPS studies to be counterbalanced to control effect bias. complex/extensive travel days. These conducted at multiple sites. Standard goniometric AROM was data had participants wear an ActiLife assessed using commonly reported GT3X+ accelerometer on the non- landmarks; lateral epicondyle (axis), dominant hip and clipped a GPS long axis of femur (stationary arm), receiver to their belt during all waking and long axis of fibula (moveable arm). hours except when bathing. Each team To measure AROM subjects processed the 6 days of data to extract maximally flexed and extended the the 11 MAPS system variables. Main knee while maintaining a 90° hip angle.

S-52 Volume 48 • Number 3 (Supplement) May 2013 13122UOMU iPhone App (Goniometer, Jinfra) A Comparison Of Standard epicondyle (axis), greater trochanter landmarks included; quadriceps tendon Goniometry Versus (stationary arm), and lateral malleolus 1” proximal from superior patella pole Drgoniometer Ipad/Iphone App (moveable arm). Once maximal joint (position 1), and along anterior tibia For Measuring Knee Flexion And movement was obtained a digital 1” distal from tibial tuberosity Extension photograph using the iPad/iPhone app (position 2). Once maximal joint Tomczyk KM, Eley DM, Berry DC: was recorded. The app automatically movement was obtained, the iPhone Saginaw Valley State University, calculated ROM by manually was placed horizontally along position University Center, MI manipulating three markers so a red 1. “Start” was pressed to measure circle with a cross inside was placed

position 1. This was repeated for Context: Range of motion on the anatomical landmarks Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 position 2 with “End” pressed in order measurements are commonly used by identified above. To ensure proper to calculate. Person Product Moment clinicians when conducting a physical positioning the app provided a red Correlation Coefficients were examination, traditionally assessed dotted line that connects the individual calculated to determine the using a goniometer. However, standard reference points to ensure proper relationships between KF and KE SG goniometry (SG) measurements have alignment. Person Product Moment and the App. An intraclass correlation demonstrated inconsistent and Correlation Coefficients were (ICC2,1) measured KF and KE inter- sometimes unreliable results calculated to determine the rater reliability. Main Outcome prompting clinicians to search for relationship between KF and KE SG Measures: SG and App KF and KE alternative methods of consistently and the app. An intraclass correlation AROM measured in degrees. Results: assessing ROM such as through the use (ICC2,1) measured KF and KE inter- Combined SG and app mean (SEM) of iPad/iPhone applications. rater reliability. Main Outcome rater scores for KE were 30.5° (1.6°) Objective: To compare the Measures: KF and KE AROM and 18.6° (1.7°), respectively. relationship between knee flexion measurements for SG and app Combined KF rater mean (SEM) (KF) and extension (KE) active ROM measured in degrees. Results: scores for SG and app were 135.7° (AROM) using SG and the iPad/iPhone Combined SG and app mean (SEM) (.89°) and 128.6° (1.8°), respectively. paid application DrGoniometer (app). rater scores for KE were 30.5° (1.6°) Significant relationships were also Design: Quasi-experimental. and 28.9° (1.6°), respectively. found between combined rater SG and Setting: Athletic training laboratory. Combined KF mean (SEMS) scores app for KE, r (39) = .848, P = .000 Participants: Forty-one participants, for SG and app were 135.7° (.89°) and and KF, r (39) = .502, P = .001. ICC 16 males and 25 females 136.7° (.91°), respectively. Significant measurements for inter-rater (age=20.5±1.1; height=171.4 cm±8.4 relationships were found between reliability values for KE and KF were cm; mass=73.9 kg±16.51) free of combined rater SG and app for KE, .805 (95% CI: .663 to .891) and .318 lower extremity injuries, surgery/pain r(39)=.907, P=.000 and KF, (95% CI: .015 to .567), respectively. for 6 months to the dominant side. r(39)=.865, P=.000. ICC Conclusions: A significant Interventions: Participants were measurements for inter-rater relationship between SG and the App placed supine for a single session reliability values for KE and KF were suggests that the iPhone App may be measurement of KF and KE ROM by .785 (95% CI: .631-.879) and .877 an option for assessing KF and KE two independent raters using the (95% CI: .781-.933), respectively. AROM; however inter-rater reliability subjects’ dominant leg (used to kick a Conclusions: A significant demonstrated poor to moderate ball). To control measurement error, a relationship existed between SG reliability between raters. Due to poor polyvinyl chloride (PVC) frame was and the Dr.Goniometer app suggesting inter-rater reliability the iPhone placed at the pelvis to maintain a 90° that the application may be a viable Goniometer app should be avoided hip joint angle. Measurements were option for assessing knee AROM. when different clinicians are counterbalanced to control effect bias. The Dr.Goniometer app is a quick measuring a patient’s ROM. Standard goniometric AROM was and easy tool that allows for long- assessed using commonly reported term data storage and may help landmarks; lateral epicondyle (axis), improve patient motivation. long axis of femur (stationary arm), and long axis of fibula (moveable arm). Subjects then maximally flexed and extended the knee while maintaining a 90° hip joint angle to collect AROM. The app landmarks included; lateral

Journal of Athletic Training S-53 13329MOIN 13281MOSP

Accuracy Of On-Person GPS magnitude of the true and relative Test-Retest Reliability Of The Units In Tracking Static And errors at most static sites. True errors Stability Evaluation Test Of Dynamic Movement In Patients for the Land Air Sea (LAS) GPS device The VSR™-Sport In A Pediatric Jackson MJ, Medel M, Sinha G, ranged 2-7m and relative errors from Sample Ragan BG: Ohio University, 4-10m. Interestingly, the least accurate Hanline VL, Olson BL: South Athens, OH readings were for the urban sites that Dakota State University, were in close proximity to buildings. Brookings, SD Context: The use of GPS units is more The error of the units for the dynamic common in athletic training to track tracking are as follows, starting with Context: The Stability Evaluation Test mean and followed by standard ® ™ functionality post-injury. The accuracy (SET) of the Neurocom VSR -Sport Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 of tracking individuals has not been deviation: Garmin Oregon with WAAS has been introduced as a clinical fully substantiated although we have enabled (high priced market item) measure of balance, particularly for established validity evidence in post- 2.13m and 1.18. There were two LAS youth who have suffered a sport- surgical knee patients. Objective: To GPS used in the study and their related concussion (SRC). The SET determine the accuracy of GPS units descriptive statistics are as follows: requires the participant to complete in participant-tracking research. mean = 3.74m and standard deviation the Balance Error Scoring System Design: Observational study. Setting: = 2.52; mean = 3.74m and standard (BESS) protocol while on the force Free-living environment. Patients or deviation of 1.52. Conclusions: On a plate; however, instead of a rater Other Participants: Three GPS global scale, accuracy within 3.5m is measuring errors (as in the BESS), the readings of National Geodetic Survey a well-performing GPS measure. On a force plate measures changes in center (NGS) benchmarks and 3 different smaller scale, 3.5m should be able to of gravity (or sway velocity) providing units tracked participant movement on help distinguish between an a more objective measure of 84 corners of 21 rectangular art individual’s locations. The efficacy of impairment. Although clinically installations in the campus the LAS (3.5m accuracy), a cheaper acceptable test-retest reliability has Bicentennial Park to test the accuracy and comparable version to the high been established for the BESS, test- of GPS data. Interventions: Two performance Garmin Oregon (2.13m retest reliability has not been types of movements were tracked to accuracy), can be used sufficiently to established for the SET protocol in a test the accuracy of GPS units: static track an individual’s position during pediatric sample. Objective: To and dynamic. NGS were used for static the course of the study. The cost examine test-retest reliability of the movements with extremely accurate effectiveness of the Garmin Oregon SET protocol of the VSR™-Sport in a locations using markers to compare is not worth the greater accuracy it pediatric sample using clinically the accuracy of GPS units with respect offers. The LAS GPS units will relevant timeframes and to investigate to the known locations of the sufficiently complete the task of gender and age group differences on benchmarks. The dynamic movements tracking participant movement. test-retest reliability in this sample. were tracked following specific Design: Repeated Measures Design. patterns whose locations are known. Setting: Boys and Girls Club of Main Outcome Measures: The GPS Brookings. Patients or Other units have some error but it has not Participants: Fifty–four healthy been established for static and children (33 males and 21 females, dynamic measures. The units offer a age=8.2±1.9yr; height =131.5 great method for tracking individual ±12.5cm; weight=31.4±11.1 kg) free functionality in non-laboratory from injury or illness known to affect settings. The efficacy must be balance completed all three testing explored. ArcGIS, a mapping software, sessions. Interventions: The SET was used to track the data and offer protocol consists of 6 conditions spatial analysis of the GIS data. The lasting 20 seconds each (3 hard and 3 NGS benchmarks offer the static soft surface stances). Participants measures of the GPS units. For completed the SET three times over dynamic movement, ArcGIS was used the course of 35 days: day 1, day 30 to pinpoint known locations and the and day 35. The testing series error of the GPS units was cited. represents points of clinical Results: All dedicated GPS units were management following SRC. Main relatively similar in terms of the Outcome Measures: Sway velocity

S-54 Volume 48 • Number 3 (Supplement) May 2013 13396MOBI

(deg/sec) of each condition and a Validation Of Postural Stability accelerometer and gyroscopic data composite of the SET was measured Assessment Using were collected with the iPad2 affixed at day 1, day 30 and day 35. An Accelerometer And Gyroscopic to the participant’s sacrum with a interclass correlation coefficient Measures standard weight-lifting belt. The (ICC) was used to calculate test-retest Graber DK, Schindler DD, Hirsch transmission of data from the iPad2 reliability for three testing timeframes JR, Kana DE, Linder SM, Alberts was synchronized with the NeuroCom (Day 1-Day 30, Day 30-Day 35, Day JL: Cleveland Clinic Sports Health, system to ensure temporal alignment 1-Day 35). ICC’s were also calculated Cleveland, OH, and Biomedical of data collected by the two systems. to determine test-retest reliability for Engineering, Cleveland Clinic, Main Outcome Measures: Anterior- gender and age group (younger cohort Cleveland, OH Posterior (AP) measure of postural Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (5-7yr) and older cohort (8-15yr)). stability was calculated using data from Results: Each testing timeframe Context: Field experts have called for the accelerometer and gyroscope elicited clinically acceptable (greater an objective assessment of postural native to the iPad2, and validated than .80) test-retest reliability for stability to be included as part of a against AP equilibrium scores composite SET scores: Timeframe comprehensive concussion manage- calculated during simultaneous 1ICC=.91 (.84-.95, 95% CI), ment program. However, the balance performance of the NeuroCom Timeframe 2 ICC=.92(.86-.95, 95% assessment most commonly utilized in Sensory Organization Test. A bivariate CI) and Timeframe 3 ICC=.86 (.76- the management of athletes with correlation analysis was completed .92, 95% CI). Although some variation concussion, the Balance Error Scoring between the NeuroCom Equilibrium existed in test-retest reliability when System (BESS), suffers from floor Scores (ES) and iPad2 Equilibrium comparing males to females and a and ceiling effects in addition to poor Scores for each of the six conditions younger cohort to an older cohort, all inter- and intra-rater reliability. and for the Composite ES. Results: ICC’s demonstrated clinically Conversely, sophisticated measures of Equilibrium Scores as calculated from acceptable findings. Conclusions: postural stability such as the Sensory accelerometer and gyroscopic data Strong test-retest reliability is Organization Test lack the portability from the iPad2 correlated significantly necessary to ensure that impairments and accessibility for widespread in- with NeuroCom equilibrium scores in defined post-concussion are due to the field use. Objective: The objective each of the six SOT conditions (r=0.44 condition, and not unreliable tests. of this project was to develop and to 0.93; p<0.01) as well as the Findings support strong test-retest validate a reliable, portable, and cost- composite equilibrium score (r=0.95; reliability of the SET in a healthy effective method of objectively p<0.01). Conclusions: Acceler- pediatric sample when delivered over quantifying postural stability as part of ometer and gyroscopic data from the timeframes following current the Cleveland Clinic Concussion (C3) iPad2 provide an accurate and concussion management protocols. Application for the comprehensive objective measure of postural stability Although some variation in reliability assessment of concussion-related that could be used in the objective exists when gender and age group impairments. Design: A prospective assessment of balance. This consumer are considered separately, reliability longitudinal study was utilized. electronics device is ideally suited to remains clinically acceptable. Setting: The validation study was be used in clinical and sport The ability to measure sway velocity conducted in the Neural Control environments to provide a portable rather than balance errors allows Research Lab at the Cleveland Clinic. method of balance assessment, and can for an objective measurement Participants: A volunteer sample of be included as part of a comprehensive of balance over time. 49 high school and college-age concussion management program. students (14-25) participated in the study. Participants were not eligible if they had a history of concussion within the past 6 months or had any musculoskeletal or neurologic condition resulting in impaired balance. Interventions: Participants completed the entire Sensory Organization Test (SOT) consisting of three 20-second trials for each of the six conditions. Simultaneously,

Journal of Athletic Training S-55 13230MOSP 13089DOSP

Validation Of Accelerometry As cognitive rest. Matched-controls were Objective Assessment Of A Physical Rest Monitor During monitored during the same time Function Following Head Injury Concussion Recovery period. Independent t-tests (˜= 0.05) Using Movement And Activity In Wells KA, Farnsworth JL, with Bonferoni adjustments were used Physical Space (MAPS) Scores McElhiney DS, David SL, Ragan to determine differences in PA Farnsworth JL, Mc Elhiney D, Kim BG: Ohio University, Athens, OH, between the concussed and control Y, Kang M, Ragan BG: Middle and Middle Tennessee State groups. Main Outcome Measures: Tennessee State University, University, Murfreesboro, TN The dependent variables (per day) were Kinesmetrics Lab, Murfreesboro, mean total PA counts, mean PA counts TN, and Ohio University, Division away from the home, mean PA counts Context: Current concussion of Athletic Training, Athens, OH Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 guidelines call for physical and at home. The amount of time spent cognitive rest after sustaining a away from home, and the total number Context: Current concussion concussion. Patient compliance with of trips travelled were examined to measures focus primarily on these recommendations relies on ensure travel behavior was similar measuring patient impairments, are subjective patient reports. There is across groups. Results: There was a clinic-based tests (ie, neurological little research into monitoring patient significant difference in mean total PA exam in front of a computer), and do compliance with physical and cognitive counts (t(11) =2.9; p<0.05) between not evaluate overall patient function. rest in the free living environment. To concussed athletes (Mean±SD: The Movement and Activity in Physical better treat concussed athletes and 298,158±116,704 counts) and Space (MAPS) system can provide an evaluate these guidelines objective controls (450,271±67,130 counts.) objective measure of overall function monitoring measures are needed. There was a significant difference in in free-living environment by using Accelerometry is applied in studies to PA counts (t(11) =2.5; p<0.05) accelerometry, on-person global track an individual’s physical activity between concussed athletes positioning system (GPS) device, and (PA) level using activity counts and has (224,661±100,306 counts) and geographic information systems been validated in various PA trials. It controls (104,201±66,297 counts). (GIS). The MAPS system has been has the potential to monitor adherence There was no significant difference in validated in post-surgical knee to physical rest (PR) following a PA at home (t(11)= 0.522; p>0.05) patients. Objective: To establish concussion. Objective: To validate between concussed athletes validity evidence for MAPS scores as the use of accelerometry in (70,129±43,193 counts) and controls objective measures of function in monitoring patient compliance with (58,609±34,962 counts). There was no concussion patients. Design: PR following a concussion. Design: significant difference regarding the Observational repeated measures Observational matched-pair design. amount of time spent away from the matched-pair design. Setting: Setting: Free-living conditions. home (t(11)=-0.9; p>0.05) or the Environmental free-living conditions. Patients or Other Participants: A number of trips travelled (t(10)=-0.1; Patients or Other Participants: A total of 14 participants, (mean age: p>0.05) (concussed 465±79 min, total of 14 university athletes (n = 7 19.8±1.0 yrs; females n= 7, males n= 4.4±1.3 trips, control 472±166 min, concussed, n = 7 healthy control; aged: 7) DI and DIII collegiate varsity or club 4.5±0.8 trips). Conclusions: mean ± SD, 19.7±1.0yrs) participated sport athletes volunteered for the study Accelerometry is sensitive to PA in this study. The healthy controls were (concussed group (n=7) and control changes associated with PR matched for age, sex, sport, perceived group (n=6); one control was removed recommendations during concussion physical activity level, and major. for non-compliance). Matched recovery. The change appears to be Interventions: Participants wore an controls were uninjured teammates. related to activities away from home. Actigraph GT3X+ accelerometer on Interventions: The independent The travel patterns and activity at home their hip and an on-person GPS variable was group membership was not altered. This provides validity receiver for up to 10 days except for (concussed or matched-control). evidence for the use of accelerometry when sleeping or bathing. These Participants wore an Actigraph in monitoring adherence to PR devices measure activity counts GT3X+ accelerometer on the hip protocols for concussed athletes. (intensity), and step counts (volume) during waking hours, carried an on- each minute and location (latitude/ person GPS device, and completed an longitude). GPS data were verified by activity diary for 5 days after participants through the use of self- concussion diagnosis. All concussed reported travelogues. MAPS scores participants followed a concussion were calculated by combining data protocol recommending physical and from the GPS and accelerometer for

S-56 Volume 48 • Number 3 (Supplement) May 2013 each day to assess patient function. Participants also completed daily symptom questionnaires. Main Outcome Measures: The dependent variables were 6 scores: MAPS intensity (MAPSI), MAPS volume

(MAPSV), total symptom load, symptom severity, symptom “bothersomeness”, and symptom frequency. Convergent validity Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 evidence for MAPS was assessed using Pearson correlation (˜ = 0.05) examining the relationship between MAPS scores and self-reported symptom scores. Known-group difference validity evidence was assessed using independent t-tests (˜ = 0.05) evaluating differences in mean

MAPSI and MAPSv scores between the concussion and control groups.

Results: The MAPSI and MAPSV scores and self-reported symptom scores were significantly correlated with total symptom load (r = -0.32; p = 0.01, r = -0.33; p = 0.01), symptom severity (r = -0.30; p = 0.02, r = -.31; p = 0.01), symptom “bothersomeness” (r = -0.32; p= 0.01, r = -0.32; p = 0.01), and symptom frequency (r = -0.32, p= 0.01; r=-.31, p = 0.01), respectively. There was no significant differences (t12 = -1.11, p =.29: t12 = -0.36, p =.73, between the concussion

(M±SD; MAPSI 1,523.4±1,068.9;

MAPSv 46.0±40.0) and control groups

(M±SD; MAPSI 2,231.8±1,314.4;

MAPSv 50.3±25.0). Conclusions: Our correlation results provided evidence of convergent validity for MAPS scores in a concussion population during recovery. Although there were no significant group differences the data did show the expected inverse relationship between function and symptoms in all 4 symptom measures. Additional validity evidence to support the use of MAPS scores is needed.

Journal of Athletic Training S-57 Free Communications, Oral Presentations: Socialization, Retention and Work- Life Balance 13150DOPEThursday, June 27, 2013, 3:15PM-4:45pm; Palm B; Moderator: Sara Nottingham, EdD, ATC, CSCS

Programmatic Factors completion of two semesters of directors should carefully consider Associated With Athletic coursework (51.4%). The program how many students to admit into Training Student Retention directors held their positions for the ATEP annually as individual Decisions 8.0±6.0 years. Interventions: An attention from faculty, staff, and Bowman TG, Hertel J, Wathington online questionnaire, developed clinical preceptors may alter HD: Lynchburg College, based upon the current literature, persistence decisions of ATSs. was sent to all PDs of CAATE

Lynchburg, VA, and University of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Virginia, Charlottesville, VA accredited undergraduate ATEPs. We asked them for demographic and Context: Athletic training education factual information about their programs (ATEPs) are charged with institution, ATEP, and themselves. meeting an increased demand for We pilot tested the questionnaire on athletic trainers with adequate three separate occasions to reduce graduates. Currently, it remains measurement error and provide unknown what the retention rate is for construct validity. Main Outcome ATEPs nationwide and what Measures: We asked the PDs to programmatic factors are associated identify the percentage of ATSs who with the retention rates of athletic graduated from their ATEP out of the training students (ATSs). Objective: total number of ATSs admitted into Determine the retention rate for ATSs their ATEP over the past 5 years. We nationwide and the programmatic used multiple regression to evaluate factors associated with ATS the ability of the demographic and retention. Design: Cross-sectional factual variables to predict the ATS online questionnaire. Setting: retention rate. Results: The Undergraduate ATEPs. Patients or participants reported an average Other Participants: Program retention rate of 81.0±17.9% directors (PDs) of all Commission (range=9%-100%). We found a on Accreditation of Athletic Training significant prediction equation 2 Education (CAATE) accredited (F4,167=16.39, R =0.282, P<0.001) undergraduate ATEPs were asked to using the timing of formal admission 2 complete an online questionnaire. into the ATEP (P<0.001, R =0.162), We obtained responses from 177 out the number of years the ATEPs had of the 343 PDs (51.6%). The been accredited (P<0.001, 2 majority of respondents represented R =0.068), the number of students ATEPs at publicly funded (50.3%) admitted to the ATEP annually 2 Master’s institutions (47.5%) with (P<0.01, R =0.032), and the number small enrollments (1000-3000 of years the PD had held their students) (26.6%) and position at their current institution 2 predominantly National Collegiate (P=0.04, R =0.019). Conclusions: Athletic Association Division 1 We believe that delaying the formal sponsored athletics (42.4%). The admission of prospective students ATEPs represented had been may aid professional socialization accredited for 10.7±4.0 years and allowing ATSs to make an informed required 2.8±0.6 academic years of decision to enter an ATEP. We also clinical education. Program believe ATEPs with a rich history of directors admitted an average of success and consistent leadership 16.0±13.9 students into the ATEP can provide an environment that annually, most doing so after fosters ATS retention. Program

S-58 Volume 48 • Number 3 (Supplement) May 2013 13428FOHE 13137DOHE

Work-Life Balance In The causing issues with WLB for the Head Managing Motherhood In The Division I Clinical Setting From AT and contained 2 lower order NCAA Division I Setting: The The Perspective Of The Head themes: 1) lack of autonomy and 2) Role Of Mentorship And Female Athletic Trainer role demands. The WLB strategies Athletic Trainers Mazerolle SM, Goodman A, Pitney theme included those strategies Barone CM, Mazerolle SM, WA: University of Connecticut, employed personally by the Head AT Ferraro EM, Goodman A: Storrs, CT; Appalachian State to promote WLB and contained 3 University of Connecticut, Storrs, University, Boone, NC; Northern lower order themes: 1) prioritization CT, and Appalachian State Illinois Universi DeKalb, IL of commitments, 2) strategic boundary University, Boone, NC

setting and 3) work-family integration. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Work-life balance (WLB) Four additional themes emerged from Context: One of the greatest catalysts has been examined in the collegiate the data regarding methods used by for turnover in the profession among level from multiple perspectives, Head ATs to promote WLB amongst women is motherhood, especially if expect for the athletic trainer (AT) their staff members: 1) modeling employed at the Division I collegiate serving in a managerial or leadership WLB, 2) encouraging disengagement level. We know that the medical role. Evidence suggests those in from the AT role, 3) cooperation and education literature regularly supervisory roles can help facilitate community workplace, and 4) identifies the importance of role WLB for their employees, yet little is administrative support and models in value, attitude, and know about the challenges they face understanding. These four themes professional character formation. individually due to their role. address the leadership role assumed However, there is very limited Objective: Investigate challenges by the Head AT and their use of research examining the role of with WLB faced by the Head AT and informal strategies to encourage mentorship and professional role strategies used in achieving WLB. WLB. Conclusions: Head ATs are models as it relates to female athletic Design: Qualitative study using susceptible to experiencing work-life trainers’ (FATs) perceptions of structured interviews. Setting: Web- imbalance, just like those ATs in non- motherhood and retention. Objective: based management system. Patients supervisory roles. The causes, To evaluate perceptions of or Other Participants: Eighteen although not avoidable, are motherhood and retention in relation total Head ATs (13 males, 5 females) manageable. Head ATs are encouraged to mentorship and role models volunteered to participate in our to prioritize their personal time and amongst FATs currently employed in asynchronous, online interview. The make efforts to spend time away from the collegiate setting. Design: average age of the participants was 44 their demanding positions as well as Structured, online asynchronous years ± 8 and they had on average 22 ± reduce, when possible the number of interviews. Setting: Female BOC 7 years of experience. Of the 18, 15 additional responsibilities that can certified ATCs working at the Division (83%) were married/partnered and 3 impede upon time available to get away I setting. Patients or Other (17%) were single. Eight of 17 (44%) from work. Furthermore, Head ATs are Participants: 27 FATs (single=14; were married with children. Only one advocates for WLB and are making married=6; married with children=7) of our Head ATs did not have travel efforts to help their ATs fulfill WLB employed in the NCAA Division I duties associated with their job by modeling the concept themselves, setting volunteered. Average age of the responsibilities. Data Collection as well as promoting a cohesive and participants was 34 ± 8. All were full- and Analysis: Participants responded supportive work environment. time BOC certified with an average 11 to a series of questions by journaling ± 7 years of clinical experience. Data their thoughts and experiences. We Collection and Analysis: Parti- included multiple analyst triangulation, cipants responded to a series of stakeholder checks, and peer review to questions by journaling their thoughts establish data credibility. We analyzed and experiences via QuestionPro™. the data via a general inductive Multiple analyst triangulation and peer approach. Results: Two higher order review were included as steps to themes emerged from our analysis of establish data credibility. The data was the data to speak of the individual analyzed borrowing from the principles experiences of the Head AT: 1) of general inductive approach. Organizational challenges and 2) Results: The first theme, impact of WLB strategies. The Organizational role models/mentors, highlights the Challenges theme portrays the factors capacity of a male or female role model

Journal of Athletic Training S-59 13029FOHE to positively or negatively influence Retention And Attrition Factors departure themes emerged from the career and WLB perceptions of For Male Athletic Trainers In The former employee data: 1) role strain, women working in the Division I National Collegiate Athletic 2) work-family conflict, 3) role setting. The second theme desire for Association Division-I Setting transition, and 4) lack of advancement. female role models/mentors, speaks Goodman A, Mazerolle SM, Pitney The role strain theme contained 2 to the participant’s desire to see more WA: Appalachian State University, subthemes; role conflict and role women in the profession handle the Boone, NC; University of overload. The lack of advancement demands of motherhood and the Connecticut, Storrs, CT; Northern theme also contained 2 subthemes; demands of a taxing clinical setting. Illinois University, DeKalb, IL lack of promotion and lack of Women who have had female mentors compensation. Male ATs experienced Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 are more positive on the prospect of Context: Social support, autonomy, role overload and role conflict that balancing the rigors of motherhood and and job satisfaction are among the created an imbalance between work the demands of their jobs. Our FATs factors influencing female athletic and family. A lack of promotional who did not have a female mentor, yet trainers’ (ATs) decision to persist in chances and low salaries were wanted one were apprehensive about the National Collegiate Athletic implicated as reasons to depart their their longevity in the field of athletic Association Division-I (NCAA D-I) role. For those with more years of training, because of motherhood. setting, while work-life balance issues service, taking an opportunity to reduce Conclusions: Similar to previous and role overload are factors leading one’s responsibilities and move toward research it appears as though the them to depart. These factors may not retirement were common departure prospect of raising a family and be similar for male ATs. Objective: strategies. Conclusions: Our balancing the demands of Division I Gain insight into the factors which findings regarding reasons to persist seem daunting for most women. affect male ATs’ decisions to persist or leave the NCAA D-I setting are However, mentorship/role models are at or depart the NCAA D-I setting. comparable to those within the a valuable tool for perseverance in the {Banerjee, 2004 #30}Design: literature. Issues with salary, career profession and at the highly demanding Qualitative study. Setting: NCAA D- advancement and role transition are not clinical settings. Our results coincide I institutions. Patients or Other unique attrition factors, but have not with research in other medical Participants: A total of 19 current been found among female ATs. Unique professions, identifying the (n = 11) and former (n = 8) employees to the profession is the competitive importance of role models on females. participated in our study. The current atmosphere which is satisfying for As more FATs remain in the employees averaged 6 ± 6 years of many ATs and influenced persistence. profession who are able to maintain NCAA D-I clinical experience, 66 ± Future research needs to examine the work-life balance and are available to 10 working hours per week during the career intentions of ATs, regardless of serve as role models, it is conceivable traditional sport season, and 34 ± 5 gender as well as the satisfaction of that the attitudes of other women may years of age. The former employees those ATs who depart the profession start to change. Future inquiry should averaged 15 ± 11 years of NCAA D-I to determine if a career/setting change examine the impact of role models at experience, 66 ± 5 working hours per mitigated their concerns. clinical settings outside of Division I week during the traditional sport and ways to increase role model season, and 45 ± 11 years of age. Data exposure to female athletic trainers. Collection and Analysis: Data were collected via in-depth, semi-structured interviews, and transcribed verbatim. Two researchers followed the steps of a grounded theory study and analyzed data independently. Data saturation guided recruitment, while a peer review and member checks established credibility. Results: Two main persistence themes emerged from the data: 1) D-I atmosphere and 2) workplace environment. The level of collegiality and support along with an exciting and competitive atmosphere were reasons for persistence. Four

S-60 Volume 48 • Number 3 (Supplement) May 2013 13023MOHE 13439MOHE

Perceptions Of Retention constructs identified in the factor Factors And Strategies That Indicators In Athletic Training analysis: work/family, work-related, Contribute To Work Life Juzeszyn LS, Kahanov L, and burnout. Results: Participants Balance Of Female Athletic Eberman LE, Pitney WA: Indiana varied in the demographic Trainers Employed In The NCAA State University, Terre Haute, IN, characteristics suggesting we Division I Setting and Northern Illinois University, identified a diverse population of Ferraro EM, Mazerolle SM, DeKalb, IL respondents. Overall, work-related Barone CM, Goodman A: and work/family issues that contribute University of Connecticut, Storrs, Context: Attrition in the profession to retention were neutral with the CT, and Appalachian State exception of irregular hours University, Boone, NC of athletic training notably occurs in Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 large numbers between five and ten (mean=3.7±1.3) and salary years of work experience creating a (mean=3.9±1.4). In addition, male Context: Work life balance (WLB) profession dominated by young, entry- and female respondents indicated can be challenging particularly for level practitioners. Theoretical relatively neutral perceptions on female athletic trainers (FATs). constructs are currently used to burnout factors. Burnout factors Evidence suggests FATs persist in the explain the retention issues in athletic contributed to retaining women more profession because of job enjoyment, training, yet an assessment of than men regarding hopelessness increased autonomy, and social support individuals who have left the (H=7.201, d.f.=1, p=0.007), loss of networks. Departure factors such as profession is lacking. Objective: To idealism (H=4.757, d.f.=1, p=0.029), long hours, travel, and inflexibility of assess reasons why athletic trainers let detachment to others (H=4.179, schedules often comprise issues with their athletic training certification (AT- d.f.=1, p=0.041), and pessimistic WLB. Time management, support C) lapse and leave the athletic training thinking (H=4.800, d.f.=1, p=0.028). networks, and setting boundaries are profession. Design: Cross sectional- Those in relationships and with strategies used to find WLB, however, observational study. Setting: Internet children also experienced work/family little is known about the strategies Survey. Patients or Other and burnout factors comparatively, FATs use to maintain WLB in the Participants: We recruited 1000 including added responsibility at home Division I setting as they seem to former certified athletic trainers who (H=26.235, d.f.=3, p<0.001), struggle more with finding WLB let their certification lapse within the children/parenting responsibilities potentially due to the responsibilities past 5 years. Eighty-four of the 1000 (H=26.235, d.f.=3, p<0.001), feeling associated with motherhood. email addresses were undeliverable down in the dumps (H=7.909, d.f.=3, Objective: To gain insight of leaving 916 viable participants p=0.048), difficulty concentrating contributing factors and strategies with198 respondents for a 22% (H=8.093, d.f.=3, p=0.044), feelings used by FATs employed in the Division response rate. Interventions: We of depression (H=9.112, d.f.=3, I collegiate setting to fulfill WLB. administered the survey online and p=0.028), and feelings of frustration Design: Structured, online determined face/content validity with (H=8.405, d.f.=3, p=0.038). asynchronous interviews via a review of three certified athletic Conclusion(s): Symptoms of burnout QuestionPro™ Setting: NCAA trainers (experience range 12±8 and life stressors contribute to the Division I Collegiate setting. Patients years), factor analysis, and strong lack of retention in the profession or Other Participants: 27 FATs indication of internal consistency more in females, yet previously (single=14; married=6; married with (Cronbach’s alpha=0.98). Main theorized attributes such as staffing children=7) currently employed as Outcome Measures: The survey issues, demanding schedule, role full-time ATs in the NCAA Division I consisted of 18 questions, including ambiguity, role strain and lack of setting participated. Majority of FATs 9 demographic questions, 7 matrices flexibility do not appear to be factors. were contracted for 12 months and regarding aspects of retention, and two Life-work issues such as salary and worked 58±19 hours a week. Primary open-ended questions to assess coping irregular work hours were greater sport coverage responsibility was strategies. The matrices employed 5- factors in retention than previously women’s basketball (9 FATs) followed point Likert scales to measure noted in the literature. Women appear by women’s soccer (7 FATs) and agreement (1=strongly disagree to to be more affected by and work/ football and volleyball (3 FATs). Data 5=strongly agree. We used a Kruskal- family issues contributing to retention. Collection and Analysis: FATs Wallis to assess work/family issues. responded to a series of open-ended We assessed gender, age, relationship questions via reflective journaling status, employment setting, highest using QuestionPro™, a secure data education level, and children on three tracking website. The survey was

Journal of Athletic Training S-61 13451FOHE piloted prior to distribution. Data was The Professional Socialization Anticipatory Socialization Period— examined borrowing from the Of Athletic Trainers In The participants were challenged by principles of general inductive Professional Sport Context mentors and instructors early in approach. Trustworthiness was Pitney WA, Abdenour TE, educational experiences to set established by multiple analyst Mazerolle SM: Northern Illinois themselves apart from others; 2) Initial triangulation, member interpretive University, DeKalb, IL; San Diego Preparatory Experiences—volunteer review, and peer review. Results: State University, San Diego, CA; activities with the teams, working Regardless of marital status, University of Connecticut, Storrs, sanctioned off season developmental participants indicated 3 main factors CT league competitions, camps, or influencing WLB; hours worked and

engaging in internships were necessary Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 travel, inflexibility and control of work Context: The professional to network with professional team schedules, and salary. These factors socialization process consists of athletic trainers and gain entry into the have been shown to affect retention by recruitment, anticipatory sociali- work setting; 3) Sacrifice— pressuring ATs to sacrifice time spent zation, organizational socialization, participants expressed financial and with family and limiting personal time, and role continuance. To date, the family time sacrifices in order to while insufficiently meeting their professional socialization of athletic work in the professional setting; and financial needs. FATs who were trainers (ATs) in high school, college, 4) Learning through Networking— married and/or had children found the and clinical/rehabilitation settings has professional team societies represent ability to prioritize and have separation been investigated, but a lack of a strong brotherhood or fraternity from work as useful strategies to information pertaining to professional whereby the participants could rely on fulfill WLB. Single FATs utilized time socialization of ATs in the professional others for advice and information away through exercise as a means to sport context has been neglected. related to the nature of the roles in the achieve WLB. Regardless of marital Objective: To gain insight and profession along with emotional status, the main factor necessary to understanding of the anticipatory and support and educational experiences. accomplish WLB was to have a strong organizational socialization Conclusions: Being challenged to support system both at work and experiences of ATs working in the excel and take the initiative to engage home. No formal policies or strategies professional sport settings with an in preparatory experiences such as were in place to help mothers achieve emphasis on identifying aspects of voluntary or low-pay internships, a work life balance. Conclusions: As gaining entry into the professional camps, and team sponsored activities indicated in previous research, FATs setting and those experiences that best appears necessary to network with experience issues with WLB in the prepare individuals for work in the professional ATs and gain entry into the Division I setting. FATs should professional context. Design: professional sport setting. Once continue to make time away from the Qualitative study using one-on-one inducted into the sport context, role of athletic trainer and as phone interviews. Setting: personal sacrifice is essentially a the literature indicates, capitalize Professional sport. Patients or Other constant throughout the AT’s career in on informal resources such as co- Participants: 12 males aged (M ± SD) professional sports. High level worker support as a means to maintain 47 ± 8 with 23 ± 9 years of financial reward may require moving WLB. WLB strategies are useful, but experiences were recruited from from an assistant’s position into a head formal policies need to be established professional teams in baseball, AT position or by being promoted to help retain FATs in the profession. basketball, football, and hockey via from minor leagues to the major Future research may investigate what purposive sampling as well as snowball league level. The professional sport policies and strategies can be sampling. Data Collection and setting emphasizes the learning of employed to achieve WLB. Analysis: In-depth, one-on-one the role through personal interactions interviews were conducted. The via a network of professional society interviews were digitally recorded and members who offer social support transcribed verbatim. Textual data was and educational opportunities to analyzed using inductive content one another to facilitate the analysis. Trustworthiness was socialization and advancement of its established with multiple analyst members. This project was funded by triangulation and peer debriefing. the National Basketball Athletic Results: Four themes emerged from Trainers’ Association Foundation the inductive analysis: 1) High Level of Professional Challenge During

S-62 Volume 48 • Number 3 (Supplement) May 2013 13219DOHE

Supervising Athletic Trainers’ Previous preparation, 3) GA Role Perspectives On Professional Orientation, 4) Program’s role in Socialization Of Graduate supporting and developing GAs, and 5) Assistant Athletic Trainers In Shortcomings and success. The Collegiate Setting Supervisors expected the GAs to Thrasher AB, Walker SE, provide coverage for their respective Hankemeier DA, Pitney WA: Ball sport at the level of a new clinician; State University, Muncie, IN, and however, supervisors often expected Northern Illinois University, the GAs to function autonomously as DeKalb, IL experienced full-time ATs. The Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 majority of the supervisors believed Context: Many newly credentialed that GAs were adequately prepared to athletic trainers gain initial work deliver patient care but lacked the experience as Graduate Assistants confidence and skills to communicate (GA) in the college setting, yet it is effectively with coaches, parents, and unknown how they are socialized into physicians regarding patient care. their roles. Exploring the perceptions Supervisors perceived GAs lack the of GA supervisors in the collegiate ability to fully execute their various setting as to how GAs are socialized roles (e.g., progress patients through could provide insight into how this rehabilitation), which was often due to process occurs. Objective: To a lack of hands-on experience. GAs explore how GAs are socialized in the were oriented to their roles and collegiate setting. Design: expectations both formally (e.g., Consensual Qualitative Research orientation/weekly meetings) and (CQR) Setting: Individual phone informally (e.g., mentorship when interviews Patients or Other initiated by GA or immediate role Participants: 21 collegiate ATs who immersion). Supervisors believed had supervised GAs in the collegiate personal characteristics of the setting for a minimum of eight years individual GA (e.g., arrogance) participated in this study (16 male, 5 inhibited their effectiveness in their female; years of supervision role more so than their professional experience: 14.6±6.6). Participants preparation. Supervisors report who met the inclusion criteria were intervening or mentoring as a recruited via an email from the Board way to professionally develop the of Certification database. Interviews GAs and address their shortcomings. were conducted until data saturation Supervisors felt most GAs adapt occurred. Data Collection and to their role over time (e.g., from 1 Analysis: Data were collected to 6 months) and are successful via phone interviews which were at meeting expectations. Conclusion: recorded and transcribed verbatim. Supervisors believed graduate Data were analyzed via a four-person assistantships are important in consensus team who independently the professional growth of new coded the data and compared ideas ATs to help transition them into until a consensus was reached and clinical practice. Supervisors are a codebook was created. An responsible for professionally independent auditor analyzed the developing GAs, but several domains and core ideas to ensure supervisors have unrealistic reliability. Trustworthiness was expectations for GAs to practice established through member checks as experienced ATs. and multi-analyst triangulation, which is the nature of consensual qualitative research. Results: Five themes emerged: 1) GA Role expectations, 2)

Journal of Athletic Training S-63 Free Communications, Oral Presentations: Neuromuscular Characteristics of Dance and Warrior Populations 13058FOMUTuesday, June 25, 2013, 8:00AM-9:00AM, Palm C; Moderator: Jatin Ambegaonkar, PhD, ATC, OT

Neck Strength, Flexibility, musculoskeletal injuries preventing to male Soldiers, but they had Posture, And Proprioception active duty. Interventions: All significantly less strength which may Differences Between Healthy subjects underwent the following predispose them to injury. Females Male And Female Soldiers In assessments: cervical strength, typically have a smaller body size than The US 101st Airborne Division shoulder strength, cervical flexibility, males, which would indicate a need for (Air Assault) forward head and shoulder posture, increased muscular strength relative to pectoralis minor length, and cervical body mass in order to safely and

McFate DA, Nagai T, Abt JP, Sell Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 TC, Smalley BW, Wirt MD, proprioception. Strength was measured properly perform the occupational Lephart SM: Neuromuscular using hand-held dynamometry with the tasks required of them. Decreased Research Laboratory, Department exception of shoulder elevation, which muscular strength also influences joint of Sports Medicine and Nutrition, was tested using an isokinetic stability, which may contribute to School of Health and dynamometer. Flexibility was increased injury risk. Further research Rehabilitation Sciences, measured using a cervical range of should focus on identifying modifiable University of Pittsburgh, motion instrument, and posture was risk factors for neck pain and Pittsburgh, PA; US Army School measured using a carpenters’ double- developing interventions influencing of Aviation Medicine, Fort Rucker, square device. Proprioception was those characteristics. Supported by AL; Blanchfield Army Community determined using a 3D motion capture USAMRMC #W81XWH-11-2-0097 Hospital, Fort Campbell, KY system. All tests were performed bilaterally when possible. Paired t-tests Context: Neck pain is a common were used to compare genders with complaint of military personnel, significance set at p< 0.05 a priori. especially in female populations. Main Outcome Measures: The Researchers have identified several dependent variables were peak force musculoskeletal and neuromuscular (normalized to body mass) for neck characteristics that may predispose flexion, extension, lateral flexion, individuals to neck pain such as rotation, and shoulder abduction/ decreased muscular strength. In many elevation, cervical range of motion cases female Soldiers are assigned to (ROM) for flexion, extension, lateral the same military occupational flexion, and rotation, forward head specialties (MOS) as male Soldiers (FH), right/left shoulder posture (RSP, and are required to perform identical LSP), pectoralis minor length, and duties under similar physical cervical active joint position sense. demands. This combination may Results: Female Soldiers ultimately place females at greater demonstrated significantly less risk of musculoskeletal injuries strength across all measurements including neck pain. Objective: To (p<0.05). Female Soldiers also determine if neck strength, flexibility, demonstrated significant increases in posture, and proprioception cervical rotation ROM (F: 80.5±6.2°, differences existed between healthy M: 74.3±4.8°, p=0.013) and male and female Soldiers. Design: significant decreases in FH Cross-sectional study. Setting: (F:20.5±1.5 cm, M:22.2±1.4 cm, Research laboratory. Participants: A p=0.015), RSP (F:14.4±2.7 cm, total of 12 female (Age=29.8±4.7 M:17.1±2.7cm, p=0.009), LSP years, height=164.5±9.2 cm, (F:13.7±2.3 cm, M:15.6±2.3 cm, weight=68.7±3.6 kg) and 12 male p=0.026). Conclusions: The current Soldiers (Age=29.2±3.9 years, results indicate gender-related height=175.2±5.6 cm., weight= differences in various musculoskeletal 82.1±9.8 kg) were recruited. Subjects characteristics. Female Soldiers were matched based on age (±3 years) displayed better flexibility and posture and MOS. All subjects were free of and similar proprioception compared

S-64 Volume 48 • Number 3 (Supplement) May 2013 13054OOTE 13153DONE

Effect Of A Lower Extremity number of sessions. At the end Female Dancers Stabilize Injury Prevention Program On of basic training, all subjects Earlier Than Recreationally Physical Performance Scores completed the Army Physical Fitness Active Females Following A In Military Recruits Test (APFT) which includes a timed 2- Jump Landing Task Peck KY, DiStefano LJ, Marshall mile run and 2 minutes each of push- Pye ML, Ross SE, Schmitz RJ, SW, Padua DA, Beutler AI, de la ups and sit-ups. Main Outcome Shultz SJ: University of North Motte SJ, Cameron KL: Keller Measures: The main outcome Carolina at Greensboro, Army Hospital, United States measures were raw and scaled scores Greensboro, NC Military Academy, West Point, for the three APFT events as well as the total APFT score. Initially, NY; University of Connecticut, Context: Poor balance has been Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Storrs, CT; University of North independent t-tests were used to associated with increased anterior Carolina, Chapel Hill, NC; assess between group differences for cruciate ligament (ACL) injury risk. Uniformed Services University of each dependent variable. Important Dancers are more stable than athletes the Health Sciences, Bethesda, variables were carried forward into during single leg static stance, which MD multivariable logistic regression may in part explain dancer’s decreased models to control for the influence of incidence of ACL injury. However, the Context: The implementation of confounding variables such as gender functional implications of static injury prevention programs in athletics and BMI. Results: Subjects in the balance measures have been has become more common due to intervention group completed the 2- questioned given the dynamic nature emerging evidence supporting their mile run 20 (95%CI: 9.27, 31.14) of sport. Whether dancers are also efficacy. Many of these programs are seconds faster when compared to the more stable during a dynamic balance designed to improve movement control group (p<.001). On average, task than athletes has not been patterns associated with lower subjects in the DIME group completed investigated. Objective: To compare extremity injury; however, the impact the run in 808(±79) seconds compared dynamic balance in collegiate dancers of these programs on general physical to the control group who completed and recreationally active individuals. performance has not been evaluated. the run in 828(±102) seconds. This Design: Descriptive cohort study. Objective: The purpose of this study corresponded with significantly higher Setting: Laboratory setting. Patients was to compare physical performance scaled scores for the 2-mile run in the or Other Participants: Six female scores between subjects who DIME group (p<0.001). There were dancers (DA) [19.8 ± 1.2 yrs, 161.7 ± participated in a lower extremity injury no significant differences in push-up 5.2 cm, 58.0 ± 8.6 kg] and 6 prevention program during warm-up or sit-up scores between the groups; recreationally active females (RA) and those who performed a standard however, significantly higher total [22.2 ± 1.6 yrs, 162.3 ± 8.0 cm, 63.0 warm-up. Design: Cluster randomized APFT scores were observed in the ± 5.6 kg]) with jumping experience. All controlled trial. Setting: US Service DIME group (275±32) when participants were healthy and Academy. Participants: 1068 compared to the control group participated in a minimum 30 minutes college freshmen entering the (269±34) (p<.001). Similar results of physical activity 3 times a week. academy in June 2011. were observed in multivariable models Dancers were also required to have at Interventions: Groups performed after controlling for gender and BMI. least 5 years of contemporary or ballet one of two 10-minute warm-ups 2-3 Conclusions: Injury prevention training. Intervention: Participants times per week for six weeks. The programs have become increasingly performed 3 trials of a jump intervention group performed the popular based on preliminary research stabilization task. This consisted of a Dynamic Integrated Movement supporting their efficacy. However, forward jump that was standardized to Enhancement (DIME) warm-up because many of these programs are a distance of 40% the participant’s consisting of 10 exercises designed to time-consuming they are not always height. Subjects jumped over a 25 cm improve lower extremity alignment, well-received by coaches. Our barrier and landed on a single limb on decrease ground reaction forces during findings suggest that the DIME group a force plate. They were then required landing, and increase lower extremity had better cardiovascular fitness and to hold the single limb stance for 10 balance and core strength. The control overall fitness scores when compared s. Both dominant (stance limb) and group performed the Army Preparation to the control group after a six-week non-dominant limbs were tested in Drill consisting of 10 exercises lower extremity injury prevention shoe and barefoot conditions. All trials designed to prepare soldiers for intervention. Whether the DIME were counterbalanced. Ground physical training exercises. Both program influences skill-related reaction force data were acquired groups completed the same fitness remains unclear. (1000Hz) over 10 s. Main Outcome

Journal of Athletic Training S-65 13087DOBI

Measures: Time to Stabilization Coordination Variability Is thoracic and lumbar segments. The (TTS) (s) was defined as the point at Higher In Non-Dancers Than In mean coupling angle across the which an unbound third order Dancers During A Jumping Task 10 trials was calculated for each polynomial fit to the ground reaction Jarvis DN, Armour Smith J, Kulig participant using circular statistics, force reached values of the ground K: University of Southern and the angular deviation of reaction force of a stable single limb California, Los Angeles, CA the coupling angle was used to assess stance. TTS was computed for coordination variability. Overall trunk anterior-posterior (AP) and medial- Context: Movements are often studied and LE variability trends between lateral (ML) directions. Differences through biomechanical analysis of groups were examined using between DA and RA were assessed independent t-tests (p<0.05). individual joints or segments, but the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 using independent t-tests (P<0.05) and study of coordination patterns across Results: Kinematic profiles were calculating effect sizes. Results: multiple segments provides a more in- similar between the two groups, Dancers stabilized sooner in the AP depth approach to the examination of indicating that both groups were direction on the dominant limb in the skilled athletic movements. In successful in performing the shoe condition (DA= 2.55± 0.7 s; RA= addition, movement variability across jumping task. Kinematic variability 3.85 ± 0.9 s; P =0.02). No other repeated trials is related to athletic was higher for non-dancers (3.2±1.8°) significant differences were noted. skill and plays an important role in than for dancers (2.3±1.6°) in the However, a large effect size (Cohen’s sports performance. Characterization LE joints (p<0.01), but there was d=0.76) was observed in the AP of coordination patterns and variability no difference between groups for direction on the dominant limb during in persons of varying athletic skill will the trunk (p=0.16). However, the the barefoot condition with dancers indicate qualities associated with elite difference in LE variability between again stabilizing sooner (DA= 2.83 ± task performance. Objective: To groups was only 0.9°, which is smaller 0.8 s; RA= 3.40 ± 0.7 s; P =0.21). examine trunk and lower extremity than the standard error of measure Conclusions: The TTS measure is (LE) kinematics and coordination for the three lower extremity joints sensitive for detecting dynamic variability in dancers and non-dancers (SEM ankle=0.9°, knee=2.1°, balance differences between healthy during rate-controlled sautés (bipedal hip=3.3°). When looking at dancers and recreationally active vertical dance jumps). Design: Cross- coordination variability between females. Dancers require less time sectional. Setting: Biomechanics joints, non-dancers had higher to stabilize compared to recreationally research laboratory. Participants: variability (38.0±8.9° trunk; 21.5 active individuals on the dominant limb Twenty healthy females; ten ±16.8° LE) than dancers (31.8±8.5° in the AP direction. Future research (age=24.8± 2.2 years; weight=57.7 trunk; 16.4±15.6° LE) for both lower may explore the relationship between ±7.1 kg; height=1.63 ±0.07 m) with no extremity (p<0.001) and trunk dancers’ ability to stabilize quickly prior formal dance training, and ten (p=0.009) couplings. Conclusions: following a jump landing task and their (age=27.1 ±3.5 years; weight=58.4 Trained dancers demonstrate similar low incidence of ACL injury. ±5.9 kg; height=1.65 ±0.07 m) kinematics but lower coordination professional dancers with an average variability compared to non-dancers 20.8±5.3 years of dance training. during a simple jumping task. Interventions: A three-dimensional Examination of coordination motion analysis system was used to between joints may allow for a collect kinematic data. Participants more thorough understanding of performed 20 consecutive sautés at a skilled athletic movements than controlled rate of 95 beats per minute. kinematic analysis alone. Sagittal plane kinematics of the middle 10 consecutive jumps for each participant were calculated. Main Outcome Measures: Kinematic variability was assessed using the mean standard deviation of angular displacement for individual joints or trunk segments. The vector coding method was used to quantify coordination variability between the knee and ankle, hip and knee, and

S-66 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Knowledge and Perception of Concussions 13065OOSPTuesday, June 25, 2013, 9:15AM-10:15AM, Palm C; Moderator: Johna Register-Mihalik, PhD, ATC

Secondary School Athletic statistics were reported to describe regulation and personal preference Trainers’ Referral Patterns For overall practices. Separate forward were primary factors influencing Patients Following Sport- stepwise binary logistic regression referral decisions, it is unclear at Related Concussion analyses (p<.05) were used to what point of care the referral McCarty CW, Mayfield RM, determine whether any personal (years occurs. Because effective referral Parsons JT, Valovich McLeod TC: certified, experience in secondary can impact the outcome of a case,

A.T. Still University, Mesa, AZ school setting) or school (enrollment, future research should assess when Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 type, presence of football) factors referral decisions occur and what Context: As state concussion laws predicted ATs’ decisions to refer factors lead ATs to refer to healthcare continue to evolve, it is important to patients to physicians following sport- professionals other than physicians. understand the factors that influence related concussion. Results: A athletic trainers’ (AT) decisions to refer majority of ATs (77.8%, n=662) refer patients following sport-related adolescent athletes to a physician concussion. It is also valuable to following sport-related concussion. determine whether ATs’ have Nearly half of these respondents established interprofessional (48.8%, n=415) indicated they refer relationships to ensure the proper 100% of concussion cases per year. management of patients following The most influential factors that lead sport-related concussion. However, it to a referral were state law (40.3%, is unclear whether ATs in the secondary n=343), personal preference (34.7%, school setting have direct access to n=295), and school district policy other healthcare professionals. (24.8%, n=211). The regression Objective: To determine secondary analyses revealed no significant school ATs’ referral patterns for personal or school predictors adolescent athletes following sport- regarding ATs’ referral decisions to related concussion. Design: Cross- physicians. ATs most commonly sectional survey design. Setting: Self- reported having an established reported online survey. Patients or relationship with sports-medicine Other Participants: 851 clinicians fellowship physicians (80%, n=596), (25.9% response rate) from a neurologists (33%, n=243), convenience sample of ATs practicing neuropsychologists (27%, n=201) and in the secondary school setting (308 physician assistants (27%, n=197), males, 376 females, 167 missing, while 7% of respondents (n=52) do not age=37.28±10.13). Interventions: have established relationships with Participants were solicited via email other healthcare providers. ATs to complete the Athletic Trainers’ “always” (18%, n=106) and “almost Beliefs, Attitudes, and Knowledge of always” (37%, n=220) referred Pediatric Athletes with Concussions patients to a sports medicine physician, (BAKPAC-AT) survey. The BAKPAC- yet despite having established AT consisted of several multipart relationships, “rarely” referred to questions to assess ATs’ current neurologists (39%, n=93) and practices regarding referrals following neuropsychologists (36%, n=72), and sport-related concussion and “never” referred to physician established relationships with other assistants (37%, n=73). Conclusions: healthcare professionals. Main Most ATs refer patients to physicians Outcome Measures: The dependent following sport-related concussion, variables were participants’ responses and occasionally refer to other to the referral and established healthcare professionals. While state relationship questions. Descriptive

Journal of Athletic Training S-67 13447DOSP 13448DOSP

Concussion Occurrence And think about being concerned“ about Preliminary Analysis Of Perception Survey For Athletes poor balance (p= .007). Least Concussion Occurrence And (COPSA) concerning s/s were extra sad (42%), Perception Among Collegiate McDevitt J, Tierney RT, Bright N, noise hurts my head (34%), nervous Athletes Komaroff E: Temple University, (33%), and easily tired (30%). Bright NB, McDevitt JK, Tierney Philadelphia, PA Seventy-one percent of the LHIS RT: Kinesiology Department, athletes and 50% of HHIS athletes Biokinetics Research Laboratory- Context: Underreporting of reported they “may report” feeling Athletic Training Division, Temple concussions is a problem in high easily fatigued (p =.014). Signs and University, Philadelphia, PA symptoms least likely to be reported school athletics. Additionally, little is Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 known as to what factors influence the were grumpy (36%), nervous (30%), Context: Each year concussions athletes’ unwillingness to report and extra sad (27%). Almost 30% of account for an estimated 300,000 to concussive signs and symptoms (s/s). HHIS athletes stated they “sometimes” 3.8 million injuries in the United Objective: Identify athletes’ get dizzy after a sports-related head States. However, due to suspected perception, reporting values, and impact (p = .003). Sixty-three percent underreporting of concussions, these occurrence of concussive s/s. Design: of athletes participating in B reported are likely underestimates as many Survey study. Setting: Urban high “sometimes” feeling dizzy after a athletes may be unaware of the schools. Participants: 302 male and sports-related head impact (p = .003). mechanisms and/or signs and female athletes participating in a The most commonly occurring s/s that symptoms (s/s) of said injury. 2010-2011 sport. Response rate was “sometimes” or “always” occur after Objective: To elucidate collegiate 20.13%. Interventions: A construct a head impact were headache (40%, athletes’ knowledge, concern, validation process was used to design 9%), dizzy (29%, 5%), blurred vision reporting habits, and occurrence of a paper and pencil survey. Flesch- (24%, 3%), and “dinged” (19%, 4%). concussive s/s using the Concussion Kincaid program was utilized to ensure Conclusion: Urban high school Occurrence and Perception Survey appropriate wording. A panel of survey- athletes are concerned and would for Athletes (COPSA). Design: The research design and concussion report s/s that are overtly detrimental COPSA is an anonymous, cross- experts evaluated the survey’s content to their health, but those s/s that occur sectional, paper-and-pencil survey. validity. Athletes were grouped into most often after a head impact athletes Setting: Two- and four-year urban high head impact sport (HHIS), low seem to be less concerned about and colleges. Patients or Other head impact sport (LHIS), or both (B). may not report those s/s. Athletic Participants: A volunteer sample of Frequency statistics and chi-squares trainers should be aware of the s/s collegiate athletes completed the were used to analyze data. Three that are occurring most often and survey; of the 100 surveys distributed, (group) x three (response) chi-square that students are less likely to 88 were returned (88% response rate). analyses were used to test associations be concerned or report. The forty-nine male (60.5%) and 32 in response options between groups (p female (seven unanswered) athletes = .05). Significant chi-squares were surveyed ranged in age from 18 to followed up with pair wise 2 x 3 chi- 30 years with primary participation squares using a Bonferroni correction in over 14 sports (e.g., base/softball, (p = .017) as needed. Main Outcome boxing, football, rugby, swimming, Measure(s): Athletes responded to track). Athletes reported an average demographic information and 12.56 ± 5.08, 4.79 ± 2.69, 2.75 ± concussion s/s data across 4 domains 1.41, and 1.73 ± 0.88 years of (knowledge, concern, report, and participation in their primary (n = occurrence). Athletes answered yes or 75), secondary (n = 34), tertiary (n no questions as well as questions using = 20), and quaternary (n = 13) sport, a 5-point likert scale. Results: Over respectively and primarily played half of LHIS athletes and 20% of gymnastics (48.8%), soccer (17.5%), HHIS athletes reported they did not and base/softball (15%). have any concussion knowledge (p Interventions: The COPSA was =.002). Seventy-two percent of LHIS created using a construct-validation athletes were “maybe concerned” process and underwent content validity about poor balance (p = .001), and over using a panel of survey-research and half of HHIS athletes “would not even concussion experts. Athletes were

S-68 Volume 48 • Number 3 (Supplement) May 2013 13075MOSP recruited via a researcher-initiated Secondary School Athletic questions. Spearman correlations team meeting and those willing Trainers’ Knowledge And were used to assess relationships and to participate completed the survey Perceptions Of Academic Mann Whitney U and Chi Square tests and submitted them to a designated box. Accommodations Following (p<.05) were used to identify Athletes were defined as those Sport-Related Concussion differences. Results: Respondents currently participating on a sports team Mayfield RM, McCarty CW, reported 44±0.33% of sport-related at their institution. Main Outcome Parsons JT, Valovich McLeod TC: concussions managed received AA. Measures: Concussive knowledge, A.T. Still University, Mesa, AZ Respondents employed directly by the concern, reporting habits and school were more knowledgeable of occurrence by indicating: “yes” or 504 plans (p<.001), IEP (p<.001), and Context: Sport-related concussions Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 “no” to 3 questions: “I know about not only affect sport participation, but had a greater belief that AT’s should sports-related head injuries and can also hinder academic success. have a role in AA. There were no concussions, “Sports-related head There has been recent emphasis on significant differences between injuries are a problem in the sport(s) cognitive rest and appropriately employment status and knowledge of I play,” and “There are things I can managing return-to-learn as part of a 504 plans (p=.143), IEP (p=.856), or do to prevent/minimize sports-related comprehensive concussion program. perceptions of AT’s role in AA head injuries”; “not”, “maybe”, or “very Following a sport-related concussion, (p=.219). There was a significant concerned”; “definitely not”, “maybe”, student-athletes may benefit from positive correlation between the or “definitely tell”; “never”, academic accommodations (AA) in the numbers of years certified and “sometimes”, or “always experience” classroom; however athletic trainers’ knowledge regarding 504 plans regarding 19 concussive s/s post- (AT) knowledge and use of AA is (r=.343, p<.001) and IEP (r=.328, p<. impact, respectively. Data were unknown. Objective: To determine 001). A significant relationship was analyzed via frequency distributions. secondary school ATs’ knowledge and also found between years of Results: Athletes were most perceptions of 504 plans, experience at the secondary school concerned with and more likely to individualized education programs and 504 plan knowledge (r=.347 report overt signs of concussion (e.g. (IEP), and ATs’ role in AA. Design: p<.001), and IEP knowledge (r=.327, loss of consciousness, 81% and Cross-sectional design. Setting: Self- p<. 001). There were no significant vomiting, 69%). However, those with reported online survey. Patients or associations between years certified a history of concussion (n=25) Other Participants: 851 clinicians (r=.057, p=.138) or years of frequently stated these overt signs never (25.9% response rate) from a secondary school experience (r=.001, occurred (60%, 63%, respectively). convenience sample of ATs that were p=.970) regarding perceptions of ATs’ Overall, athletes claimed to know some currently practicing in the secondary role in AA. Conclusions: ATs (64.8%) to quite a lot (31.8%) about school setting (308 males, 376 employed directly by the secondary concussions, but responded that they females, 167 missing, age= school and those with more “might be” concerned or report a 37.28±10.13). Interventions: experience as a secondary school AT majority (15/19) of their concussive s/ Participants were solicited via email were more knowledgeable of AA. This s. Conclusions: Possible confusion to complete the Athletic Trainers’ may be the result of knowledge gained and suspected underreporting of Beliefs, Attitudes, and Knowledge of as a member of the school staff. concussions warrant increased education Pediatric Athletes with Concussions Understanding AA is important for all initiatives.Sports-medicine (BAKPAC-AT) survey. The BAKPAC- ATs, as the prescription of cognitive professionals should capitalize on AT consisted of several multipart rest and return-to-learn is becoming the notion that most collegiate athletes questions to assess ATs’ knowledge more widely recommended in believe there are things they can do to and perceptions regarding 504 plans, concussion management. Further prevent/minimize the injury and properly IEPs, and ATs role in returning student- research should be conducted gathering educate athletes regarding its s/s and athletes back into the classroom. prospective information of AA for highly individualistic presentation. Independent variables included student-athletes following sport- employment status (full-time vs. part- related concussion as well as educating time), employment model (direct vs. ATs on the importance of addressing outreach), years certified, and years academics following concussion. of experience in the secondary school setting. Main Outcome Measures: The dependent variables were participants’ responses to the AA

Journal of Athletic Training S-69 Free Communications, Oral Presentations: Various Approaches for Classroom and Clinical Education 13008FOPETuesday, June 25, 2013, 10:30AM-11:45PM; Palm C; Moderator: Jolene13372MOHE Henning, EdD, ATC, LAT

The Entry-Level Masters Route preparation of MATS to practice as Employers’ Knowledge Levels To Certification: Program ATs. Descriptive statistics and non- Of The Various Types Of Athletic Standards, Outcomes And parametric correlations were Training Education Programs Student Characteristics calculated. Results: MATS survey: Burgess MJ, McCarty CW, Ostrowski JL: Weber State profile of MATS is a student in their Laidlaw CR, Van Lunen BL: Old University, Ogden, UT mid-20s, Caucasian, received Bachelor Dominion University, Norfolk, VA, Degree in exercise science < 2 years and A.T. Still University, Mesa, AZ Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Entry-Level Masters prior to entering an ELM program. athletic training education programs Geographical area and institution’s Context: As athletic training (ELM ATEPs) have increased by over reputation were primary contributing education continues to evolve, it is 400% in the past 10 years, however factors in choosing an ELM program. essential that employers have an little is known about characteristics of Following graduation 93.5% planned understanding of the differences students who enroll or about the to seek employment using ATC between the types of athletic training standards of programs themselves. credential. No significant DV education programs (ATEPs) so they Objective: Explore characteristics of correlations. PD survey: 91% first-to- can make the best hiring decisions. ELM athletic training students (MATS) second year average retention rate; Objective: To assess athletic training to develop a profile; explore ATEP 81% average two-year graduation rate. employers’ perceived knowledge requirements, retention and BOC pass Average first-time BOC pass rate (PKn), objective knowledge (ObjK), rates, and placement rates. Design: reported was 91.7% (three-year and their confidence in their Cross-sectional survey design. aggregate). 91% of ELM ATEPs knowledge (CfK) of the types of Setting: Online survey. Patients or require a thesis or structured research ATEPs available within athletic Other Participants: All ELM project. The lowest BOC pass rates training. Design: Cross-sectional Program Directors (PDs) listed on the were reported in ATEPs without survey. Setting: Web-based survey. CAATE website as of April 2012 were structured research requirements Patients or Other Participants: 133 contacted. PDs were asked to (r=0.762, p=0.006). Significant of 420 employers (31.67% response complete a survey and to forward a correlation between retention rates rate) from a convenience sample of survey link to MATS currently enrolled and graduation rates (r=0.696, employers from the NATA public in their ATEP. 79 MATS (136 surveys p=0.025). Conclusions: Despite vacancy notice (79 males, 54 females, forwarded; 58% response rate) and 11 speculation regarding the future of age=42.89±9.84) participated in the PDs (25 PDs contacted; 44% athletic training education, little is study. Participants were separated by response rate) completed the surveys. known about the ELM route to job type, which included 65 clinicians, MATS: average age 24.7 years (range: certification. A profile of MATS will 42 educators, and 26 administrators. 21-42); 68% female, 56% first-year aid in ATEP recruitment efforts. Our Interventions: Participants were MATS. Average years experience as data indicates that the overwhelming solicited via email (between Fall 2010 PD: 8 (SD: 3.6; range: 3-12). majority of ELM graduates will and Spring 2012) to complete the Interventions: Surveys administered practice professionally using their ATC online survey. The PKn section online via Formstack.com. Survey credential (93.5% MATS report, included four Likert-scale items responses were returned to the server 93.6% PD report). First-time BOC (range 1-4) regarding how as anonymous data. Main Outcome pass rates reported in ELM ATEPs are knowledgeable participants perceived Measures: MATS survey: well above the national average. The themselves regarding professional demographics (age, race, standing in ELM route to certification appears to ATEPs, professional master’s ATEPs, ATEP), characteristics of under- produce high-quality athletic trainers and post-professional ATEPs. The graduate education, rationale for who are likely to remain in the field. ObjK and CfK sections included 12 enrolling in ELM program, perceived Institutions considering developing an multiple-choice questions (MCQ) level of preparation to become a ELM program should strongly about the different ATEPs certified AT. PD survey: demographics consider incorporating a thesis or accompanied by a Likert-scale item (number of years as PD, PD’s route to structured research project. (range 1-4) assessing their CfK for certification), history of ATEP, each MCQ. Reliability from an retention/graduation/BOC pass rates, unrelated pilot sample (n=13) for the graduation requirements, perceived

S-70 Volume 48 • Number 3 (Supplement) May 2013 13138FOPE

OKn section was determined to be of ATEP, employers may have difficulty The Relationships Among excellent; percent agreement selecting the best candidate for Workload, Instructor Approach averaged 96% with a range of employment. As educational To Teaching, And Student 83.33%-100%. Main Outcome programming continues to change, it is Evaluation Of Teaching Measures: The independent variable essential to educate employers about Wilkinson RD: University of was employer job type (educator, qualifications from differing programs. Wisconsin – Milwaukee, clinician, administrator) and Milwaukee, WI dependent variables were PKn, ObjK, and CfK composite scores. ObjK Context: Instructors in Commission scores were calculated by awarding on Accreditation of Athletic Training Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 one point for each question answered Education (CAATE) accredited correctly (maximum score=12). PKn Athletic Training Education Programs and CfK scores were attained by (ATEPs) have various workload totaling all values and calculating assignments, including teaching, the average value back to the Likert research, administration, and/or scale (total divided by 4). Higher athletic training sport coverage scores indicated higher perceived (ATSC). Most commonly, the dual- knowledge or a higher confidence appointment model consists of in their knowledge. Significant teaching and ATSC. Role strain occurs differences (P<.05) were calculated when an individual has difficulty using one-way ANOVAs and Kruskal- meeting the obligations associated Wallis H tests. Results: Overall, with multiple roles; commonly participants perceived themselves experienced by dual-appointment “moderately knowledge-able” (3.11/ instructors. Various factors may 4.0±0.73) of ATEPs, however impact instructor approach to teaching composite ObjK scores were (IAT) and student evaluation of 7.27±2.86 (CI=6.78-7.76). Despite teaching (SET), including workload. mediocre composite ObjK scores, Objective: The purpose of this study employers were “moderately was to determine the relationships confident” (3.04/4.0±0.68) in their among workload, IAT, and SET in ObjK responses. Job type was CAATE accredited Wisconsin ATEPs. associated with higher PKn scores Design: Self-administered surveys (H(2)=20.36,P<0.001), ObjK scores addressing workload, the Approaches (F=19.26,P<0.001), and ConK to Teaching Inventory (ATI), and the scores (H(2)=29.99,P<0.001). Student Evaluation of Educational Educators had higher PKn scores Quality (SEEQ) instrument. Setting: (3.51/4.0±0.50), ObjK scores Wisconsin ATEPs. Patients or Other (9.26±2.26,CI=8.55-9.97), and CfK Participants: Instructors (n = 25, scores (3.48/4.0±0.50) than mean age 40.12 ± 8.293) included clinicians (PKn=3.01/4.0±0.67, certified athletic trainers (AT) ObjK=6.48±2.56,CI=5.84-7.11, teaching classroom-based courses. CfK=2.84/4.0±0.52) and admin- Program directors were asked to istrators (PKn=2.72/4.0±0.90, forward recruitment materials to their ObjK= 6.04 ±2.82,CI=4.90-7.18, AT instructors. Undergraduate students CfK=2.81/4.0±0.91), indicating that (n = 200) enrolled in courses taught they were more knowledgeable and by instructor participants were also more confident of the differences surveyed. Instructors were asked to between ATEPs than the other two forward recruitment materials to their groups. Conclusions: Findings from students. Interventions: Instructors this study suggest that employers are completed a questionnaire addressing only moderately familiar with workload and the ATI. Each ATI differences between ATEPs. With question was labeled Student Focused only limited knowledge of the (SF) or Teacher Focused (TF). Mean qualifications attained from each type scores for SF and TF questions were

Journal of Athletic Training S-71 13227FOPE established. Students completed a A Small Group Standardized needing PIR ten weeks into each spring questionnaire including the SEEQ, Patient Encounter Improves semester. Interpersonal commu- regarding their instructor. The ATI and Athletic Training Students’ nication and PIR were assessed by the SEEQ have demonstrated positive Psychosocial Intervention And instructor using a checklist (e.g., reliability and validity. Main Referral Skills. inquired as to perception of weight, Outcome Measures: The SEEQ Walker SE, Thrasher AB: Ball listened, made referral). An includes nine sub-sets: Learning, State University, Muncie, IN experienced researcher/clinician in Enthusiasm, Organization, Group PIR reviewed the checklist to establish Interaction, Individual Rapport, Context: Athletic trainers provide validity. Checklist reliability was

Breadth, Examinations, Assignments, social support, counseling, established via inter rater reliability Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and Overall. Mean scores from the intervention, and referral to patients measures between the instructor and overall total and the sub-sets were during clinical practice but report SP (ICC .781). Main Outcome determined. Data were analyzed to receiving little to no experience Measures: The independent variable determine statistically significant developing these skills during their was the small group SP encounter and relationships (p<.05), utilizing the education. Standardized patients (SPs) the dependent variable was the Pearson correlation coefficient. can provide this learning experience to students’ interpersonal and PIR Results: There was a statistically better prepare students for clinical performance measured by the significant positive relationship (.553, practice. Objective: The purpose of checklist. An independent t-test p=.005) between the SF mean and this study was to examine the effects determined the effects of the the total SEEQ mean. SEEQ sub-sets of a small group SP encounter on intervention on interpersonal also demonstrated statistically athletic training students’ communication and PIR skills. Data significant positive relationships with interpersonal communication, were analyzed using SPSS (Version the SF mean, including Enthusiasm psychosocial intervention, and referral 15.0, SPSS Inc. Chicago, IL) with an (.582, p=.003), Group Interaction skills (PIR). Design: Quasi- alpha level of .05. Results: An (.527, p=.008), Individual Rapport experimental. Setting: One independent t-test revealed a (.492, p=.015), Breadth (.421, Midwestern university. Patients or significant increase in performance by p=.040), Assignments (.453, p=.026), Other Participants: All athletic the experimental group on their PIR and Overall (.559, p=.005). training students (N=39, 14 male, 25 skills (p=0.001) but no difference Additionally, a statistically female, aged 21.67±1.30) who had between the two groups on significant positive relationship completed the Psychology of Injury interpersonal communication skills (.506, p=.010) existed between course during the fall semester of (p=0.346). The checklist from the ATSC workload and the TF mean. 2006-2009 and were enrolled in a instructor revealed that on PIR skills, Conclusions: In this study, Current Concepts of Athletic Training the experimental group completed an instructors with higher SF course during the spring semester average of 4.55±1.88 out of nine skills means received higher SEEQ participated in this study. correctly while the control group only scores. A SF approach has been Interventions: During the fifth week completed 2.63±1.21 correctly. linke to improved student learning of the spring semester, the Conclusion: A small group SP outcomes. Additionally, in- experimental group (n=20; spring encounter did improve students’ PIR structors carrying ATSC were found 2007 and spring 2009) engaged in a skills. These results suggest a small to approach their teaching from small group SP encounter. Randomly group SP encounter provides an more of a TF approach. ATSC assigned to groups containing three or efficient clinical educational workload may have a negative four, the participants interacted with a experience to better prepare athletic impact on approach to teaching. SP with a cocaine addiction needing training students for clinical practice. Time and/or role strain may be PIR. Verbal feedback was provided on limiting factors for exploring their performance during and after the alternative teaching techniques for encounter from the SP, a clinician, and dual-appointment instructors. instructor who were present during all Further research is needed to small group SP encounters. The confirm the educational impact of control group (n=19; spring 2008 and the dual-appointment model. 2010) received no intervention. To evaluate the effectiveness of the SP encounter, all participants individually evaluated a SP with an eating disorder

S-72 Volume 48 • Number 3 (Supplement) May 2013 13326FOPE

An Examination of the Interviewswere recorded, transcribed Experiences of Athletic Training verbatim, and analyzed using the Preceptors with Different process of open,axial, and selective Amounts Of Clinical And Clinical coding with ATLAS.ti software. Teaching Experience Trustworthiness was established by Nottingham SL: Chapman member-checking interviews with University, Orange, CA participants and having twopeer debriefers critically review the data and researcher’s findings. Results:

Context: The 2012 Commission on Fourcategories emerged from the data, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Accreditation on Athletic Training including benefits, preparation, Education(CAATE) standards include qualifications,and challenges of being several changes that allow more a preceptor. While participants institutional autonomy when described it wasbeneficial to have determining the qualifications and students, they also faced several preparation of preceptors.Clinical challenges, includingbalancing their Education Coordinators (CECs) must responsibilities as a clinician and make educated decisionsregarding the preceptor and keeping theirknowledge selection and training of preceptors, current. Participants discussed that yet minimal research exists inthis area mentorship from other preceptorsand to guide their decisions. Objective: past experiences as students were To explore the experiences primary contributors to their role as ofpreceptors with different amounts of apreceptor, whereas preceptor training clinical and clinical teaching and communication of expectations by experience toprovide information theCEC could have been improved to regarding the selection and preparation better prepare them for their preceptor of preceptors.Design: Descriptive role.Participants described that qualitative interview study. Setting: clinical experience, willingness to be Three undergraduate CAATE- a preceptor, andconfidence were the accredited Athletic Training Education main qualifications for becoming a Programs (ATEPs). Participants:17 preceptor. Conclusions:The results of preceptors (8 males, 9 females; 9.88 this study provide several points for ±9.46 years of clinical experience; CECs to consider whenselecting and 5.06±3.92 years of clinical teaching preparing preceptors. CECs should experience) working in the university, ensure that potentialpreceptors are communitycollege, rehabilitation confident, established clinicians clinic, and high school settings. before becoming preceptors. Participants were selectedthrough a Inaddition, CECs should ensure that combination of purposeful and they are adequately preparing convenience sampling and had to andcommunicating with preceptors becurrent preceptors for a CAATE- before and after they take on that accredited ATEP. Participants were responsibility.Lastly, educators and recruitedthrough the CECs of three researchers should consider the institutions, and the researcher sought challenges faced bypreceptors and to interviewparticipants with a wide develop strategies for managing these range of clinical and clinical teaching challenges, such ascreating efficient experience. Data was collected until evaluation tools, providing easily variety of participant experiences was accessible continuingeducation obtained and saturationof data opportunities, and developing occurred. Data Collection and mentorship programs for preceptors. Analysis: The researcher interviewed participants using an individual, in- person, semi-structured format.

Journal of Athletic Training S-73 Education Evidence-Based Forum Tuesday, June 25, 2013, 12:00PM-1:00PM; Palm C; Moderators: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

S-74 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Ankle Injury Epidemiology 13110DOMUTuesday, June 25, 2013, 1:15PM-2:30PM; Palm C: Moderator: Cathleen13197MOIN Brown-Crowell, PhD, ATC

Effect Of Lateral Ankle Sprain applied where sphericity was violated. Prevalence Of Functional Ankle On Self-Reported Disability Over Post-hoc dependent t-tests were Instability In High School And A Two-Week Period performed to determine differences Division I College Athletes McLeod MM, Hafner R, Harkey within groups over time. Independent Tanen LM, Docherty CL, Van Der MS, Gribble PA, Pietrosimone BG: t-tests were performed post-hoc to Pol BJ, Simon J, Schrader JW: University of Toledo, Toledo, OH determine differences between groups Indiana University, Bloomington, at each time interval. Alpha level was IN Context: Previous lateral ankle sprain set a priori at P<0.05. Results: There (LAS) is a risk-factor for recurrent was a significant group by time Context: While much research exists Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 ankle sprain and development of interaction for the FADI (F1. 2.091=9.90, on the epidemiology of lateral ankle chronic ankle instability (CAI). P<0.01) and FADI-Sp (F1. 1.862=7.69, sprains, there is little information that Increased self-reported disability is a P<0.01). FADI was significantly lower investigates the prevalence of common complaint in those with CAI. in LAS group compared to healthy functional ankle instability (FAI). Although acute LAS patients frequently group (100±0.00%, all time points) at Ankle sprains are a common sports return back to physical activity within 36h (72.43±12.33%, P<0.01), 5d injury and are often regarded as trivial two-weeks following initial injury, (88.30±9.40%, P<0.01), 7d (90.06 by athletes and coaches however, limited objective investigations exist ±9.11%, P<0.01), 10d (88.19 further work needs to be done to on the effect of LAS on self-reported ±15.71%, P<0.01), and 14d increase awareness of residual disability and restoration of function. (95.71±5.04%, P<0.01). FADI-Sp was symptoms of a lateral ankle sprain Objective: Determine differences in significantly lower in LAS group including FAI. Objective: The self-reported disability following acute compared to healthy group purpose of this study is to determine LAS over time, compared to healthy (100±0.00%, all time points) at 36h the prevalence of FAI among high controls. Design: Case-Control. (55.82±25.04%, P=0.01), 5d (71.98 school and collegiate athletes. Setting: Research laboratory. Patients ±16.04%, P<0.01), 7d (80.35 Design: Cross-sectional survey. or Other Participants: Ten LAS patients ±15.83%, P<0.01), 10d (77.75 Setting: Pre-participation physical (3M, 7F, 20.80±1.75yrs, 172.21 ±23.64%, P<0.01), and 14d examinations, pre-season parent ±11.09cm, 71.29±18.54kg) and 9 (90.33±10.39%, P<0.01). FADI was meetings, team meetings. Patients or healthy controls (4M, 5F, 20.44 significantly lower between time Other Participants: We collected a ±1.51yrs, 174.98±9.11cm, 75.10 points 36h-5d (P<0.01), 36h-7d total of 672 questionnaires. One ±17.05kg) participated. Inter- (P<0.01), 36h-10d (P=0.03), 36h- hundred sixty participants were ventions: Participants incurring a LAS 14d (P<0.01), 5d-14d (P=0.02), and excluded due to either incomplete during intercollegiate or recreational 7d-14d (P=0.03) for LAS group. Also, questionnaires or a history of sports completed the Foot and Ankle FADI-Sp was significantly lower fractures. A total of 512 subjects Disability Index (FADI) and FADI between 36h-5d (P=0.02), 36h-7d remained (316 collegiate athletes [186 Sport (FADI-Sp) questionnaires within (P=0.01), 36h-14d (P<0.01), 5d-7d males, 130 females, 19.6±1.2 years] 36 hours(h), and at 5, 7, 10, and 14 (P=0.04), 5d-14d (P=0.01), 7d-14d and 196 high school athletes [113 days(d) following the initial sprain. (P=0.03) for LAS group. Conclusions: males, 83 females, 15.8±1.2 years]); FADI and FADI-Sp questions are Self-reported disability remained response rate of 76%. Interventions: related to self-reported disability lower in the LAS group at all time - All athletes completed the during activities of daily living, and points with the greatest increases in Cumberland Ankle Instability Tool physical activity, respectively. LAS self-reported disability between 36h- (CAIT) on both ankles. Subjects also participants underwent treatment as 5d for FADI and FADI-Sp. For FADI, answered a series of questions related directed by their individual healthcare there was no significant increase to demographic background including: professional. Main Outcome between 5d-7d and 5d-10d, whereas age, sex, sport, and history of lower Measures: FADI and FADI-Sp scores significant increases were observed leg fracture. For collegiate athletes, a were computed as percentages, with between all time points for FADI-Sp questionnaire packet was distributed smaller values indicating greater except 10d. Further studies should during the required pre-participation disability. Separate 2x5 (group by time) determine if prolonged deficits in physicals. For high school athletes, repeated measures analyses of variance self-reported function predict deficits parental consent was obtained prior to were performed to determine in long-term joint health. distributing questionnaires at pre- differences for the FADI and FADI-Sp. participation physicals, pre-season Greenhouse-Geisser corrections were parent meetings, or individual team

Journal of Athletic Training S-75 13225FOMU meetings. Athletes who scored less Does Severity Of A Previous Dependent variables included the than or equal to 23 on the CAIT were Ankle Injury Influence Region- FAAM total score and the 8 SF-12 identified as having FAI. Frequencies Specific And Generic Health- subscale scores (Physical Functioning were calculated to determine the Related Quality Of Life In [PF], Role Physical [RP], Bodily Pain overall prevalence and percentage of Collegiate Athletes? [BP], General Health [GH], Vitality unilateral and bilateral FAI. Separate Lam KC, Bay RC: A.T. Still [VT], Social Functioning [SOF], Role Chi-square test of independence was University, Mesa, AZ Emotional [RE], Mental Health [MH]). calculated comparing the frequency of All scores range from 0-100, with FAI in men and women and in high Context: Health-related quality of life higher scores indicating better school and college athletes. Main (HRQOL) characterizes the impact an HRQOL. Generalized linear models Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Outcome Measures: Presence or injury, condition, or treatment has on were used for group comparisons. absence of FAI were the dependent various health domains (eg, physical, Group differences were evaluated variables. Results: Of all participants, emotional, social) from the patient’s with pairwise comparisons 23.4% were identified as having FAI, point-of-view. Previous findings in (Bonferroni), pd”.05. Results: half of these participants had FAI college athletes suggest that a positive Significant differences were reported bilaterally and the remainder had knee injury history may negatively for the FAAM total score (p<.001, unilateral FAI. High school athletes are impact knee-specific HRQOL but not SAI=94.7±0.7, MAI=98.0±0.7, NAI more likely to have FAI than their generic HRQOL. It is unknown if =99.7±.5), RP (p=.02, SAI=87.1±1.9, 2 collegiate counterparts (x (1)=10.45, similar findings exist in individuals MAI=91.8±1.9, NAI=93.4±1.2), BP p<.001). Specifically 31.1% of the with a previous ankle injury. (p=.04, SAI=79.2±3.0, MAI =86.9 surveyed high school athletes had FAI Objective: To determine whether ±3.0, NAI=88.4±2.0), MH (p=.04, (13.3% had unilateral FAI and 17.9% region-specific (Foot and Ankle SAI=72.3±2.2, MAI=79.2±2.2, NAI had bilateral FAI) while only 18.7% of Ability Measure [FAAM]) and generic =78.3±1.5). Pairwise comparison the college athletes had FAI (10.8% (Short Form 12 [SF-12]) HRQOL reported group differences between had unilateral FAI and 7.9 had bilateral differs in collegiate athletes based on the SAI and NAI groups but no FAI). FAI was also more prevalent the severity of a previous ankle injury. differences for the MAI group when among women than men in both high Design: Cross-sectional. Setting: compared to other groups. No group 2 school (x (1)=5.01, p=.01) and Athletic training facilities. Patients differences (p>.05) were reported for 2 collegiate settings (x (1)=10.13, or Other Participants: Two hundred the remaining SF-12 subscales: PF p=.01). Overall, 32.1% of the women and seventy-two intercollegiate (SAI=96.2±1.2, MAI=98.1±1.2, in this study were identified as having athletes, who were medically cleared NAI=97.2±0.8), GH (SAI=85.5±2.0, FAI, compared to only 17.4% of the for full participation, were included in MAI=82.5±1.9, NAI=85.0±1.3), VT men. Conclusions: A higher the study. Sixty-five athletes reported (SAI=66.8±2.5, MAI=72.0±2.5, percentage of both unilateral a previous severe ankle injury (SAI), NAI=69.0±1.6), SOF (SAI=84.4±2.7, and bilateral FAI exists among high defined as an injury causing loss of MAI=88.6±2.6, NAI=88.2±1.7), RE school and female athletes. Athletic participation for e”10 days (male=32, (SAI=88.1±2.0, MAI=91.7±2.0, trainers, physicians and coaches female=33, age=19.5±1.6 years, NAI=90.6±1.3). Conclusions: should pay special attention to height=175.8±10.7 cm, mass= Despite returning to full participation, these populations as they are at a 72.0±12.4 kg), 63 reported a previous individuals with a previous SAI tend to higher risk for developing FAI. mild ankle injury (MAI), defined as an report difficulties completing injury causing loss of participation for activities of daily living (ADL), more >1 but <10 days (male=32, pain with ADLs, and lower mental female=31, age=19.1±1.2 years, health satisfaction than individuals height=174.6±10.9 cm, mass= with no ankle injury history. Our 69.4±12.2 kg), and 144 reported no findings suggest that, unlike previous previous ankle injury (NAI) (male=85, knee injuries, previous ankle injuries female=59, age=19.4±1.5 years, can negatively impact both region- height=175.3±11.7 cm, mass= specific and generic HRQOL. 71.7±13.0 kg). Interventions: The Clinicians should be aware that independent variable was injury history individuals with a previous SAI may group. Participants completed the continue to experience HRQOL FAAM (21 items) and SF-12 (12 deficits despite being medically items) during a single testing session. cleared for full participation. Main Outcome Measures: S-76 Volume 48 • Number 3 (Supplement) May 2013 13375MOIN 13017FOMU

The Severity Of A Previous foam (TFo). Main Outcome Self-Perceived Ankle Instability Ankle Injury Does Not Impact Measures: Dependent variables Correlates With Poor Clinical Postural Control included sway velocity (SV) and BESS Balance Assessments Williams TA, Kulow SM, Valovich error scores (ES) for each stance Linens SW, Ross SE, Arnold BL: McLeod TC, Lam KC: A.T. Still condition. SV (deg/sec) was defined Georgia State University, Atlanta, University, Mesa, AZ as the ratio of the distance traveled by GA; University of North Carolina at the center of gravity to the time of the Greensboro, Greensboro, NC; Context: The evaluation of postural trial. ES were counts of errors Virginia Commonwealth University, control is an important component to committed during each condition. Richmond, VA the management of sport-related Generalized linear models were Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 injuries. While current evidence utilized for group comparisons and Context: A variety of balance tests indicates that postural control is group differences were further have differentiated stable and unstable negatively impacted by a previous evaluated with pairwise comparisons ankles. However, few studies have ankle injury and chronic ankle (Bonferroni), p<.05. Results: determined the relationship between instability, it is unknown whether the Significant group differences were self-reported instability and clinical severity of a previous ankle injury, reported for SV (p=.001) and ES balance measures associated with based upon total time loss, influences (p=.01) for the TFo condition. chronic ankle instability (CAI). postural control. Objective: To Pairwise comparisons indicated that Objective: To investigate the determine whether the severity of a the SAI group (SV=6.35±0.34, relationship between self-perceived previous ankle injury impacts postural ES=5.13±0.39) demonstrated ankle instability with clinical balance control as measured by the Stability significantly higher SV and ES than the measures. Design: Correlational. Evaluation Test (SET), an instrumented NAI group (SV=4.79±0.28, Setting: Laboratory. Participants: version of the Balance Error Scoring ES=3.78±0.26). No significant CAI subjects had a history of ankle System (BESS). Design: Cross- differences were found when sprains and symptoms of “giving way” sectional. Setting: Athletic training comparing the MAI (SV=5.53±0.35, (N=17; 168±9 cm; 68±12 kg; 23±4 facilities. Patients or Other ES=4.11±0.39) with the SAI or the NAI yrs) and stable ankle subjects (SA) had Participants: Intercollegiate athletes group. No other group differences no history of ankle injuries (N=17; who had a history of a severe ankle were reported for the remaining 168±8 cm; 66±12 kg; 23±3 yrs). injury (SAI), defined as an injury conditions for SV (p<.13) or ES Interventions: Self-perceived ankle causing loss of participation for e”10 (p<.13). Conclusions: Our findings instability was measured using the days (male=12, female=26, suggest that the severity of a previous Cumberland Ankle Instability Tool age=19.3±1.3 years, height =173.3 ankle injury does not generally impact (CAIT). CAI and SA subjects ±10.1 cm, mass=69.0±10.2 kg), a mild postural control when measured by the performed single leg balance on the ankle injury (MAI), defined as an SET or the BESS. Differences injured leg or a side matched leg, injury causing loss of participation for reported between the SAI group respectively. Subjects performed 4 >1 but <10 days (male=19, and NAI group suggest that the TFo clinical balance tests: 1) Time-In- female=18, age=19.2±1.2 years, stance may be useful in identifying Balance (TIB); 2) Foot Lift Test (FLT); height=176.0±12.2 cm, mass= potential postural control deficits in 3) Star Excursion Balance Test 69.5±13.2 kg), and no ankle injury collegiate athletes. Future (SEBT) in posteromedial reach (NAI) (male=52, female=35, investigations should determine direction; and 4) Side-To-Side Hop age=19.4±1.4 years, height= 175.5 whether postural control deficits (SSH). For TIB, subjects stood on the ±11.4 cm, mass=72.1±13.0 kg). All demonstrated in the TFo stance test leg with their eyes closed for up participants were medically cleared condition are clinically significant (eg, to 60 s. Subjects’ time-in-balance was for participation with no restrictions. predisposes the individual to an ankle recorded as the time when balance was Interventions: The independent or lower extremity injury). lost by touching down with non-weight variable was injury history group. bearing leg or as 60 s if they remained Participants completed the SET, a balanced. The FLT required subjects series of 20-second balance tests on a to stand on the test leg for 30 s with portable force plate under the six BESS eyes closed. The number of times a stance conditions: double-leg firm part of the foot was lifted or the (DFi), single-leg firm (SFi), tandem contralateral foot touched down were firm, (TFi), double-leg foam (DFo), tallied. The SEBT required subjects single-leg foam (SFo), and tandem to stand on their test leg and reach for

Journal of Athletic Training S-77 maximum distance with the contralateral leg in posteromedial direction. For the SSH subjects completed 10 side-to-side 30 cm hops as quickly as possible. Balance tests were counterbalanced. Pearson product-moment correlations were calculated between CAIT scores and each balance measure. Alpha level was

set a priori (0.05). Main Outcome Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Measures: The degree of perceived ankle instability was quantified with total score on CAIT (lesser scores=greater instability). Balance was quantified with length of time balancing (s) for TIB, frequency of foot lifts (score) for FLT, distance reached (normalized to leg length) for SEBT, and time (s) to complete SSH. Poor balance was indicated by less time-in-balance, greater frequency of foot lifts, shorter reach distance on SEBT, and longer time to complete side hops. Results: Significant Pearson product-moment correlation coefficients were found between CAIT and TIB (r=-0.35, P< 0.05) and FLT (r=.43; P< 0.05). No correlation (P>.05) was found between CAIT and SEBT (r=0.32) or SSH (r=-0.23). Conclusions: While each test can be used to identify balance deficits associated with CAI, the TIB and FLT are the only balance tests that have a relationship with self-perceived feelings of instability. Our results also indicate that among clinical tests static balance measures are more indicative of self-perceived instability than dynamic balance measures.

S-78 Volume 48 • Number 3 (Supplement) May 2013 Ankle Evidence-Based Forum Tuesday, June 25, 2013, 2:45PM-3:45PM; Palm C; Moderators: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Journal of Athletic Training S-79 Free Communications, Oral and Thematic Presentations: Abdominal Conditions Case Studies 13049UCWednesday, June 26, 2013, 8:00AM-8:45AM; Palm C; Moderator: Michael Milligan, MD, CAQSM

Abdominal Pain In A Collegiate deteriorating the athletic trainer term diabetes and females over the Softball Player referred the patient to the hospital. age of 30. Also, the patient did not Pouliot S, Rothbard M, Geiger A: While hospitalized for two weeks, a present with other risk factors Southern Connecticut State brachial PICC line insertion for TPN associated with gastroparesis, which University, New Haven, CT feeding was established, which include systemic sclerosis, stabilized her condition. After hypothyroidism, and anticholinergic, narcotic and antidepressant Background: A 22 year-old female discharge and consultation, she was Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 softball player presented to the athletic referred to a motility specialist and medications. Conclusion: Gastro- trainer with abdominal pain, nausea, was admitted to a different hospital. paresis is a condition that inhibits constipation, post-prandial fullness, A four-hour gastric emptying gastric emptying without an and unexplained 12.73kg weight loss scintigraphy test was administered. intestinal blockage. In this case, it equaling 22% of her body weight over After one hour, 90% of the food appeared that a vascular and a four-month period. The pain was remained in her stomach. After four neuromuscular dysfunction limited described as severe, constant, and hours, 75% remained, confirming gastric emptying, and food never unbearable upon ingestion of food. gastroparesis. To improve intestinal reached the intestines for further Initial examination by the athletic motility she was prescribed 10mg of digestion and absorption. Gastro- trainer revealed abdominal bloating, Domperidone® bid, which was paresis has a poor prognosis and palpable tenderness, and weak pulses. progressively increased over four significantly impacts the life and The patient’s previous medical history days to 20mg tid, but with no daily activities of those affected. was significant for idiopathic improvement. An MRA was ordered, Although gastroparesis is generally abdominal pain for four years prior and identifying abdominal vascular incurable, effective communication by status-post five months chole- damage. Specifically, the median the patient, athletic trainers, and cystectomy. Differential Diagnosis: arcuate ligament appeared to be physicians and highly specialized prompt intestinal cancer, ovarian cancer, blocking the inferior mesenteric medical care helped save her life. This ovarian cysts, Crohn’s disease, Ciliac artery and vagus nerve, causing case presented unique challenges in disease, and gastroparesis. diminished blood flow and nerve recognizing, treating, and managing this Treatment: Upon examination, she signals to the stomach. Two days patient who must live and cope with this was disqualified from athletic post-discharge, the PICC line lifelong debilitating condition. participation and was referred to a PCP. appeared to be infected, the patient Physician examination confirmed the displayed signs of renal failure, and athletic trainer’s findings and ordered she was referred back to the hospital. a vaginal ultrasound that identified The PICC line was removed. She ovarian cysts, and an abdominal CT underwent surgery for a Jejunostomy scan that revealed intestinal tube insertion providing 1560 mL of inflammation indicating the possibility Vital AF 1.2 Cal™ every day and was of cancerous cells. A second CT-scan released from the hospital one week with contrast was unremarkable, ruling later. During a follow-up out cancer. The patient was referred to consultation by the athletic trainer, a gastroenterologist for additional the patient was permanently testing. An endoscopy and disqualified from athletic colonoscopy were performed. Results participation based on her condition were unremarkable. A 90-minute and augmented nutritional intake. gastric emptying test was then Status post 8 months, a Mickey tube performed, which demonstrated was inserted to replace the significant delayed gastric emptying. Jejunostomy tube, which is expected A preliminarily diagnoses of to remain in place indefinitely. gastroparesis was made. Erythromycin Uniqueness: Gastroparesis is a rare was prescribed to facilitate intestinal disorder with an incident rate of motility, which had no effect on her 0.0001% in non-diabetics; however, symptoms. With her condition it typically affects people with long-

S-80 Volume 48 • Number 3 (Supplement) May 2013 13155SC

Ulcerative Colitis In A High body strength training, which the with the athlete, parents, coaches, School Football Player athlete completed as tolerated. When teachers and guidance counselors. Stollery JC, Filep EM, Lopez RM: the athlete began this rehabilitation, his This plan should include education University of South Florida, total weight loss was approximately about the condition, excused trips to Tampa, FL 10.0 kg (~ 22 lbs). During recon- the bathroom during class/practice ditioning, the athlete often reported without asking, ensuring proper Background: This case involves a 16- feelings of depression, fear and anxiety hydration and nutrition, core year-old varsity high school football to the athletic trainer. The athlete also strengthening and cardiovascular player (height: 172.7 cm weight: 73.5 experienced frequent, intense, conditioning, and proper storage of kg) at the position of free safety. This uncontrollable urges to go to the medications at the school. athlete had no previous history of bathroom that often interrupted school, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 chronic illnesses or injury prior to the practice, games and rehabilitation. The current condition; however, his family athlete also experienced an accident in history revealed that one of his school, which devastated his relatives has Crohn’s Disease. During rehabilitation process and psyche. summer break, the athlete went on Finally, after approximately 12 weeks, vacation and became ill upon his return. he received clearance from a pediatric The athlete presented with bloody gastrointestinal specialist and was diarrhea and abdominal pain 7 weeks given a new medication regimen before preseason football. He (Cimzia, a once-monthly subcutaneous continued to experience diarrhea and injection). At this time, he was then lost a significant amount of weight, able to complete a full week of football weighing 63.5 kg. He was taken to the practice and participate in the third hospital and placed on the antibiotic game of the season. His weight Flaggyl for 4-6 weeks. After 6 weeks, increased to 70.3 kg, and he was able he experienced bloody stool again and to participate as a starter for the fifth was taken to the hospital and admitted football game. Throughout the for 5 days. The hospital admittance remainder of the season, his weight occurred one week before the start of loss from the diarrhea was controlled preseason football. Differential by the Cimzia injections; however, he Diagnosis: Intestinal infection, still suffered from occasional bouts of ulcerative colitis, Crohn’s disease, diarrhea and abdominal pain. irritable bowel syndrome Treatment: Uniqueness: This disease is rarely A colonoscopy during the second seen in adolescent athletes. Ulcerative hospital visit revealed ulcers lining the colitis is a genetic condition that will colon, leading to a diagnosis of last the athlete’s lifetime. The ulcerative colitis. The athlete was management of ulcerative colitis is placed on the steroid Asacol to difficult in the initial stages; in decrease the inflammation of his colon particular, the combination of this and reduce diarrhea. He was not condition with athletic activity made cleared for activity until stool was it more challenging for the athlete to clear of blood. During this time, his return to ADLs. The infection that appetite increased, and he began trying triggered the disease was Aeromonas to gain weight. A strict diet and sobria, found in contaminated water adequate hydration helped achieve and fish and was contracted while the weight gain. Fatigue was a limiting athlete was on vacation. Conclusions: factor in ADLs; however, he was For an adolescent, ulcerative colitis cleared to participate in conditioning can be a devastating condition. The activities with the football team during athletic trainer should be empathetic the second week of preseason. The and understanding when dealing with athletic trainer designed a this athlete. It is necessary to form a rehabilitation program consisting of plan and communicate this plan cardiovascular conditioning and full

Journal of Athletic Training S-81 13120UC

Residual Stump Appendicitis in antibiotics. Differential Diagnosis: who has recently had an abdominal the Competitive Athlete: A Case Abdominal abscess, Post-surgical surgery, there are many common Report adhesions, Peritonitis, Cholecystitis, causes that should be considered, both Bonnett JH, Smith JJ, Watson DJ: Kidney stone, Ruptured bowel, Muscle surgical and non-surgical. Conditions University of Delaware, Newark, strain Treatment: On the day of not related to previous surgery could DE admission, the athlete underwent include kidney stones, cholecystitis, laparoscopic exploration of the muscle strains, and bowel obstruction. Background: Following a 7 to 10 day abdominal cavity including irrigation Surgically related diagnoses for period of non-specific abdominal pain, and drainage. Surgeons found a abdominal pain may include abdominal a 19 year-old male intercollegiate residual, several millimeter long tip of abscess, post-surgical adhesions, and Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 football player underwent a the original appendix adhered to the peritonitis. Sports health care laparoscopic appendectomy for a colon which they then excised. The professionals should consider residual ruptured appendix. Surgeons found post-operative diagnosis was residual stump appendicitis in the differential inflammation and infection throughout stump appendicitis and abdominal diagnosis for all athletes with a the abdominal cavity along with a abscess. The athlete was discharged previous history of appendectomy. gangrenous appendix. One week later two days later following an uneventful he had a Computed Tomography (CT) recovery. Over the past eight weeks, guided drainage of two pelvic his activity has gradually increased to abscesses containing murky fluid. The light running and lifting while paying athlete was cleared for return-to-play special attention to any signs of progression three weeks later and abdominal pain or abnormalities. began progressively increasing Upon clearance from his surgeon, the conditioning and strength training athlete will begin full-contact football exercises in preparation for return to drills. No more complications have football practice. Approximately 8 occurred and the athlete continues to weeks after the initial appendectomy, progress through his return-to-play the athlete reported to the athletic protocol. Uniqueness: Residual training room presenting with right- stump appendicitis is a residual sided flank pain. The athlete reported inflammation of the remnants of a that the previous training session had removed appendix. It is a rare, been an upper body work-out focusing underreported condition. Of those on chest, arms, back and core previous cases, there is only one other musculature. A physical examination case where surgeons found a residual revealed rebound tenderness in the tip of the appendix. This case involved right upper and lower quadrants and a middle-aged adult rather than a nausea with no other acute distress. competitive young athlete. Further, the His bowel sounds were diminished. reported time frame for the The athlete was sent by the Team development of this condition ranges Physician for a CT scan of the abdomen from 2 months to 50 years. This case and pelvis with intravenous contrast. presented with an accelerated time Imaging showed inflammation and frame, likely due to the demands on increased free fluid in the abdomen and the body as a result of participation in a 10 millimeter tubular structure in the intercollegiate athletics. Con- pericecal area. Following consultation clusions: In this case, a young, with the general surgeon, it was competitive athlete with a recent believed that the inflammation was a appendectomy presented with acute result of the original appendicitis. The abdominal symptoms including athlete was administered oral rebound tenderness and nausea which antibiotics in order to control the proved to be residual stump infection. Two days later, the athlete appendicitis. For the clinician who is reported increased pain and he was faced with an athlete presenting with referred to the general surgeon and abdominal pain, nausea, and vomiting, admitted to the hospital for intravenous

S-82 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Impact of Preseason on Exertional Heat Illness Wednesday, June 26, 2013, 9:15AM-10:15AM; Palm C; Moderator: Kristin13069DOEM Kucera, PhD, ATC

The Georgia Study: The Risk of reporting period. Any EHI that Athletic Trainer Staff Size, Exertional Heat Illnesses in High resulted in a participant being Number Of Exertional Heat School Players restricted from continuation of activity Illness Events, And Use Of Ferrara MS, Cooper ER, Miles JD, constituted an occurrence. The overall Exertional Heat Illness Curry PR, Grundstein A, Casa D, EHI’s was calculated and the HS and Prevention Strategies In US Powell JP: The University of HE variables were combined into one High School Football Programs Georgia, Athens, GA variable (HS/HE). IR was calculated Kerr ZY, Casa DJ, Comstock RD, with 95% confidence intervals (CI). Marshall SW: University of North Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Results: There were 651 reported EHI Carolina, Chapel Hill, NC; Context: Exertional heat illness (EHI) occurrences with 200,937 athlete- University of Connecticut, Storrs, is a fairly common occurrence in exposures (AE) recorded for an overall CT; The Research Institute at football particularly in the first couple IR of 3.24/1000AE (95%CI=3.00, Nationwide Children’s Hospital, of weeks of the pre-season with heat 3.50). For HS/HE, there were a total Columbus, OH cramps accounting for about 75% of of 174 reported cases for an overall all EHI cases while heat exhaustion and IR of 0.87/1000AE (95%CI=0.74, Context: An estimated 6,500 high heat syncope (HS/HE) accounted for 1.00). We founds that 49% (IR=1.84/ school football student-athletes are the remaining 25%. Numerous 1000AE; 95% CI=1.46, 2.29) of the treated annually for exertional heat investigators have posed various HS/HE cases occurred during the first illness (EHI). Variable athletic trainer preventive measures to reduce the rate week of practice 23% (IR=1.55/ (AT) coverage may lead to disparities of EHI but it is difficult to develop a 1000AE; 95%CI=1.10, 2.12) in week in implementing EHI prevention direct cause and effect relationship 2, 11% (IR=0.74/1000AE; 95%CI strategies. Lack of AT coverage may between variables and reducing the =0.44, 1.17) in week 3 and 9% also lead to an increase in the illness rate. The purpose of this study (IR=0.63/1000AE; 95%CI=0.35, frequency of EHI events. Objective: was to evaluate the incidence rates of 1.06) in week 4. We also found that To compare the prevalence of EHI EHI’s during football and to determine 79% of the EHI’s occurred at a WBGT prevention strategies and number of 0 if there was a relationship between the less than 30 C WBGT during the EHI events in the 2011 high school rate of EHI, the week of practice and course of the project and for the first football pre-season between high the environment. Design: Pro- week of practice, 61% of the EHI’s school programs staffed by one AT 0 spective observational epidemio- occurred at a WBGT of less than 30 C. versus multiple ATs. Design: Cross- logical design. Setting: Inter- Conclusion: To our knowledge, sectional study. Setting: NATA- scholastic (IS) institutions (Georgia this was the first ever, large-scale affiliated ATs providing care to high High School Association members) study directly relating to IS school football student-athletes during representing 5 geographical regions football players where EHI was the 2011 pre-season. Patients or (North, Central, Metro Atlanta, related to WBGT. This data is of Other Participants: We contacted Southeast, and Southwest). paramount importance in seeking 6,343 ATs that provided care to football Participants: IS football players from to determine where the risks are student-athletes in the 2011 pre-season 23 schools in the state of Georgia for greatest and what variables may be from a membership list provided by the 2009 – 2011 seasons, during the changed or manipulated to make the NATA. ATs completed the online months of August and September. sport activities in the pre-season questionnaire (n=1,137; 17.9%). Our Interventions: EHI types were period safer for the participants. sample represented ATs from all 50 US recorded by athletic trainers for their We found that the significant EHI states except Alaska and Rhode Island, respective schools. EHI definitions cases (HS/HE) occurred during the states not considered high risk for pre- were based on the NATA position first 2 weeks of practice at WBGT season EHI events. Most were male statement: heat cramps (HC), heat that is not considered extreme. As (51.8%), had over 10 years experience exhaustion (HE), heat syncope (HS), EHI policies are developed, the (57.9%), and had an average age of and heat stroke (STR). There were no first two weeks provided the 37.0 years (±10.2). Interventions: recorded STR’s during the 3-year greatest risk of HS/HE case and all ATs answered questions via an online period. Main Outcome Measures: preventive measures should be questionnaire pertaining to: number of EHI’s were recorded during all employed to mitigate these risks. ATs, high schools’ demographics, EHI practice, conditioning, and game prevention strategies implemented activities held during the 3-year (e.g., cold water immersion,

Journal of Athletic Training S-83 13F14FOEX monitoring ambient temperature, etc.), Demographics of Exertional activities held during the 2 month and number of EHI events in the 2011 Heat Illnesses Among reporting period. Any EHI that pre-season. We categorized our Interscholastic Football Athletes resulted in a participant being respondents based as ATs working by During August/September: A restricted from continuation of activity themselves (“Solo”; n=221) during the 3-Year Study constituted an occurrence. Results: 2011 pre-season or those reporting Cooper ER, Miles JD, Curry PJ, A total of 652 EHI’s (477 HC, 175 additional staff (“Assisted”; n=916). Grundstein A, Ferrara MS: The SEHI’s) were recorded over the 3-year Additional staff included high school/ University of Georgia, Athens, GA period. Percent of overall OEHI and college student AT assistants, percent of SEHI cases reported by volunteer ATs, or staff/volunteer Context: American interscholastic academic class were: freshman physicians. Main Outcome (IS) football players encounter many (OEHI=11%, SEHI=18%), sopho- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Measures: Using independent sample different illnesses/injuries during pre- more (OEHI=23%, SEHI= 30%), t-tests, we compared the number of season practice sessions in the juniors (OEHI=26%, SEHI= 26%) and implemented EHI prevention summer months. Exertional heat seniors (OEHI=40%, SEHI=26%). By strategies and number of treated EHI illness (EHI) is one area of concern. offensive player position, lineman had events between “Solo” and “Assisted” Questions have been raised as to the greatest number of episodes ATs. Using chi-square tests, we whether or not these EHI occurrence (OEHI=35%, SEHI=51%), followed compared the prevalence of specific risk rates vary among player by running backs (OEHI=31%, EHI prevention strategies demographics; academic class of the SEHI=22%) and wide receivers implemented between “Solo” and participants, their specific position on (OEHI=20%, SEHI=16%). De- “Assisted” ATs. Results: In the 2011 the team, and the level of play. fensively, lineman once again had the football pre-season, ATs utilized 7.6 ± Objective: To determine who is greatest occurrences (OEHI=39%, 2.5 different EHI prevention strategies sustaining EHI’s among IS football SEHI= 61%), followed by defensive and 0.5 ±1.4 EHI events were treated participants with respect to academic backs (OEHI=34%, SEHI=18%) and per high school football program. The rank, player position, and level of linebackers (OEHI=28%, SEHI= numbers of EHI prevention strategies participation on the team for IS 21%). Level of play indicated that and EHI events were positively institutions in the state of Georgia. “starters” represented the largest correlated (P=0.02). “Assisted” ATs Design: Prospective observational number of recorded EHI’s (OEHI utilized more EHI prevention epidemiological design. Setting: =72%, SEHI=54%), followed by strategies than “Solo” ATs (7.9 vs. 6.5; Interscholastic institutions (Georgia “substitutes” (OEHI=27%, SEHI P<0.001). Assisted ATs were more High School Association members) =45%) and non-players (OEHI=1%, likely to use the following EHI representing 5 geographical districts SEHI=1%). Conclusion: This data prevention strategies than “Solo” ATs: (North, Central, Metro Atlanta, demonstrates specific player “Checked environmental temperature” Southeast, and Southwest). characteristics which can be used by (75.9% vs. 59.7%; P<0.001); and Participants: IS football players the athletic trainer to determine higher “Filled immersion tub with ice water from 23 schools in the state of risk populations to monitor during pre- prior to start of practice” (48.9% vs. Georgia for the 2009 – 2011 seasons, season, regular practice sessions and 26.7%; P<0.001). “Assisted” and during the months of August and games. Observationally, linemen “Solo” ATs did not differ in the number September. Interventions: EHI types (offensive & defensive) experience a of EHI events treated in the 2011 pre- were recorded by athletic trainers for higher number of SEHI’s than all other season (0.52 vs. 0.44 per program; their respective schools. EHI positions. In addition, participants P=0.39). Conclusions: Although definitions were based on the NATA who are labeled “starters” had a greater considered a rare event, a high number position statement: heat cramps (HC), occurrence of OEHI than “substitutes”, of EHI events occurred during the pre- heat exhaustion (HE), heat syncope however the risk for SEHI’s were season. High school football programs (HS), and heat stroke (STR). There similar between these two groups. must ensure that AT staff, regardless were no recorded STR’s during the 3- Athletic trainers can use this data to of their number, have adequate year period. Overall EHI’s (OEHI), HC formulate strategies to reduce EHI resources to implement EHI and significant EHI’s (HS and HE were occurrence among these target groups. prevention strategies, and are well tabulated as one variable due to low This project was funded by the NATA trained to identify and manage EHI. numbers of HS) were calculated Research & Education Foundation. Study funded in part by Society for (SEHU). Main Outcome Measures: Public Health Education/CDC EHI’s were recorded during all Student 2012 Fellowship in Injury/ practice, conditioning, and game Violence Prevention and Control.

S-84 Volume 48 • Number 3 (Supplement) May 2013 13F11DOEX 13F15FOIN

Acclimatization In Georgia (95%CI=1.10, 1.54). IR’s for HS/HE A Climate Assessment Of Best Interscholastic Football Players: were highest in week 1, 1.84/1000AE Football Practice Times A Three-Year Perspective (95%CI=1.45, 2.30) and were 1/3 of Grundstein A, Cooper E, Miles JD, Miles JD, Curry PJ, Cooper ER, that by week 4, 0.63/1000AE Curry PR, Ferrara MS: University Grundstein AJ, Ferrara MS: The (95%CI=0.34, 1.09). During week of Georgia, Athens, GA University of Georgia, Athens, GA one, the IR was 1.04/1000AE (95%CI=0.53, 1.85) for practices Context: Football players are among Context: Proper acclimatization can <120 min., but the rate increased 2.5 the most susceptible athletes to heat- mitigate the risk of exertional heat times for practices lasting 120-150 related illnesses. Practices are illness (EHI) during the pre-season min. (2.41/1000AE, 95%CI=1.61, variously held in the morning and/or period. Physiologic changes due to 3.48) and increased 4.5 times for afternoon but no study has examined Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 acclimatization begin to take place practices lasting e”3 hrs. (4.72/ from a climate perspective which time within the first 3-5 days of heat 1000AE, 95%CI=1.79, 5.15). For of the day provides the safest training exposure and continue for up to 2-3 week two of practice, the IR was 0.50/ conditions with regard to heat months. However, there have been 1000AE (95%CI=0.16, 1.20) for exposure. Objective: To determine the minimal field-based studies to practices lasting up to 150 min., best times to schedule football determine the actual acclimatization showing 30 minutes of practices to minimize exposure to period for interscholastic (IS) football acclimatization. For the third week, oppressive heat. Design: Ob- players. Objective: To evaluate another 30 minutes of acclimatization servational study. Setting: Weather acclimatization trends in IS football was seen for a 180-minute practice stations across the United States. players in Georgia. Design: session (0.85/1000AE, 95%CI Patients or Other Participants: Prospective epidemiological design. =0.58, 1.21). Conclusion: These None. Interventions: A 15-year Setting: Interscholastic institutions data are the first to demonstrate climatology (1991-2005) of August from 5 geographic regions in the state acclimatization in adolescents in a wet bulb globe temperatures (WBGT) of Georgia (North, Metro Atlanta, field-based setting. The first two was computed for 217 locations Central, Southeast, Southwest) weeks of practice had the greatest across the contiguous United States Participants: IS football athletes risk of EHI. For the first week, using weather station observations and from 23 schools in Georgia for practices lasting longer than 120 a physically-based WBGT model. August, 2009-2011 seasons. minutes, and those lasting longer Main Outcome Measures: The Interventions: An ATC was identified than150 minutes in the second week ACSM (2007) WBGT guidelines were at each school and recorded all demonstrated an increased risk. used to determine the risk categories. athlete-exposure (AE), EHI, and Importantly, these data show We examined six, 3-hour training practice duration data. EHI types were acclimatization from the first week session times (6-9 a.m., 7-10 a.m., 8- identified as heat cramps (HC), heat to the second week, with both 11 a.m., 3-6 p.m., 4-7 p.m., 5-8 p.m. exhaustion (HE), heat syncope (HS), a decrease in the HS/HE IR’s from LDT) to identify how the WBGT varies and heat stroke (STR) as defined by the week 1 to week 4 along with with the time of day the practice National Athletic Trainers’ Association athletes’ ability to acclimatize, session was held and how frequently Position Statement. Due to the low withstanding an additional 30 the WBGT during those sessions number of HS’s, HS and HE were minutes of practice per week exceeded key ACSM safety thresholds combined to form one variable (HS/ through. Athletic Trainers and where practices would need to be HE). Main Outcome Measures: The other authorities should use this limited (30.1oC) or canceled (32.3oC). dependent variable was EHI data to create acclimatization Results: Across the country, morning occurrences (HS/HE) and the guidelines for football, decreasing practices had lower WBGT values and independent variables were practice serious EHI events. This project a lower frequency of exceeding ACSM week and practice duration. Injury was funded by the NATA Research safety standards than afternoon rates (IR) were calculated using the & Education Foundation. practice times. Climatologically, following equation: number of WBGTs were lowest for 6-9 a.m. injuries/number of athlete exposures practices and greatest for those at 3-6 (AE) x 1000 with 95% confidence p.m., with WBGT values averaging intervals (CI). Results: In August, almost 7oC greater during the 3-6 p.m. there were 141 HS/HE’s recorded and session. Starting a morning practice 106,782AE for three seasons resulting one (two) hours after 6 a.m. increased in an overall IR of 1.32/1000AE the WBGT by an average of 1.7±0.5oC

Journal of Athletic Training S-85 (3.7±0.9oC). Importantly, only a small percentage of hours (<2.5%) exceeded the critical 32.3oC threshold for canceling practice at any station for 6-9 a.m. sessions, increasing up to a maximum of 10% between 8-11 a.m. Afternoon practice sessions more frequently exceeded safety standards with some locations experiencing up to 20% (66%) of hours exceeding the o o 32.3 C (30.1 C) thresholds. Starting Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 the practice session one (two) hours after 3 p.m., resulted in an average decrease in WBGT of 0.8±0.2oC (1.9±0.3oC). Further, delaying the start time by one (two) hours decreased the percentage of exceedance relative to the 3-6 p.m. period by 40±9% (70±9%) for the 32.3oC threshold and 35±6% (66±8%) for the 30.1oC threshold for those stations (+1 standard deviation) with the greatest percentage of hours that exceeded the ACSM thresholds. Conclusions: Climatologically, mornings from 6- 9 a.m. are the best times to practice to minimize exposure to oppressive heat. While afternoons are hotter, delaying the start of practice a few hours may substantially reduce the likelihood of oppressive conditions and the probability of a practice being limited or cancelled.

S-86 Volume 48 • Number 3 (Supplement) May 2013 Heat & Hydration Evidence-Based Forum Wednesday, June 26, 2013, 10:30AM-11:30AM; Palm C; Moderator: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Journal of Athletic Training S-87 Free Communications, Oral Presentations: Kinesio Taping Across the Spectrum 13431MONEThursday, June 27, 2013, 8:00AM-9:15AM; Palm C; Moderator: Mark Merrick, PhD, ATC

The Effects Of Kinesio Taping® effect sizes (ES) were calculated for for identifying impairments among On Postural Control Deficits In statistically significant measures. this subset. Furthermore, significant Healthy Ankles, Copers, And Main Outcome Measures: differences in tape condition Individuals With Functional Independent variables included group were found for only three variables Ankle Instability and tape condition; while dependent with very small effect sizes, Shields C, Needle AR, Rose WC, variables included time-to-boundary suggesting Kinesio® tape does Swanik CB, Kaminski TW: (TTB) and traditional center-of- not affect static postural control. University of Delaware, Newark, pressure (COP) measures in both the This data agrees with previous

DE mediolateral (ML) and antero- research on effects of Kinesio® tape Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 posterior (AP) planes. Results: on dynamic postural control. Future Context: Ankle sprains are the most Significant differences between research may investigate alternate common injury among physically active groups were observed for AP COP taping techniques that may improve standard deviation (F =4.31, balance deficits in FAI. people, with common sequelae 2,57 p=0.018) and range (F =4.92, including functional ankle instability 2,57 (FAI). Copers are a cohort who have p=0.011). Significant differences sprained their ankle but not suffered any between tape conditions for ML TTB absolute minima (F =3.61, further dysfunction. Kinesio® Tape has 3,159 emerged as a technique that may p=0.015) and standard deviation (F =5.71, p=0.002), and AP TTB improve joint stability; however, 3,138 standard deviation (F =3.32, limited research has investigated its 3,141 efficacy among injured populations. p=0.029) were also observed. Objective: To examine the immediate Pairwise comparisons revealed large and prolonged effects of Kinesio to medium effect sizes for group Taping® on postural control in healthy, differences and small effect sizes coper, and functionally unstable ankles. for differences across tape Design: Cross-sectional study. conditions. FAI displayed higher Setting: Athletic training research COP standard deviation laboratory. Patients or Other (healthy=0.012±0.002m, Participants: Sixty physically active, FAI=0.014±0.003m, p=0.027, ES college-aged participants (35 females, =0.56) and range (healthy 25 males, height=72.5±9.7cm, =0.065±0.012m, FAI= 0.075± mass=74.2±16.2kg, age=21.5±2.6yrs.) 0.017m, p=0.021, ES=0.83) participated in this study. Subjects were compared to healthy ankles, as well stratified into healthy, coper, or FAI as increased COP range compared using the Cumberland Ankle Instability to copers (copers=0.065±0.012m, Tool and history of ankle sprain. p=0.033, ES=0.83). Improvements Interventions: Each participant were observed in ML TTB absolute performed 20-second single-limb minima from PRE (0.116±0.064s) balance trials on a force plate with eyes to KT-24 (0.133±.065s, p=0.025, closed. Testing was performed prior ES=0.15), as well as, increases in to tape application (PRE), immediately ML TTB standard deviation from following (KT-I), at 24-hours (KT-24), KT-I (1.975±1.786s) to KT-24 and immediately after tape removal (0.926 ±0.486s, p=0.002, ES=0.14) (POST). Separate 2-way repeated- and from KT-24 to POST measures ANOVA’s (p£ 0.05) were (1.780±1.696s, p=0.009, ES=0.06). conducted comparing group and tape Conclusions: As functionally condition. Pairwise comparisons were unstable ankles demonstrated used for post-hoc analysis with a diminished postural control using Bonferroni correction to control for traditional COP measures, our data multiple comparisons. Cohen’s d support the use of these variables

S-88 Volume 48 • Number 3 (Supplement) May 2013 13177MONE 13289DOPR

Effects Of Kinesio Tape On 48 hrs later for follow up measures. Kinesiology Taping Does Quadriceps Function In Patients Subjects wore their taping intervention Not Improve Shoulder With A History Of Knee Joint for the duration of the study. Main Proprioception, Shoulder Injuries Outcome Measures: A blinded Strength, Or Scapular

Davis B, Kim KM, Hart JM, Hertel assessor obtained Hmax:Mmax ratios for Kinematics In Healthy Or J: Hampden-Sydney College, the quadriceps at baseline, Shoulder Impingement Hampden-Sydney, VA; Texas immediately following treatment, 20 Subjects: A Preliminary Report State University, San Marcos, minutes following treatment and at Keenan KA, Akins JS, Varnell MS, TX; University of Virginia, 24-48 hours following treatment. Abt JP, Sell TC, Lovalekar MT,

Charlottesville, VA Knee extension torque and CAR were Lephart SM: Neuromuscular Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 measured during a knee extension Research Laboratory, Department Context: Quadriceps dysfunction maximal voluntary isometric of Sports Medicine and Nutrition, commonly persists in people with a contraction (MVIC) at baseline and School of Health and Rehabilitation history of knee injury or surgery. after 24-48 hours. CAR was measured Sciences, University of Pittsburgh, Modalities such as ice, heat, as the ratio between MVIC and the Pittsburgh, PA transcutaneous electrical nerve peak torque generated by an electrical stimulation, and joint mobilization stimulation delivered to the thigh have been shown to improve superimposed during the MVIC test. Context: Kinesiology tape (KT) use A 2X4 ANOVA was used for H :M quadriceps dysfunction by removing max max in the clinical setting is growing; the underlying cause, arthrogenic and a 2X2 ANOVA was used for knee however, little evidence-based muscle inhibition. Kinesio Tape (KT) extension torque and CAR. Results: research exists to support/refute its has been used clinically in this patient There was no significant interactions use. KT has been asserted to reduce for quadriceps H :M (F = population however the max max 3,42 pain, alter muscle activation, enhance neurophysiologic rationale for its use 1.94,P =0.14). The ratios did not proprioception, and promote change over time (F is lacking. Objective: To compare 3,42 posturalalignment, which may be quadriceps function in patients with a =0.52,P=0.67) and were not crucial when treating patients with different between groups (F = history of knee joint injury, and 1,14 subacromial impingement syndrome evidence of quadriceps arthrogenic 0.55,P=0.47). There were no (SIS). Objective: To determine the muscle inhibition, after application of interactions for knee extension effect of KT on shoulder torque (F =0.007,P=0.93) or KT. Design: Randomized controlled, 1,14 proprioceptionstrength, and scapular quadriceps CAR (F = 0.03, single blinded study. Setting: 1,14 kinematics (SK) in healthy and SIS Laboratory. Patients or Other P=0.86). Neither knee extension subjects. Design: Placebocontrolled Participants: Sixteen subjects with a torque nor quadriceps CAR were quasi-experimental study. Setting: documented history of knee injury or different over time (Torque: Research laboratory. Participants: F =0.004,P=0.95, CAR: F = surgery and quadriceps central 1,14 1,14 Data were collected on 10 healthy, activation ratio (CAR) less than 90% 0.92,P=0.35) or between groups physically active (age=25.78±3.78 (Torque: F =0.25,P=0.63, CAR: participated. Subjects were randomly 1,14 years, height=1.69±0.09 m, F =0.39,P=0.54). Conclusions: allocated to either KT (7 males, 1 1,14 mass=67.18±14.25 kg) and 9 female; age=25±5.0 years; height KT did not change quadriceps physically active SIS participants =178.1±7.5cm; mass=78.9±14.1kg) neurophysiologic function (age=26.39±4.20 years, height or sham group (2 males, 6 females; immediately after or after a short =1.73±0.10 m, mass=77.52±14.87 age=23±3.5 years; height =175.3± period of time in patients with kg). Control subjects had no history of 11.7cm; mass=74.6±16.0kg). Inter- history of knee injuries and with musculoskeletal shoulder pathology; ventions: The KT group received a evidence of quadriceps dysfunction. SIS subjects were diagnosed by a taping treatment using elastic KT healthcare professional and presented covering from anterior inferior iliac with clinical signs of impingement. spine to patella with approximately Interventions: Tests were performed 75% of elastic tension in the mid line on the dominant side (arm used to of the thigh. The sham group received maximally throw a ball) for controls a sham taping treatment using a non- and impinged side for SIS subjects. All elastic tape (Cover-Roll). Subjects control subjects (n=10) received KT remained in the lab for 2 post- and SIS subjects were randomized to treatment measures and returned 24- receive KT (n=5) or sham taping (ST,

Journal of Athletic Training S-89 13244MOPR n=4). Taping was performed by a taping does not appear to aid/impair Kinesio Tape For The Lower Leg certified kinesiology tape practitioner shoulder proprioception, strength, or Shifts Lateral Plantar Forces using the method recommended by the SK. Future research should explore if During Gait certifying organization. Participants similar results can be replicated with Caccese JB, Griebert MC, Needle were tested pre- and post-application. larger sample sizes and in other AR, Kaminski TW: University of Threshold to detect passive motion pathological groups. Supported by Delaware, Newark, DE (TTDPM) was assessed using an Freddie H. Fu, MD Graduate Research isokinetic dynamometer (passive Award and University of Pittsburgh, Context: Kinesio taping (KT) has mode, 0.25°/s) for shoulder internal/ School of Health and Rehabilitation become widely used in sports medicine external rotation (IR/ER, 3 repetitions Sciences Research Development Fund over recent years for various Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 each). Path of motion replication pathologies. Mechanical support and (POMR) and SK were assessed using increased proprioception are proposed a 3D motion analysis system and benefits, but little evidence exists as custom guide (POMR: D2 to the efficacy of KT. Previous proprioceptive neuromuscular research suggests that KT changes facilitation pattern, 3 repetitions each; timing of plantar forces among SK: scaption, 5 repetitions humeral patients with a history of medial tibial elevation/depression). Isokinetic stress syndrome (MTSS). It is unclear shoulder IR/ER strength was assessed how KT may affect the magnitude of using an isokinetic dynamometer (60°/ these plantar forces. Objective: To s, 5 repetitions each). Post-test/pre- examine effects of lower leg KT on test differences were calculated. Data plantar forces in healthy subjects and were analyzed by group using one- subjects with a history of MTSS. sample Wilcoxon Signed Rank Tests. Design: Pre-test post-test with Mann-Whitney U tests were used to control group. Setting: Biomechanics assess differences between groups laboratory. Patients or Other (Controls vs. KT, KT vs. ST). Statistical Participants: Forty physically active significance was set at p<0.05 a subjects (20 male, 20 female) priori. Bonferonni corrections were volunteered for this study. Twenty applied to each variable category. subjects had no history of exercise- Main Outcome Measures: Mean related leg pain and twenty subjects absolute error and root mean squared had a history of MTSS. Interventions: error in degrees were calculated for Subjects were asked to walk barefoot TTDPM (IR/ER) and POMR (3D across a pressure mat system prior to humeral position), respectively. tape application (PRE), immediately Scapular positions were extracted at following application of KT to the 90° and 120° of humeral elevation/ lower leg (KT-I), and 24-hours after depression. Average peak torque was KT use (KT-24). Tape was applied normalized to body weight (%BW) for directly to the skin from the superior shoulder IR/ER. Results: No third of the medial tibia to the arch of significant differences were the foot at 75% tension. Five trials demonstrated in TTDPM (p- were collected for each condition to range:0.273-0.893), POMR (prange: ensure a reliable recording. Main 0.028-0.799), strength (p- Outcome Measures: Each trial was range:0.225-1.000), or SK (p- partitioned so the foot was divided into range:0.043-1.000) when analyzed by six areas: medial forefoot (MFF), group. No significant differences were medial midfoot (MMF), medial demonstrated between groups in rearfoot (MRF), lateral forefoot TTDPM (p-range:0.190-0.733), (LFF), lateral midfoot (LMF), and POMR (05range:0.0.142-1.000), lateral rearfoot (LRF). The dependent strength (prange: 0.286-0.95), or SK variable was normalized peak force (N/ (p-range:0.071-1.000). Conclusions: kgbw). A 3-way repeated-measures Preliminary findings indicate that ANOVA was used to determine if

S-90 Volume 48 • Number 3 (Supplement) May 2013 differences existed across tape conditions, foot areas, and groups. Results: A significant interaction effect of condition, area, and group was observed for peak force (F10,380=2.788, p=0.002). Pairwise comparisons revealed that KT lowered peak forces in the LFF (PRE=1.12±0.28 N/kgbw, KT- I=1.01±0.20 N/kgbw, KT-24= Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 1.02±0.23 N/kgbw, p<0.02) and LMF (PRE=0.35±0.27 N/kgbw, KT- I=0.29±0.26 N/kgbw, KT-24= 0.31±0.28 N/kgbw, p<0.03) in healthy controls, but not MTSS subjects (LFF: PRE=0.98±0.30 N/kgbw, KT- I=1.01±0.31 N/kgbw, KT-24= 1.03±0.40 N/kgbw, p>0.05; LMF: PRE=0.27±0.24 N/kgbw, KT-I= 0.29±0.24 N/kgbw, KT-24=0.31±0.28 N/kgbw). KT also increased LRF peak forces from PRE (Healthy=0.95±0.14 N/kgbw, MTSS=0.86±0.15 N/kgbw) to KT-I (Healthy=1.01±0.19 N/kgbw, MTSS=0.95±0.26 N/kgbw)in both groups (p<0.05). Conclusions: Our results suggest that the use of KT on the lower leg may increase the lateral forces in the rearfoot in healthy and MTSS subjects, potentially due to initial contact occurring in a more supinated position. However, we observe that forces in the midfoot and forefoot are decreased, suggesting a beneficial role of the tape. While limited effects of KT were observed in the MTSS group, there were no baseline differences in plantar forces observed in our subset of patients, in contrast to previous studies.

Journal of Athletic Training S-91 Free Communications, Oral Presentations: Risk Factors and Management of Patellofemoral Pain Thursday,13152FOIN June 27, 2013, 9:30AM-10:30AM; Palm C; Moderator: Megan Quinlevan, ATC

Gender-Specific Biomechanical data collection, participants were 0.30± 0.08% BW; P=0.04) Profiles For The Development followed prospectively for a maximum compared to females who did not Of Patellofemoral Pain of 4 years to identify those diagnosed develop PFP. Conclusions: Bio- Boling MC, Nguyen A, Padua DA, with PFP. Incident PFP was determined mechanical risk factor profiles for Marshall SW, Cameron KL, by a manual review of medical records PFP appear to differ between males Beutler AI: University of North by the principal investigator. Main and females. These findings may be Florida, Jacksonville, FL; High Outcome Measures: Sagittal, used to develop effective PFP Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Point University, High Point, NC; frontal, and transverse plane hip and injury prevention programs University of North Carolina, knee kinematics during the jump- specific to gender. (Funded by Chapel Hill, NC; Keller Army landing task at initial contact (IC) and R01-AR050461001 and R03- Hospital, West Point, NY; 50% of stance phase (50%), mean and AR057489-01A1) Uniformed Services University of peak isometric strength [normalized to the Health Sciences, Bethesda, body weight (%BW)] of the knee MD flexors, knee extensors, hip extensors, hip abductors, hip internal rotators, and Context: Females are reported to have hip external rotators, Q-angle, and a two times greater risk of developing navicular drop were included in the patellofemoral pain (PFP) as data analysis. Separate one-way compared to males. In order to better analyses of variance were performed understand this gender discrepancy in to compare each dependent variable the risk of developing PFP, it is between individuals who developed imperative that researchers investigate PFP during the follow up period and the risk factors for PFP that are those who did not develop PFP for specific to males and females. males and females, separately Objective: To prospectively compare (P<0.05). Results: 188 participants lower extremity kinematics, strength, (94 females, 94 males) were Q-angle, and navicular drop between diagnosed with PFP during the those who developed PFP and those follow-up period. In males, the PFP who did not develop PFP in a cohort group displayed less knee flexion of males and females. Design: (16.9±7.5° vs. 20.2±7.9°; P=0.01) Cohort. Setting: US Service and greater hip external rotation (- Academies. Patients or Other 5.5±7.6° vs. -3.2 ±0.04°; P=0.01) at Participants: The cohort consisted of IC, greater hip abduction mean 4019 participants (1455 females: (0.35±0.09%BW vs. 0.33± 0.08% age=18.6±0.8yrs, height =165.7 BW; P=0.03) and peak (0.42± ±6.5cm, mass=62.9±7.9kg; 2470 0.09%BW vs. 0.39±0.09%BW; P= males: age=18.9±0.9, height 0.02) strength, and greater navicular =177.86±6.9cm, mass= 77.25± drop (8.2±3.5mm vs. 7.5±2.8mm; 12.0kg) who were freshmen at the P=0.02) compared to males who did time of enrollment in the current not develop PFP. In females, the PFP investigation. Interventions: Each group displayed less knee external participant underwent a baseline rotation at IC (-1.8±7.3° vs. -3.8± biomechanical assessment including 7.5°; P=0.02), greater knee internal three-dimensional motion analysis rotation at 50% (3.8±9.7° vs. during three trials of a jump-landing 1.5±9.7°; P=0.04), greater hip task, assessment of peak and mean extension peak strength (0.30 isometric strength of thigh and hip ±0.08%BW vs. 0.27±0.08%BW; musculature (two trials), and P=0.01), and less hip abduction measurement of Q-angle and navicular mean strength (0.28±0.07%BW vs. drop (three trials). Following baseline

S-92 Volume 48 • Number 3 (Supplement) May 2013 13453FOBI 13F13DOBI

Altered Hip Adductor – Gluteus symptomatic). For each DV during the Differences In Pelvic And Trunk Medius Activation Differences two phases of stair ambulation, Kinematics Among Those With And Knee Valgus In Those With separate two-way (Group, Limb) And Without Patellofemoral Patellofemoral Pain ANOVA’s were utilized for statistical Pain Aminaka N, Pietrosimone BG, analysis. Significance was set a priori Bazett-Jones DM, Earl-Boehm J, Gribble P: University of at P<0.05. Effect sizes (Cohen’s d) Bolgla L, Hamstra-Wright KL, Wisconsin-La Crosse, La with 95% confidence intervals also Emery CA, Ferber R: Department Crosse, WI, and University were calculated. Results: A of Health & Human Movement of Toledo, Toledo, OH significant effect for limb was found Sciences, Carroll University,

for H-G during stair ascent Waukesha, WI; Department of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (F =4.193, P=0.048, d=0.34 Context: Gluteus medius (GMed) 1,38 Human Movement Sciences, weakness in patients with [95%CI=-0.29, 0.96]). The University of Wisconsin- patellofemoral pain (PFP) has been asymptomatic side had earlier Milwaukee, Milwaukee, WI; observed previously. However, there is activation of HA relative to GMed, Department of Physical Therapy, limited evidence of neuromuscular and compared to the symptomatic side Georgia Health Sciences kinematic alterations related to GMed (Symp=-155.02±134.13msec, University, Augusta, GA; function. Furthermore, it is unknown Asymp=-211.16±188.04msec). A Department of Kinesiology & whether the muscular imbalance significant group difference was found Nutrition, University of Illinois at between the hip adductor (HA) group for H-G during stair descent, Chicago, Chicago, IL; Faculty of and the lateral hip musculature exists, indicating that the PFP group displayed Kinesiology, University of Calgary, which may contribute to further earlier activation of HA relative to Calgary, Canada kinematic deficits in those with PFP. GMed, compared with the healthy group (F =6.862, P=0.013, d=-0.61 Objective: Determine if there were 1,38 Context: Patellofemoral pain (PFP) differences in HA and GMed activation [-1.25, 0.02], PFP=-24.24 is the most common injury in running onset and knee kinematics between ±132.16msec, Healthy =50.42 and jumping sports. Investigators have PFP and healthy participants. Design: ±104.49msec). For knee valgus during reported reduced hip and trunk strength Case-control. Setting: Research ascent, there was a significant group and differences in hip and knee difference (F =6.424, P=0.016, laboratory. Patients or Other 1,38 mechanics in those with PFP. However, Participants: Twenty PFP (13F/7M, d=0.67 [0.03, 1.31]). The PFP group no study has investigated pelvis and 21.45±3.90years, 169.96±10.47cm, displayed more knee valgus, compared trunk mechanics in this population. 71.30±14.50kg) and twenty healthy to the healthy group (PFP= Objective: To compare sagittal, participants (13F/7M, 21.35± -0.12±6.23°, Healthy=-4.23±5.80°). frontal, and transverse plane pelvis and 3.76years, 172.21±9.24cm, 69.68± A significant group difference was also trunk mechanics in those with and 9.78kg) volunteered. Interventions: found for knee valgus angle during without PFP. Design: Cross- Knee valgus/varus angles during stance descent. The PFP group displayed sectional. Setting: Research phase of stair ambulation were more knee valgus compared to the laboratory. Patients or Other healthy group (F =7.452, P=0.01, obtained using 3-D motion analysis, in 1,38 Participants: 31 controls (17 order to obtain the mean valgus angle d=0.75 [0.11, 1.39], PFP= 1.73 females, 14 males: age= 27.0 during the first 30% of the stance ±4.14°, Healthy=-1.035±3.01°). ±77.1years; mass=68.4±11.5kg; phase. A positive value indicated knee Conclusion: An imbalance between height=173.0±9.2cm) and 46 PFP valgus. Additionally, electro- the medial and lateral thigh/hip patients (25 females, 21 males: myographic recordings of the HA and musculature exists in those with PFP, age=29.0±7.1 years; mass= 75.5 GMed were obtained to identify the which may lead to increased knee ±20.4kg; height=171.3±17.8cm) differences in the activation onsets valgus during activity. The results volunteered to participate. PFP relative to footstrike. A negative value support the previous literature participants were assessed by an AT indicated that HA activated earlier than on muscular and kinematic deficits and met inclusion criteria based on the GMed. Main Outcome in PFP patients, and may suggest that Boling (2006). The control Measures: Dependent variables excessive or premature activation participants were free from lower included the HA-GMed activation of HA may possibly cause inhibition extremity injury and had no history of difference (H-G) and the mean knee of GMed. Reestablishing muscle PFP. All participants exercised valgus angle, during stair ascent and balance in the lower extremity regularly a minimum of 30 minutes at descent, separately. Independent should be a continued focus in least 3 days/week. For the PFP variables included group (PFP, rehabilitation of PFP patients. participants the most painful knee was Healthy) and limb (asymptomatic, Journal of Athletic Training S-93 13F23FOTE tested, and this was matched to the demonstrate greater transverse plane Prospective Pain And Function controls. Interventions: The motion at the trunk during running, Outcomes After 6-Weeks Of independent variables were sex (male, potentially showing the importance of Rehabilitation For female) and group (PFP, Control). hip and trunk muscular training in Patellofemoral Pain Syndrome Three-dimensional kinematic data females, possibly as a preventative Hamstra-Wright KL, Earl-Boehm were collected at 200 Hz and ground measure for PFP. Funded by the NATA J, Bolgla L, Emery CA, Ferber R: reaction force data were collected at REF: 808OUT003R, Alberta Department of Kinesiology & 1000 Hz while participants ran (3.5- Innovates: Health Solutions, Nutrition, University of Illinois at 4.5 m/s) wearing standard footwear. Wisconsin Athletic Trainers’ Chicago, Chicago, IL; Department After several practice trials, 5 trials Association, and UW-Milwaukee of Human Movement Sciences, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 were recorded. Main Outcome College of Health Sciences. University of Wisconsin- Measures: The dependent variables Milwaukee, Milwaukee, WI ; were stance phase peak absolute joint Department of Physical Therapy, angles of the pelvis (APT, drop/lift, Georgia Health Sciences rotation) and trunk (FTL, contra- and University, Augusta, GA; Faculty ipsilateral lean, right and left rotation). of Kinesiology, University of 2X2 ANOVAs were performed to Calgary, Calgary, Canada identify differences between the independent variables (P<0.05) and Context: Therapeutic exercise is a post-hoc tests were performed with common intervention for a frequently Tukey (P<0.0125). Results: There diagnosed knee injury, patellofemoral was a significant group x sex pain syndrome (PFPS). Recent results interactions for APT (P=0.020). Post- from our randomized controlled trial hoc comparisons indicated that (RCT) study indicate 6-weeks of females with PFP demonstrated rehabilitation focused on significantly less (P<0.001) peak APT strengthening knee or hip/core than female controls (PFP=3.7±6.0°, musculature are equally effective in Control=13.5±6.9°) and male reducing pain and increasing function controls (10.9±6.7°, P=0.006). There in physically active individuals with was no significant difference PFPS. However, pain and functional (P=0.096) in peak APT between outcomes after treatment remain females and males (8.1±6.1°) with unknown. Objective: To assess PFP. Main effects for sex were found differences in pain and function post- for peak pelvic lift (males: 3.7±2.1°, rehabilitation (6-WK) compared to 6- females: 5.3±2.0°, P=0.003), FTL months post-rehabilitation (6-MOS) (males: 15.7±5.6°, females: 12.3± in PFPS patients who experienced 5.9°, P=0.016) and peak right (males: treatment success compared to those 12.0±4.7°, females: 17.0±5.8°, who did not. Design: Single-blind P<0.001) and left (males: 10.7±4.4°, RCT multi-centered study. Setting: females: 13.9±6.0°, P=0.003) trunk Four clinical research laboratories rotation. There were no significant across North America. Patients or differences in other variables Other Participants: 202 PFPS patients, measured (P>0.05). Conclusions: assessed by an AT and meeting Decreased APT in females with PFP, inclusion criteria based on Boling et combined with decreased FTL, may al. (2006), volunteered to participate shift the center of mass posteriorly. (67 males, 135 females: age= This would increase the knee extensor 29.36±7.33 years, mass= demand and patellar compression, 69.46±14.17 kg, height=170.86±9.48 making women more susceptible to cm). Interventions: PFPS patients PFP. This might also be a were randomly assigned to a treatment compensatory strategy resulting from protocol (knee vs. hip/core). Each PFP. Individuals with PFP do not patient visited an AT 3 times/week over exhibit compensatory lateral trunk lean 6-weeks for rehabilitation or pelvic drop. Females in general progression. After completion of the S-94 Volume 48 • Number 3 (Supplement) May 2013 treatment protocol, PFPS patients focused on knee or hip/core strength were asked to discontinue the appears to be an appropriate exercises and report back to the intervention for physically active laboratory in 6-months. Main PFPS patients. Funded by the NATA Outcome Measures: Pain and REF: 808OUT003R and Alberta function were measured at 6-WK and Innovates: Health Solutions. 6-MOS using a 10 cm visual analog scale (VAS) and the anterior knee pain scale (AKPS). Treatment success was defined a priori as a decrease in VAS

by 3 cm and/or an increase in AKPS Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 of 8 points (maximum points possible: 100). Differences in pain and function over time (6-WK, 6-MOS) and between groups (successful, unsuccessful) were assessed using two 2x2 repeated measures ANOVAs (Pd”0.05). Results: Of the 202 patients, 141 reported successful outcomes and 105 provided 6-WK and 6-MOS VAS and/or AKPS data. Thirty- eight of the 202 patients were unsuccessful and 26 provided 6-WK and 6-MOS VAS and/or AKPS data. There were no differences in pain over time in patients reporting successful outcomes (6-WK: 2.12±2.09 cm, 6-

MOS: 2.29±2.37 cm, F1,129=21.55 , P=0.99, n=105) nor in patients reporting unsuccessful outcomes (6- WK: 4.42±2.43 cm, 6-MOS:

4.25±2.60 cm, F1,129=21.55, P=0.99, n=26). There were also no differences in function over time in patients reporting successful outcomes (6- WK: 89.40±10.48, 6-MOS:

88.59±11.07, F1,118=18.35, P=0.72, n=98) nor in patients reporting unsuccessful outcomes (6-WK: 78.68±9.93, 6-MOS: 78.91±10.51,

F1,118=18.35, P=0.72, n=22). Regardless of time, the successful group had lower VAS (2.19±2.23 cm, P=0.00) and higher AKPS scores (89.06±10.76, P=0.00) compared to the unsuccessful group (4.34±2.49 cm, 79.22±10.39). Conclusions: At 6-months post-treatment, patients experienced no increases in pain or decreases in function regardless of whether reporting successful or unsuccessful outcomes at 6-weeks post-treatment. Therapeutic exercise

Journal of Athletic Training S-95 Free Communications, Oral Presentations: Prospective Clinical Trials in Athletic Training 13300FOINThursday, June 27, 2013, 11:45AM-12:45PM; Palm C; Moderator: Darin Padua, PhD, ATC

Kinematic Risk Factors For acquisition computer software was in the incidence rate of lower- Lower-Extremity Stress used to collect three-dimensional extremity stress fracture injuries Fracture Injuries coordinates of selected anatomical during follow-up. Future research Cameron KL, Peck KY, Owens landmarks at a sampling rate of 144 Hz. should examine the role of injury BD, Svoboda SJ, Padua DA, Primary Outcome Measures: The prevention programs in decreasing DiStefano LJ, Beutler AI, Yau R, primary outcome of interest was the stress fracture incidence by targeting Marshall SW: Keller Army incidence rate of lower-extremity high-risk movement patterns. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Hospital, United States Military stress fracture during the follow-up Academy, West Point, NY; period. The electronic medical University of North Carolina at records of each potential incident case Chapel Hill, Chapel Hill, NC; were reviewed and each case was University of Connecticut, Storrs, confirmed by an adjudication CT; Uniformed Services University committee consisting of two sports of Health Sciences, Bethesda, MD medicine fellowship trained orthopaedic surgeons. The association Context: Stress fracture injuries between incident stress fracture and disproportionately affect athletes and sagittal, frontal, and transverse plane military service members and little is hip and knee kinematics during the known about the modifiable jump-landing task were examined at biomechanical risk factors associated initial contact (IC), 15%(T15), with these injuries. Objective: The 50%(T50), 85%(T85) and 100% purpose of this study was to (T100) of stance phase. We used prospectively examine the association univariate and multivariable Poisson between biomechanical factors upon regression models to analyze the data. entry to military service and the Results: Overall, 94 (5.1%, 95%CI: subsequent incidence rate of lower- 4.14, 6.21) subjects sustained an extremity stress fracture during incident stress fracture during the follow-up. Design: Prospective follow-up period. Compared to those cohort study. Setting: We analyzed with greater than 5° of knee valgus, data from the JUMP-ACL cohort, an subjects with neutral or varus knee existing prospective cohort of military alignment exhibited incidence rates cadets. Patients or Participants: All for stress fracture that were 43%-53% participants were college freshmen lower at IC (IRR=0.57, 95%CI: 0.29, entering a U.S. Service Academy. 1.11, p=0.10), T50 (IRR=0.47, There were 1895 participants available 95%CI=0.23, 1.00, p=0.05), and T85 for analysis. Fifty-two participants (IRR=0.53, 95%CI: 0.29, 0.98, reported a history of stress fracture at p=0.04). Subjects with greater than 5° baseline and were excluded from of internal knee rotation exhibited further analysis leaving 1843 rates for stress fracture that were 2-4 participants. Interventions: Detailed times higher at T15 (IRR=2.31, motion analysis was conducted at the 95%CI: 1.01, 5.27, p=0.05), T50 initiation of each subject’s military (IRR=3.98, 95%CI: 0.99, 16.00, career. Kinematic data were collected p=0.05), and T85 (IRR=2.31, 95%CI: from the subject’s dominant leg during 0.86, 6.23, p=0.10), when compared three jump-landing trials. A Flock of to those with neutral or external knee Birds® (Ascension Technologies, rotation. Conclusions: Knee valgus Inc., Burlington, VT) electromagnetic and internal rotation during a jump motion analysis system controlled by landing task at baseline appear to be Motion Monitor® (Innovative Sports associated with a 2-4 fold increase Training, Inc. Chicago, IL) data

S-96 Volume 48 • Number 3 (Supplement) May 2013 13F06FOTE Optimal Rehabilitation Protocols visited an AT 3 times per week over a HIP protocols for patients with for the Treatment of 6-week period for rehabilitation PFPS. Funded by the NATA REF: Patellofemoral Pain Syndrome: progression. Main Outcome 808OUT003R and Alberta an Outcome-Based RCT Study Measures: VAS and AKPS were Innovates: Health Solutions. Ferber R, Bolgla L, Earl-Boehm J, collected at baseline and one time per Emery CA, Hamstra-Wright KL: week over 6-weeks. Treatment Faculty of Kinesiology, University success was a priori defined as a of Calgary, Calgary, Canada; decrease in VAS by 3cm and/or an increase in AKPS of 8 points. Data Department of Physical Therapy, were analyzed using an intent-to-treat Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Medical College of Georgia, basis. We calculated the mean change Augusta, GA; Department of scores within groups, and differences Human Movement Sciences, in change scores between groups, with University of Wisconsin- 95% confidence intervals (CI) and Milwaukee, Milwaukee, WI; performed 2x2 ANOVAs (group x Department of Kinesiology & time; P<0.05) on the VAS and AKPS Nutrition, University of Illinois- scores. Results: At baseline, no differences (F =0.92; P=0.54) in Chicago, Chicago, IL 1,199 VAS were observed between HIP (5.12±1.65cm; CI: 5.50-4.73cm) and Context: Patellofemoral pain KNEE (4.97±1.61cm; CI: 5.35- syndrome (PFPS) is the most common 4.60cm) and no differences injury in running and jumping sports. (F =0.78; P=0.66) in AKPS were The gold standard for PFPS 1,199 observed between HIP (75.00±9.74; rehabilitation has traditionally been CI: 77.28-72.72) and KNEE strengthening the muscles surrounding (75.62±9.81; CI: 77.91-73.34). 23 the knee (KNEE). More recently, it has patients dropped out after baseline been suggested the aetiology of PFPS testing, 141 PFPS reported a is related to reduced hip and core successful outcome, and 38 were strength (HIP). However, no unsuccessful. Of the 141 successful randomized controlled trial (RCT) outcomes, 70 were HIP and 71 were studies have determined the optimal KNEE and no differences in either VAS rehabilitation for PFPS. Objective: (F =0.77; P=0.69) or AKPS To compare pain and function between 1,138 (F =0.91; P=0.57) were measured KNEE and HIP rehabilitation 1,138 between groups. HIP exhibited an protocols using an RCT approach. We average decrease of 3.58±1.94cm in hypothesized greater improvements in VAS (CI: 1.38-2.16) and 17.62±9.46 visual analog scale (VAS) and Anterior increase in AKPS (CI: 90.37-93.68) Knee Pain Scale (AKPS) scores for while KNEE demonstrated an average HIP as compared to KNEE. Design: decrease of 3.65±1.74cm in VAS (CI: Single-blind RCT multi-centered 1.19-1.79) and 18.91±12.69 increase study. Setting: Four clinical research in AKPS (CI: 90.69-93.79). laboratories across North America. Conclusions: With ATs as the primary Patients or Other Participants: 202 interventionists, this RCT study PFPS patients, assessed by an AT and demonstrated significant improve- meeting inclusion criteria based on ments in pain and function for one of Boling et al. (2006), volunteered to the most common musculoskeletal participate (67 males, 135 females: injuries. Both KNEE and HIP age=29.36±7.33 years; mass= 69.46± protocols improved patient-centered 14.17kg; height= 170.86±9.48cm). outcome scores after 6-weeks of Interventions: PFPS patients were therapeutic strengthening. This is the randomly assigned to a treatment first RCT study investigating KNEE vs. protocol: KNEE vs. HIP. Each subject

Journal of Athletic Training S-97 13344MCS

Patient-Centered And Clinical OCM one day post-injury (Day1), one minimal functional loss. Uniqueness: Outcomes Associated With week post-injury (Week1), and at There is a lack of evidence supporting Grade II Lateral Ankle Sprains: return to play (RTP)(19.6±5.86days). the use of PRO and OCM to track the A Case Series Active DROM was measured in progress during rehabilitation of lateral Mulligan RP, Mutchler J, Hoch MC, degrees with the patient in prone ankle sprains. This case series Van Lunen BL: Old Dominion position with the knee extended. Pain demonstrates how patient-centered University, Norfolk, VA was measured in centimeters using a measures of function can be used to visual analog scale (VAS) and changes enhance patient evaluation and track Background: The purpose of this in self-reported injury status were rehabilitation progress when combined measured using the GROC. The FAAM with traditional clinical indicators of case series is to describe the clinical Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and patient-centered outcomes of 5 contains 21 items related to activities function. Conclusions: Following collegiate athletes who presented to of daily living (highest score=100%), lateral ankle sprain, patients their respective athletic training the FAAM-Sport contains 8 items demonstrated decreases in pain, facilities with grade II lateral ankle related to sport-specific activity increases in DROM, and sprains. These patients (2 female, 3 (highest score=100%), and the CAIT improvements in perceived injury male; age=19.4±0.8years) were contains nine items pertaining to status which corresponded with participating in NCAA athletics instability during activity (highest improvements in self-reported (lacrosse, track, soccer and baseball) score=30). All items on the FAAM, measures of health assessed through and sustained a lateral ankle sprain FAAM-Sport, and CAIT are graded on PRO instruments. All patients associated with an inversion a Likert scale with higher scores demonstrated improvements in OCM mechanism while running or landing. indicating greater self-reported and PRO at RTP regardless of their Four patients reported no previous function. The TSK-11 is an 11-item rehabilitation plan. However, PRO history of ankle sprain. All patients questionnaire graded on a 4-point instruments continued to identify exhibited mild-to-moderate instability Likert scale (total=44, lowest=11) improvements at RTP despite a plateau with manual stress tests (anterior with higher scores indicating greater in certain OCM. This demonstrates the drawer and talar tilt), point tenderness fear of movement. Results: All benefit of combining OCM and PRO over the lateral ankle ligaments, patients demonstrated improvements for tracking the rehabilitation progress limited ROM compared to the in OCM as indicated by changes in for patients with lateral ankle sprains. contralateral ankle, pain with weight- DROM (Day1=6.6±8.47°; Week1 bearing, and sudden onset of edema =10.6±5.32°), pain on the VAS within 72 hours of injury. All patients (Day1=5.28±2.41cm; were monitored over the course of Week1=1.5±1.19cm) andhe GROC treatment using objective clinical (Day1=-0.02±2.0; Week1=2.8±0.83). measures (OCM) including pain, the The improvements in OCM global rating of change scale (GROC), corresponded to improvements in and active dorsiflexion range of overall health status as indicated by motion (DROM) along with self- changes in PRO measures for the reported measures of health including FAAM (Day1= 55.50±20.00%; the Foot and Ankle Ability Measure Week1=79.00±23.50%), the FAAM- (FAAM), the FAAM-Sport, the Sport (Day1=11.87±3.56%; Week1 Cumberland Ankle Instability Tool =27.50±6.38%), the CAIT (Day1 (CAIT), and the Tampa Scale of =8.20±7.43; Week1 =13.60 ±7.43) Kinesiophobia-11 (TSK-11). While and the TSK-11 (Day1=26.80±3.27; the FAAM, FAAM-Sport, and CAIT are Week1=22.20±3.03). The GROC patient reported outcomes (PRO) continued to improve at RTP focusing on regional measures of (4.5±0.55) while pain (0.06±0.09cm) health associated with the foot and and DROM (10.6±7.13°) did not ankle, the TSK-11 describes the fear change. Upon RTP, all patients of movement. Treatment: Treatment demonstrated high levels of function and rehabilitation protocols for each on each PRO measure (FAAM patient were dependent upon the =98.50±2.05%; FAAM-Sport= discretion of their respective athletic 96.25±5.59%; CAIT=24.60±3.21; trainer. Patients completed PRO and TSK-11=16.00±2.34) indicating

S-98 Volume 48 • Number 3 (Supplement) May 2013 13435FOHE

Treatment Characteristics And istics included duration of care healthcare system when ATS are Estimated Direct Costs Of Care [initial evaluation to last documented provided in a population-based Provided By Athletic Trainers episode of care (EOC)], EOC’s practice model outside of CMS. For Upper Extremity Disorders: (number of documented patient A Report From The Athletic encounters), type of ATS provided Training Practice-Based (CPT codes). DCC were estimated Research Network by applying the 2012 CMS Physician Sauers EL, Bliven K, Lam KC: A. Fee Schedule (MPFS) national T. Still University, Mesa, AZ payment amount. The MPFS online

database was utilized to determine Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 the non-facility (i.e., non-hospital) Context: Data regarding the treatment price for each CPT code. Codes were characteristics and estimated direct priced in accordance with the costs of care (DCC) for athletic number of units recordedand the training services (ATS) provided DCC for each EOC were estimated. outside of the Centers for Medicare Results: The most frequent region and Medicaid Services (CMS) system ofupper extremity injury was the are limited. To appropriately value ATS shoulder (43.4%) followed by the occurring in traditional practice wrist (12.1%). Sprain/strain of hand/ settings, it is important to describe the finger (ICD9: 842.10) was the most treatment characteristics and frequent UED diagnosis overall estimated DCC for ATS as if those (12.5%). Subluxation/dislocation services were reimbursed by CMS. (ICD9: 831.00) was the most Objective: Describe treatment common shoulderdiagnosis (14.5% characteristics and estimated DCC for of all shoulder injuries) and sprain/ ATS for upper extremity disorders strain (ICD9: 842.00) was the most (UED). Design: A retrospective common wrist diagnosis (53.0% of analysis of electronic medical records. all wrist injuries). The most Setting: Athletic Training Practice- frequently utilized treatments were Based Research Network (AT-PBRN). hot or cold pack [CPT 97010 Patients or Other Participants: (33.0%)], therapeutic exercise Medical records of 951 patients [CPT97110 (21.9%)], manual (male=648, female=303, age= therapy [CPT 97140 (8.3%)], 17.1±2.0 yrs, height=171.7±12.0 cm, electrical stimulation [CPT mass=71.7±16.1 kg) diagnosed with an 97032(6.8%)], and ultrasound [CPT UED by an athletic trainer (AT) 97035 (5.9%)]. The average duration within the AT-PBRN. Interventions: of care was12.0±30.4 days and the Medical records of patients who average number of EOC’s was received ATS between October 2009- 2.71±3.7 per UED. The average October 2012 from 65 clinical number of treatments provided per practice sites within the AT-PBRN EOC was 1.94±1.01. The average were reviewed. All medical records total cost of carewas $188.34 were created by an AT utilizing a web- ±316.67 per UED and the average based electronic medical record cost per EOC was $67.52 (EMR). Each UED was defined as a ±33.30.Conclusions: These data unique case and identified utilizing provide important information about UED-specific diagnostic codes the treatmentcharacteristics and (ICD-9). Main Outcome estimated DCC for ATS provided Measures: Summary statistics were outside of the CMS system. calculated for patient and UED Thesedata speak to the value of ATS demographics. Treatment character- and potential cost savings to the

Journal of Athletic Training S-99 Free Communications, Oral Presentations: Concussion Education and Policy Thursday, June 27, 2013, 3:00PM-5:00PM; Palm C; Moderator: Tricia Kasamatsu, MA, ATC 13096FOSP 13144MOSP

Changes In Athlete Self- of HRQOL in pediatric patients. Lower The Relationship Between The Reported Symptomatology scores indicate lower HRQOL. A Time In Each Step Within A Over Time Following Sport- generalized estimating equations Return To Play Guideline For Related Concussion: Are We approach was used to assess change Sports-Related Concussion Overly Optimistic? over time. Bonferroni-adjusted Among High School Student- Bay RC, Valovich McLeod TC: A.T. comparisons evaluated pairwise Athletes Still University, Mesa, AZ differences (p<.05, two-tailed). Shimizu A, Furutani T, Kocher M, Results: 147 athletes completed the Wahl T, Oshiro RS, Tamura K, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: The decision to return an SCAT2 symptom evaluation at BL, D0, Murata N: Department of athlete to play following concussion D3, D10 and D30. A subset of these Kinesiology and Rehabilitation relies, in large part, on athlete self- athletes (n=121, 82%) completed the Science, University of Hawaii at report of symptomatology. Current PedsQL and MFS at BL, D3, D10 and Manoa, Honolulu, HI, and State of guidelines suggest that athletes should D30. The TSS and TSE both showed Hawaii Department of Education, never return-to-play following significant increases from BL (TSS: Honolulu, HI concussion if they have ANY 9.5±12.5; TSE:4.4±4.8) at D0 (TSS: symptoms. Objective: To assess 27.2±20.6, TSE: 10.7±5.8 and D3 Context: Assessment and manage- changes in high school athlete self- (TSS: 17.4±19.3, TSE: 7.5±6.5), ment in sport related concussion has reported symptoms and health-related p<0.001. Average scores for both been studied from various aspects. quality of life (HRQOL), following a returned to BL by D10, p=1.0. Current research demonstrated the concussion. Design: Cohort. However, at D30, both were importance of creating a return to play Setting: High school athletic training significantly lower (TSS: 2.6±4.5, guideline for concussed athletes to facilities. Patients or Other TSE: 1.8±3.1) than BL, p<0.001. A return to play in the safest manner. Participants: A convenience sample similar pattern was noted for the Objective: To investigate the of 147 adolescent athletes (118 males, PedsQL and MFS scales: Scores were relationship between the numbers of 29 females, age=16.0±1.1; grade= lower at D3 than BL (p<0.001), but days from concussion onset to full 9.4±1.0) who suffered a sport-related exceeded BL at D10 and D30, return to sports participation using the concussion diagnosed by an athletic p<0.001. Conclusions: Athlete self- State of Hawaii return to play (RTP) trainer. Interventions: The report of symptomatology must be protocol among high school student- independent variable was time since considered in making a return-to-play athletes. Design: Retrospective case concussion. Participants completed decision; however, concussion review of concussions reported the Sport Concussion Assessment management models may offer a between 2010 and 2012. Setting: The Tool-2 (SCAT2) symptom evaluation perverse incentive; they may lead State of Hawaii has implemented a during a pre-season baseline (BL), at to unintended and undesirable comprehensive RTP protocol that Day of Injury (D0), Day 3 (D3), Day consequences. Concussed athletes know tracks step wise cognitive rest periods 10 (D10) and Day 30 (D30) post- they must be “symptom-free” to return- and physical exertion periods of injury. Two measures of HRQOL, the to-play. Our data suggest that athletes concussion recovery. Certified Pediatric Quality of Life Inventory report significantly fewer and less athletic trainers from 64 high schools (PedsQL) and Multidimensional severe symptoms at D30 than at BL. in the State of Hawaii participated in Fatigue Scale (MFS) were completed Likewise, by D10, their HRQOL the Concussion Management Program. at BL, D3, D10 and D30. Main significantly exceeds BL. We suspect They were instructed to complete a Outcome Measures: Dependent that concussion does not decrease concussion log for each concussed variables included scores from the symptomatology or increase HRQOL athlete. Participants: De-identified SCAT2 symptom scale, PedsQL Total from baseline measures a few days post- data from 375 were concussions and MFS General Fatigue subscale. concussion. Alternatively, self-report of accurately reported with patients Two summary scores were calculated both may be overly optimistic and completing the RTP protocol during from the 22-item SCAT2 symptom driven by the desire to return-to-play. 2010-2012. 229 male (mean age ± SD scale: Total Symptom Score (TSS) and Funded by a grant from the National = 15.56 ± 1.18) and 138 females Total Symptoms Endorsed (TSE). Operating Committee on Standards (mean age ± SD = 15.29 ± 1.16) were Lower scores indicate lower symptom for Athletic Equipment (NOCSAE). included. Interventions: The severity (TSS) and fewer endorsed completion date of each step was symptoms (TSE). The PedsQL and recorded as follows: Step 1 = MFS are valid and reliable measures cognitive rest, Step 2 = return to

S-100 Volume 48 • Number 3 (Supplement) May 2013 13295SCS school full time, Step 3 = Light Return To Play Progression Tasks were changed every 30 to 60 exercise, Step 4 = Running, Step 5 = Following Concussion Using seconds, depending on fitness level and Non-contact drills, Step 6 = Full Standardized Exercise And exertion, and a two minute rest was contact practice, and Step 7 = no Intensity given between each circuit. Exercise restrictions. Each step was separated Lake AW, Cruickshank JA, Brooks intensity for phase three was kept by at least a 24 hour period. Main KL: Cleveland Clinic, Cleveland, between 11 and 14 on the RPE scale. Outcome Measures: Correlation OH Phase four also used four exercise analysis and multiple regression circuits with the addition of change of analysis were conducted to analyze the Background: This case series follows direction and plyometric tasks to the relationship among the steps in the components of the phase three nine high school football players Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 protocol. Days between each step and through a return to play progression circuits. Exercise intensity for phase the total days each concussed athlete following a concussion. The athletes’ four fell between 14 and 18 on the spent to complete the protocol served average age was 16.22 years and RPE scale. Phase four also included as the primary outcome measures. average grade in school was 10.89, non-contact sports specific drills as Results: Days between Step 2 and 3 average height and weight were 70.97 part of practice following completion had the strongest correlation with the inches and 201.11 pounds of the exercise circuits. Phase five total days missed in the protocol (p < respectively. Six athletes were consisted of a full-contact practice 0.01, r = 0.84). With multiple followed after their first documented and phase six entailed participation in regression analysis, the time between concussion. Three had at least one a game. Results: The average amount Step 2 and 3 remained significant previous concussive injury with the of time for return to play for athletes predictor of the total days missed (R most recent for each occurring during without previous concussion was 22 square = 0.70). Conclusions: 70% of the previous football season. Six days (range 15 to 29). For those with the total days missed in the protocol injuries occurred in practice and three previous history of concussion this were accounted for the days between during game play. All athletes were was 21.33 days (range 17 to 23). Step 2 and 3. In other words, the longer evaluated by an athletic trainer or Overall the time elapsed between the the concussed athlete took to complete physician within 24 hours and concussion incident and initiation of the light exercise phase without any determined to have sustained a exercise was on average 11.67 days reoccurring symptoms, the more concussion. Treatment: The athletes (range 5 to 16). For the athletes with severe the concussion was. Possible participated in a six phase return to previous concussion this was 13.33 reasons for the concussed athletes play progression where phase one days (range 8 to 16), and for those whose Step 2 to 3 were prolonged consisted of rest, resolution of without history of concussion this was might be due to two reasons: Their symptoms, a full day of school without 10.83 days (range 5 to14). For athletes cognitive rest period was too short, and the return of symptoms and without history of concussion phases no formal school accommodations neurocognitive testing showing two, three, four, and five occurred at plans administered. Future studies recovery. Phases two through four 10.83, 14, 16.5, and 18.17 days should investigate the symptoms and consisted of exercise controlled for respectively. For the athletes with neurocognitive scores reported during activity and intensity level. Exercise previous history of concussion those each step of the RTP protocol. Also, intensity was monitored using the Borg averages were 13.33, 15, 17, and 18.67 the effect of implementing school Rating of Perceived Exertion Scale days respectively. Average time accommodations to recover from (RPE) and/or heart rate monitoring. elapsed between the initiation of concussion should be investigated. Criterion for progression to each new exercise and full return to game play step of these phases was remaining for all athletes was 10.78 days (range asymptomatic before, during and after 7 to 16). For athletes without previous exercise, monitored with a graded concussion this was 11.17 days (range symptom checklist, and at least 24 7 to 16) and 10 days (range 8 to13) hours between steps. In phase two of for those with a previous concussion the program, athletes completed 15 history. Uniqueness: This case is minutes of stationary cycling at an unique in that exercise and intensity intensity of 8 to 11 on the RPE scale. were controlled and standardized using In phase three, athletes completed four the RPE scale and/or heart rate exercise circuits alternating monitoring during each phase of the cardiovascular stress with upper body, return to play progression. lower body, core, and balance activity.

Journal of Athletic Training S-101 13084MOSP

Conclusions: Certified Athletic Self-Reported Concussion type, presence of football) Trainers were able to successfully Management Practices Among demographic predicted the use of return multiple athletes to high school Secondary School Athletic baseline or follow-up assessments and football utilizing a return to play Trainers whether the AT clears athletes to progression that controlled for both Weber ML, Mayfield RM, McCarty return-to-play. Results: The majority exercise type and level of exertion CW, Parsons JT, Valovich McLeod of ATs indicated they had a written throughout the return to play process. TC: A.T. Still University, Mesa, AZ concussion policy (82.4%, n=701) and standing orders approved by their Context: The evaluation of sport- directing physician (67.3%, n=573). Baseline testing was used by 75.1% related concussion by athletic trainers Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (AT) is essential in ensuring proper (n=639), with the majority using management and safely returning an computerized neurocognitive tests athlete to play. Current (71.2%, n=606) and fewer using recommendations suggest a written balance assessments (9.2%, n=78) and policy and multifaceted approach to a symptom scale (11.4%, n=97). assessment and management Follow-up concussion testing was constitute best practices, however it is employed by 81.8% (n=696) with unclear how secondary school ATs are computerized neurocognitive testing practicing. Objective: To describe the being employed by 68.5% (n=583), concussion management practices balance testing by 23.5% (n=200), among secondary school ATs. Design: symptom scales by 35.5% (n=302) Cross-sectional design. Setting: Self- and sideline assessments (eg. SCAT2) reported online survey. Patients or by 40.5% (n=345). Approximately Other Participants: 851 clinicians 70% (n=603) of ATs indicated they (25.9% response rate) from a clear athletes following return-to-play convenience sample of ATs that were protocols. The regression analyses currently practicing in the secondary found that years of certification school setting (308 males, 376 (p=.049) and type of secondary school females, 167 missing, age= 37.9 (p=.033) predicted the use of baseline ±22.3). Interventions: Participants testing with ATs practicing 3-5 years were solicited via email to complete more likely to baseline test compared the Athletic Trainers’ Beliefs, to those practicing less than 2 years Attitudes, and Knowledge of and public charter school affiliation Pediatric Athletes with Concussions more likely to test than public schools. (BAKPAC-AT) survey. The BAKPAC- There were no significant predictors AT consisted of several multipart of follow-up testing. Conclusions: questions to assess ATs’ current Most ATs surveyed were engaged in concussion management practices management protocol involving regarding policy, standing orders, baseline and follow-up testing. In both baseline and follow-up testing and instances, neurocognitive testing was clearing athletes to return-to-play. most often utilized. Ideally, a Main Outcome Measures: The multifaceted approach that also dependent variables were participants’ includes balance testing and symptom responses to the concussion assessment should all be administered management questions. Descriptive at baseline and follow-up. statics were used to evaluate the use Demographic information regarding and types of baseline and follow up years certified and location of practice assessment tools. Separate forward can aid educational efforts to ensure stepwise binary logistic regression all ATs are using best practices analyses (p<.05) were used to in concussion management. determine whether any personal (years certified, experience in secondary school setting) or school (enrollment,

S-102 Volume 48 • Number 3 (Supplement) May 2013 13142OOSP

Comparison Of Concussion 12. Interventions: Two different ImPACT. The two testing batteries used Management Programs On neurocognitive tests used in a CMP in this study are just one part of Return To Participation were compared: 19 schools utilized the multifaceted nature of RTP Outcomes Of Concussed High the Immediate Post-Concussion decision-making within a School Student-Athletes During Assessment and Cognitive Testing comprehensive CMP. Thus, utilizing 2011-12 (ImPACT) and 21 schools utilized additional clinical examinations is Kanaoka T, Goeckeritz LM, Uyeno Standard Assessment of Concussion vital to prevent the premature release RK, Oshiro RS, Furutani TM, Wahl (SAC). Main Outcome Measures: of concussed student-athletes. TP, Kocher MH, Murata NM: State The difference in means between two of Hawaii Department of different neurocognitive tests used in Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Education, University of Hawaii the CMP (ImPACT n=225, SAC Honolulu Community College, n=165) were compared using an Honolulu, HI, and Department of independent samples t-test. Days of Kinesiology and Rehabilitation restricted participation post- Science, University of Hawaii at concussion and duration of the GRPP Manoa, Honolulu, HI until return to unrestricted participation, mean, standard deviation (SD), and 95% confidence intervals Context: A multifaceted approach for (CI) were reported. The duration of the the management of sport-related GRPP was defined as the number of concussion that includes a clinical days of the rehabilitation period, examination, graded symptom check starting from light aerobic exercise to list, postural stability testing, full-contact practice. The GRPP neurocognitive testing, and a Gradual consisted of five steps, each separated Return to Play Protocol (GRPP) has by a minimum of 24 hours. Results: A been recommended by several significant (F1=2.865, p=.033) concussion consensus statements and difference was found between position papers. Healthcare restricted participation post- professionals caring for concussed concussion for ImPACT=26.25±18.99 student-athletes across the United (CI= 23.76 – 28.75) days compared States may not be following these to SAC=22.50±14.17 (CI= 20.32 – guidelines and therefore allowing 24.67) days. No significant (F1=.728, student-athletes to return to p=.870) difference was found for the participation (RTP) prematurely. average duration of the GRPP Objective: To investigate how the incorporating ImPACT=10.30±7.06 duration of RTP and GRPP for (CI=9.38 – 11.25) days compared to concussed high school student- SAC=10.18±7.37 (CI=9.05 – 11.31) athletes was influenced by the type of days. Conclusions: The duration of Concussion Management Program GRPP for concussed student-athletes (CMP), which incorporated two was not significantly different; different neuropsychological testing however, the days of restricted batteries for RTP decision-making. participation post-concussion was Design: Retrospective cross- significantly different when using the sectional investigation. Setting: Two two different neurocognitive testing different neurocognitive tests were batteries (SAC or ImPACT) within the utilized within the CMP of 37 public CMPs. The schools that utilized high schools and 3 private high schools ImPACT in the CMP had a significantly in the State of Hawaii. Patients or longer number of days restricted than Other Participants: Concussed the schools that utilized SAC in the student-athletes (n=390, between the CMP. This result indicates a more ages of 13 to 18) received baseline and conservative approach to RTP post-concussion neurocognitive decision-making by Athletic Trainers testing during school year (SY) 2011- who utilized the CMP incorporating

Journal of Athletic Training S-103 13136UOSP 13446FOSP

Concussion Management the military, sport-related concussion, An Investigation Of Concussion Protocols In The Military And management protocols, duties of Education Content And The Role Of The Athletic healthcare professionals and athletic Effectiveness Trainer: A Systematic Review trainers. Data Extraction: Full-text Hildenbrand KJ, Pietz KM; Bergens BL-F, Kasamatsu TM, of 22 articles was reviewed, we Washington State University, Cleary MA: Athletic Training summarized major findings in a Pullman, WA Education Program, Chapman spreadsheet and scored each article on University, Orange, CA the Strength of Recommendation Context: Since 2009, both Taxonomy (SORT) or if the article Washington and Idaho have enacted contained human subjects we scored

Context: Athletic trainers are on the concussion laws requiring formal Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 forefront of managing mild traumatic it using the Physiotherapy Evidence education of athletes and coaches. Our brain injury or concussions in the Database (PEDro) scale. Data primary focus was to determine the physically active population. Synthesis: Data were synthesized by effectiveness of currently provided However, in the various military categorizing the SORT levels of education methods regarding settings, other health care evidence and summing the frequency concussion knowledge within professionals tend to fill the role of of each level of evidence (1 through Washington and Idaho high schools (9th concussion management. Incidence 3). We found that 86.4% (19/22) of -12th grade). Objective: The proposed rates are increasing in theaters the articles were not human subjects project is designed to identify and (combat) such as Operation Iraqi and were scored as SORT Levels of assess effectiveness of the variety of Freedom and Operation Enduring Evidence 3 and 13.6% (3/22) were concussion education instructional Freedom largely due to increased scored 2. For the 22.7% (5/22) of delivery methods currently used. symptom awareness and increased use articles that included human subjects, Design: The study used content of improvised explosive devices. the PEDro score was 5±0 points. analysis to understand existing Many of the concussion management Conclusions: The military education methods, including protocols in the military have been recognizes the importance of comparisons between the content of developed from sport-related concussion management and the various identified methods. A pre- concussion research, with one implements current research into survey was administered to both difference being the small number of their management protocols. The coaches and student athletes prior to athletic trainers working with soldiers Military Acute Concussion dissemination of the current in garrison (domestic base). Evaluation was adapted from the concussion education program utilized Objective: To critically analyze the Standardized Assessment of by each school. Following the athletic concussion management protocols of Concussions and is used to diagnose season a post-survey was conducted to the military and determine the and help guide a safe return to duty. assess retention of knowledge. potential role athletic trainers could Neuropsychological batteries such as Setting: Surveys were administered in fulfill while working in this emerging ImPACT have been validated and a classroom or gymnasium location practice setting. Data Sources: A implemented in garrison and in during both the pre-education survey computerized search for relevant theater. As opposed to in garrison, and post-season survey. Patients or articles was performed using the concussion management in theater is Other Participants: Participants databases PubMed, Military and complicated by access to medical were high school football and girls’ Government Collection, SPORT resources, remote locations, and soccer athletes and coaches from Discus, and Health Source: Nursing/ duration of missions. Athletic Washington and Idaho. The schools Academic edition from 2000-2012. trainers’ understanding of were selected based on proximity to The search was conducted using the concussion management and the area, availability of an athletic keywords: concussion management coordination with military personnel trainer at the location and various and military, sport concussion may positively impact the soldier’s alumni connections. Fourteen high epidemiology, sport-related standard of care upon return from schools participated, including 14 concussion, and WARCAT. Limits theater. Concussion management in football programs and 6 soccer teams. were: published in peer reviewed garrison needs continued Interventions: Surveys were journals, full text available, English, investigation and development which administered in a paper and pencil and humans. Study Selection: may be where athletic trainers can format by an athletic trainer or coach. Articles were selected by reading the make the greatest contribution. The survey was based on a combination abstract, scanning headings and titles of multiple existing surveys regarding for relevance to concussion injuries in concussion knowledge. The survey

S-104 Volume 48 • Number 3 (Supplement) May 2013 13059FOSP was used to examine the currently A Content Analysis Of Trends In states mandate AT training and 4(7.8%) provided program from each school. State Sport Concussion physician training. Thirty-four Main Outcome Measures: There Management Legislation (62.7%) require signed informed were several outcomes in this study Parsons JT, Mayfield RM, Valovich consent before participation. Patient including (a) identify concussion McLeod TC: A.T. Still University, management cluster: All (n=40; education methods utilized to meet Mesa, AZ 100%) require removal from play if requirements of the concussion laws, concussion is suspected, but only (b) detail current curriculum and Context: Since 2009, 40 states have 14(27.5%) prohibit same-day return; conduct a literature search to passed sport-concussion management no states require baseline determine optimal instructional neurocognitive testing, but 2(3.9%) (SCM) legislation. With the exception Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 delivery, (c) statistically compare the of NFL influence, most statutes require it post-injury. Provider impact of methods of education, and reflect the nuances of local state decision-making authority cluster: (d) disseminate information politics. Therefore, little is known All (n=40; 100%) require clearance concerning optimal concussion about the collective management before RTP, and 9(17.6%) restrict education interventions and methods. trends emerging from these initiatives, clearance authority to physicians; Results: The content analysis is on- nor is there a complete understanding 17(33.3%) give clearance authority going as fall sports seasons are of the impact of these statutes on to undefined “licensed health care concluding. Initial results of pre- athletic training (AT) practice. providers”, while 28(54.9%) require season surveys demonstrate that Objective: To identify the components the provider to have “training student athletes still struggle with of state SCM legislation and the in concussion evaluation and basic concussion application frequency with which they are management”; the most commonly questions. Most students answered implemented. Design: A descriptive, authorized providers are physicians incorrectly that LOC must occur for a content analytic study. Setting: Text (n=40; 100%), ATs and physician concussion to be present. Athletes of approved state SCM statutes. assistants (n=11; 21.6%), nurse also struggled to answer correctly Patients or Other Participants: The practitioners (n=10; 19.6%) when an athlete should be removed text of all enacted state SCM statutes and neuropsychologists (n =7; 13.7%). from play, or allowed to return based was secured from state legislative Return to play cluster: Only 5(9.8%) on initial symptoms. This survey was websites. When necessary, secondary and 8(15.7%) mention, but do before the education program was policy documents created by other not mandate, academic accommo- administered, so results will need to stated agencies and referred to by SCM dation or graduated return-to-activity, be compared to post education statutes were secured. Data respectively. Liability protections surveys. Once the content analysis is Collection and Analysis: All texts cluster: 8(15.7%) provide immunity to complete comparing pre and post were subjected to an inductive content schools, 7(13.7%) to school season surveys, results will determine analytic process based on an employees, and 9 (17.6%) to areas of weakness in currently established coding scheme. This volunteer providers. Conclusions: delivered concussion knowledge produced 39 variables in six clusters This study reveals the rapidly among coaches and student athletes. representing key statutory emerging policy trends in SCM. Conclusions: Through assessing components: 1) descriptives, 2) It finds an inconsistent, and sometimes effectiveness of current concussion education, 3) patient management, 4) inefficient, national legal framework. education programs in Washington and provider decision-making authority, 5) It also demonstrates a contradictory Idaho, awareness of gaps in knowledge return-to-play (RTP) procedures, and legal standing for ATs who and delivery methods is exposed. 6) liability protections. The lead are frequently authorized to make Results allow for development of an author completed all coding, following clearance decision, but who effective concussion education model a coding scheme approved by an expert are sometimes required to receive to be established and promoted panel, which also resolved coding remedial concussion education statewide . problems. Results: Descriptives: and training. Future research Thirty-nine states and D.C. (n=40; must incorporate regulatory and 78.4%) passed SCM statutes; five scope of practice analysis to (9.8%) are pending; 6(11.8%) have more accurately account for none. Education variable cluster: All provider clearance authorization. (n=40; 100%) require distribution of concussion education, but only 24(47.1%) require focused training for coaches; surprisingly, 8(15.7%)

Journal of Athletic Training S-105 Free Communications, Oral Presentations: Patient Related Outcome, Correlation to Clinical or Lab Measures Tuesday, June 25, 2013, 8:00AM-9:15AM; Palm D; Moderator: 13F01MONE A Comparison Of Self-Reported percentage of limb length (cm) of the function compared to patients with Disability And Dynamic Postural participant (%MAXD). Scores on the CAI. This project was supported by a Control Between Patients With FAAM and FAAM-Sport are NATAREF Osternig Masters Grant. Chronic Ankle Instability, Ankle represented as a percentage. Group Copers, And Healthy Controls means and standard deviations of the Boley HA, Carey SE, Rullestad A-SEBT trials, FAAM, and FAAM- EA, Terada M, Quinlevan ME, Sport were used for analysis. Separate Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Gribble PA: University of Toledo, one-way ANOVA’s were used to Toledo, OH compare the group means and standard deviations of the A-SEBT, FAAM, and Context: Diminished dynamic postural FAAM-Sport. A Tukey’s post-hoc test control assessed by the star excursion was applied in the event of statistical balance test (SEBT) and decreased significance. Pearson product moment self-reported function assessed by the correlations were used to determine Foot and Ankle Ability Measure the relationship among dependent (FAAM) and FAAM-sport has been variables. Significance was set a priori demonstrated in individuals with at P<.05. Results: Significant group chronic ankle instability (CAI) differences were observed for compared to healthy controls. %MAXD (F2,29=11.03, P<0.01), However, limited comparisons have FAAM (F2,29=25.18, P<0.01), and been made between CAI patients and FAAM-sport (F2,29=24.62, P<0.01) ankle sprain copers who have sprained scores. For %MAXD, CAI patients their ankles but did not develop CAI. (CAI=58.80%±6.05) performed Additionally, it is unclear if there is a worse than copers (67.79%±4.73, correlation between the SEBT and P<0.001) and controls (67.22%±2.47, FAAM measures. Understanding the P=0.03). For the FAAM, CAI scores differences between these measures (87.16%±5.61) were lower than among these groups may provide copers (97.77%±2.39, P<0.001) and insight into the consequence and controls (98.66%±3.78, P<0.001). interventions for CAI. Objective: To For the FAAM-Sport, CAI scores compare SEBT performance, and self- (74.63%±8.17) were lower than reported disability among individuals copers (93.08%±7.27, P<0.001) and with CAI, copers, and healthy controls; controls (97.65%±6.62, P<0.001). and to determine if there is a %MAXD was significantly and correlation between the selected moderately correlated with the FAAM outcome measures. Design: Case- (r=0.50, P<0.01) and FAAM-sport control study. Setting: Research (r=0.44, P<0.01). Conclusion: laboratory. Patients or Other Participants with CAI demonstrated Participants: Fourteen ankle coper decreased dynamic postural control on participants (7M,7F; 20.2±1.9yrs; the A-SEBT and increased self- 168.7±9.5cm; 70.3±13.3kg), 9 reported disability compared to copers participants with CAI (4M,5F; 20.7 and healthy controls. Furthermore, we ±2.2yrs; 170.5±9.9cm; 76.1±15.6kg), observed a moderate correlation and 8 healthy control participants (8F; between self-reported disability 20.6±1.1yrs; 162.9±4.1cm; 59.0± measures and anterior reach of the 6.8kg) volunteered. Interventions: SEBT, suggesting that participants with Participants completed the FAAM and lower perceived ankle function may FAAM-sport, and performed the exhibit less dynamic postural control. anterior reach of the SEBT (A-SEBT). Future research should identify the Main Outcomes: Three trials of the A- mechanism by which copers are able SEBT (cm) were reported as a to retain these higher levels of

Journal of Athletic Training S-105 13418MONE 13309UONE Correlation Between Plantar ranging from 1.65-6.65. Participants Relationship Between Cutaneous Sensation And Self- also completed self-reported Functional Hop Tests And Reported Health In Individuals measures of health including the Foot Patient-Orientated Outcomes With Chronic Ankle Instability and Ankle Ability Measure-Sport After Anterior Cruciate Powden CJ, Houston MN, Powell (FAAM-Sport), Tampa Scale of Ligament Reconstruction MP, Hoch MC: Old Dominion Kinesiophobia-11 (TSK-11), and Veasley SJ, Martinez JC, Bell University, Norfolk, VA Disablement in the Physically Active DR, Pennuto AP, Meyer J, Scale (DPA). The self-reported Rubino T, Soontararak M, Trojian Context: Individuals with chronic number of previous ankle sprains TH, Joseph MF, DiStefano LJ: (PAS) and episodes of giving way ankle instability (CAI) have University of Connecticut, Storrs, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 demonstrated decreased sensation on (EGW) in the past three months were CT, and University of Wisconsin, the plantar aspect of the foot compared also recorded. Main Outcome Madison, WI to healthy individuals. It is unclear if Measures: Lower SWM detection this sensory deficit is related to thresholds represented greater Context: Individuals following an decrements in self-reported measures sensitivity while higher FAAM-Sport, anterior cruciate ligament (ACL) of health or the injury characteristics lower TSK-11, and lower DPA scores reconstruction have a high risk of re- often used to quantify the magnitude represented greater levels of self- injury and problems with activities of of CAI. Objective: To determine if reported health. Five separate Pearson daily living. Functional performance plantar cutaneous sensation is Product Moment correlations (r) were measures, such as the unilateral single- correlated to self-reported measures performed and squared (r2) to hop test, are frequently used in return- of health or injury characteristics in determine the relationship between to-play decisions after ACL individuals with CAI. Design: plantar cutaneous sensation and reconstructions. Minimal research has Correlational investigation. Setting: measures of self-reported health, PAS, been done to evaluate if hop tests are Laboratory. Participants or other and EGW. Descriptive statistics were related to an individual’s pain and Participants: Ten participants with CAI reported as mean±standard deviation. ability to perform normal activities of (2 male, 8 female, age=22.5±2.9years, Alpha level was set a priori at p<0.05 daily living. Objective: To evaluate if height=171.6±10.1cm, weight= 71.4 for all analyses. Results: There was a unilateral single-hop and triple-hop ±13.2kg) were included. Inclusion significant correlation between SWM tests are associated with patient- criteria consisted of a history of one detection threshold (4.3±0.2) and PAS oriented outcomes and if the hop tests or more ankle sprains, two or more (5.9±4.1,r=0.66,r2=0.44,p=0.03). can discriminate between injured and episodes of giving way in the previous There were no significant correlations uninjured limbs. Design: Case Series three months, and answering “yes” to between SWM detection threshold and Setting: Laboratory Patients or five or more questions on the Ankle the TSK-11 (18.8±4.9, r=0.50, Other Participants: 52 participants Instability Instrument. Interventions: r2=0.25,p=0.14), the DPA (13.6±5.5, (14 males, 38 females, age: 21±3, Participants reported to the laboratory r=0.34,r2=0.12,p=0.33), the FAAM- height: 170.9±7.0 cm, mass: for a single session. Sensation was Sport (24.3±14.6, r=-0.13, r2= 0.02, 71.5±11.9 kg) with a history of at least assessed using Semmes-Weinstein p=0.72), or EGW (8.1±8.1, r=-0.35, one ACL reconstruction and currently Monofilaments (SWM) on three sites r2=0.12,p=0.32). Conclusions: without any physical activity of the plantar surface (heel, base of the Individuals with CAI reporting a restrictions in sports that involve 5th metatarsal, head of the1st greater number of PAS exhibited cutting and landing volunteered to metatarsal). SWM were applied higher SWM detection thresholds participate. Interventions: Partici- perpendicular to the skin for 1-2 indicating decreased sensitivity. pants completed a baseline seconds. Based on the participant’s Although plantar sensation was not demographic questionnaire and the perceptual response, a heavier or significantly correlated to measures of International Knee Documentation lighter weight SWM was applied for self-reported health, SWM detection Committee (IKDC 2000) question- the subsequent stimulus. An adapted threshold did explain 25% of the naire prior to testing. Participants staircase algorithm determined the variance in TSK-11 scores. This performed two trials of the unilateral lightest weight SWM which could be suggests the relationship between single-hop for distance followed by identified, representing the detection plantar sensation and kinesiophobia the unilateral triple-hop for distance threshold. The detection threshold warrants further investigation. on both injured and uninjured limbs. from all three sites was averaged for Main Outcome Measures: The each participant and used for analysis. IKDC is a valid patient-oriented SWM are reported as an index value outcomes questionnaire to evaluate

S-106 Volume 48 • Number 3 (Supplement) May 2013 13270DOBI patients’ pain, symptoms, and function There Is No Relationship centimeters (cm) and normalized to of the knee post-surgically. The 2 trials Between Dynamic Balance And leg length (%) in each direction. A from each jump were averaged Knee Health Related Quality Of composite score (CS) for each limb together and normalized for body Life In ACL Reconstructed was also calculated by adding reach height. An asymmetry index was Patients distances in each direction and created for both hop tests (injured/ Pennuto AP, Stiffler MR, Smith dividing by three times the limb length. uninjured). Pearson correlation MD, DiStefano LJ, Martinez JC, Relationships were examined by coefficients were calculated to Bell DR: University of Wisconsin- calculating pearson correlation evaluate the relationship between hop Madison, Madison, WI, and coefficients between IKDC scores test performance (single-hop, triple- and SEBT composite scores and

University of Connecticut, Storrs, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 hop, single-hop index, triple-hop CT individual reach measurements. Paired index) and IKDC score. Paired t-tests t-tests were used to examine reach evaluated the difference between Context: Knee health related quality distances between healthy and injured and uninjured limb of life (HRQOL) is an important reconstructed limbs (P<.05). Results: performance on the hop tests. indicator of recovery after severe knee No significant relationships were Results: Neither hop test variable was injury such as rupture to the Anterior observed between IKDC score and significantly correlated with IKDC Cruciate Ligament (ACL). Clinical reach distances in the reconstructed score (Mean±SD: 84.07± 10.85) assessments of dynamic balance are limb (ANT: 81.8±20.4%, r = -0.18, (P>0.05). Both hop tests were able to often used during the rehabilitation P=0.21; PM: 89.5±14.3%, r = -0.07, detect differences between injured and process and to assist with return to P=0.61; PL: 86.4±17.3%, r = -0.03, uninjured limbs (Single-hop: sport decision making. However, the P=0.83; CS: 85.9±15.6%, r = -0.11, Injured=0.88±0.15 % Body Height relationship between dynamic balance P=0.44). However, the reconstructed (BW), Uninjured =0.92 ±0.16%BH, and knee HRQOL has not been limb did have deficits in reach distance P=0.004; Triple-hop: Injured examined. Objective: To determine if in the ANT direction (Injured: =2.61±0.59%BH, Uninjured =2.74± dynamic balance is related to knee 80.7±20.6%, Uninjured: 82.4±20.9%, 0.49%BH, P=0.02). Conclusion: HRQOL and if dynamic balance differs t = -2.5, P=0.02). All other findings Individuals after an ACL between reconstructed and healthy were not significant (P>0.05). reconstruction continue to limbs. Design: Cross-sectional. Conclusions: Deficits in dynamic demonstrate deficits in functional hop Setting: Laboratory. Patients or balance exist after ACL reconstruction. performance after they have Other Participants: Forty-nine However, there is no relationship completed rehabilitation and are patients with a history of unilateral between dynamic balance and knee participating fully in physical activity. ACL reconstruction volunteered to HRQOL in individuals with ACL However, performance on functional participate (14 males, 35 females, reconstruction. Clinical assessments hop tests does not appear to be an Height: 170.9±6.9cm, Mass: of dynamic balance may still hold effective tool to measure current knee 75.2±23.8kg, Age: 20.7±2.9yrs, promise for assisting with return to function and pain. Clinicians should Average time from surgery=45 sport but may not be a good indicator evaluate both patient-oriented months). Patients were cleared to of knee HRQOL. Additional research outcomes and functional performance. return to activity from their personal is needed to develop these physician. Interventions: Dynamic relationships. Studies should examine balance was assessed via the star these variables in reconstructed excursion balance test in three individuals at similar time frames directions: anterior (ANT), following surgery and after their return posteromedial (PM), and posterol- to activity. Supported by the UW ateral (PL). All individuals completed Sports Medicine Foundation. 4 practice and 3 recorded trials on the healthy and reconstructed limbs. Subjects were instructed to reach as far as possible whilst keeping their hands on their hips. Patients also completed a knee HRQOL questionnaire (IKDC 2000 Subjective Form). Main Outcome Measures: Reach distances were measured in

Journal of Athletic Training S-107 13264FOIN Comparison Of IKDC And responses (p< 0.05) in SANE and SANE Outcome Measures IKDC was assessed by repeated And Establishing MCID measures ANOVA (RM-ANOVA). Following Knee Injury In MCID was calculated for SANE using Active Females known IKDC MCID values as an Winterstein AP, McGuine TA, anchor. Logistic regression models Hetzel SJ, Carr KE: University of using improved status as the dependent Wisconsin-Madison, Madison, WI variable and change from baseline of SANE as the independent variable were developed. MCID for SANE at

Context: Knee injury among young Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 active females remains a pressing each time point was the value that public health issue. Clinicians are maximized the sensitivity and being called upon to pay greater specificity of the receiver operating attention to patient-oriented characteristic (ROC) curve from the outcomes to better evaluate the impact logistic model. Results: Moderate to of these knee injuries. Little agreement strong correlations were seen between exists on which outcome measures are SANE and IKDC (0.65-0.83). SANE, best and clinicians cite several barriers on average, was 2.7 (95% CI: 1.5, 3.9; to their clinical use. Single p-value < 0.001) units greater than Assessment Numerical Evaluation IKDC over all time points. At baseline (SANE) may provide meaningful (p=0.005), 3 months (p=0.010), and outcome information while lessening 12 months (p=0.031) SANE was the time burden associated with other statistically significantly higher than patientoriented knee measures. IKDC. The MCID for SANE at 6 Objective: The purposes of this study months was calculated to be 7 (sn were to determine the correlation 89.7%, spc 67.9%). The MCID for between a SANE assessment and the SANE at 12 months was calculated to 2000 International Knee be 19 (sn 87.4%, spc 72.5). Documentation Committee (IKDC) Conclusions: SANE and IKDC scores questionnaire and to determine the were strongly correlated across all minimal clinically important time points from pre-injury to 12 difference (MCID) for the SANE month follow-up. The ability to score in a population of active young calculate the MCID gives added females following knee injury from meaning to the SANE score and allows pre-injury through one year follow-up. for greater clinical application for a Design: Observational prospective range of knee injuries. Providing cohort. Setting: Data were collected clinicians with patient-oriented at a sports medicine clinic and outcome measures that can be university health service. Participants: obtained with little clinician and patient A convenience sample of 263 high burden may allow for greater school and college females (age = 17.8 acceptance and use of outcome ±1.6 years) who were diagnosed by a measures in clinical settings. physician with a knee injury that was a result of participation in sport or regular fitness activities. Interventions: Knee function was assessed using IKDC and SANE at pre- injury, by recall, at diagnosis, 3, 6, and 12 months post-injury. Main Outcome Measures: Pearson’s correlation coefficients (95%CI) were calculated to assess relationship and strength of association. Comparison of mean

S-108 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Stumped: Differential Diagnosis in Athletic Training (Case Studies) Tuesday, June 25, 2013, 9:30AM-10:45AM; Palm D; Moderator: 13035MC Morel-Lavallee Lesion In A Male use of a GameReady. An increase in location help differ MLL from a bursa High School Soccer Player the effusion presented six days later. injury. As an athletic trainer, Younger R, Mazoué C, Pollack M: Blood-tinged joint fluid was removed witnessing the shearing mechanism of University of South Carolina, and an MRI was ordered.The MRI injury and, recognizing the primary Columbia, SC revealed subtle marrow edema at the symptom of recurrent edema medial femoral condyle with no joint associated with a MLL may prevent a effusion. A large fluid collection,

Background: A male, 18 year old, high patient from progressing to surgery. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 school soccer player presented with termed a Morel-Lavellee lesion Gradual progression in exercises and edema over the VMO and joint (MLL), in the anteromedial soft return to play are needed to prevent the stiffness of the right knee. Additional tissues peripheral to the medial reoccurrence of fluid accumulation symptoms included a description of retinaculum measuring 10 cm in during conservative treatment as well feeling a ‘weight’ on the knee with a length in a crescent configuration was as after surgical removal. burning sensation when in contact with found. Surgery was performed within fabric. The patient reported a the following month. A fibrous mechanism of the right knee sliding membrane measuring 15 cm proximal/ with anterior medial contact on the distal, 8 cm medial/lateral was ground, causing a sheering force removed, the area was irrigated with between the dermal layers and bacitracin-impregnated saline, a underlying structures. The patient Wound VAC on continuous suction reported a feeling that the patella was and knee immobilizer were put in stationary in contact with the ground place. Six days later an irrigation and while the medial tibiofemoral joint debridement with the delayed primary continued. Two initial evaluations at the closure and removal of the Wound time of the MOI, by different VAC took place. The patient was given physicians found a structurally sound a Kneehab XP and remained in the knee examination and no reason to knee immobilizer for another four cease activity. The patient continued to weeks. The patient continues with play for the 4-month period before rehabilitation and treatment seeing the current primary physician. maintenance. Reappearance of Upon evaluation, the physician again symptoms have been controlled within found a structurally sound knee with the past month and progression to minimal tenderness over the return to play has begun. Uniqueness: quadriceps tendon and pes anserine MLL, is simply defined as a closed burse with edema over the VMO area. degloving injury caused by a shearing Differential Diagnosis: Differential force to the skin. Pseudocysts form diagnoses were a ruptured bursa with at the site, causing reoccurring fluid nerve damage, bone contusion, accumulation consisting of blood, quadriceps tendonitis, and pes anserine lymph, and necrotic fat. It commonly bursitis. Treatment: X-rays were occurs in the greater trochanter, lower negative and the patient was treated with back and gluteal regions due to their an injection into the pes anserine bursa greater propensity to shearing forces. of lidocaine and dexamethason. Follow It is very rare for a MLL to occur in up care instructions included the use the knee/quadriceps region. Due to the of GameReady, Voltaren creame, a separation of the dermal layers and DonJoy reaction knee brace and subcutaneous tissue from the physical therapy. During the first underlying fascia, proper healing and physical therapy session, the edema preventing reoccurrence is difficult. significantly increased. Drainage of 30 Conclusions: A MLL of the knee is a cc of serous fluid were aspirated from rare injury. Due to the infrequency, the VMO area and sclerosing agents recognition is challenging for all were injected, followed again by the health care providers. Size and

Journal of Athletic Training S-109 13115FC A Case Of Benign Paroxysmal the head of the patient to the affected be overlooked with an injury like this Positional Vertigo In A High side and placing the neck in as much because of its uniqueness and lack of School Football Athlete cervical extension as possible. The awareness in our field. Even though Snyder MM, Barry KE, Williams athletic trainer waited for the the injury is not life threatening, it is a KN, Millward MJ: Ashland nystagmus to stop then rotate the head serious condition of the inner ear and University, Ashland, OH; Ohio to the opposite side, waiting for immediate treatment is crucial to University, Athens, OH; Austin nystagmus to subside and then rotate prevent the condition from getting Peay State University, Clarksville, the athlete to their side. After two worse. TN; MedCental Health System, minutes, the patient sat up in normal Shelby, OH position. The Semont maneuver was Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 executed if the episode continued. The Background: An 18 year old male Semont maneuver was performed by high school football center turning the patient to the unaffected experienced benign paroxysmal side and putting the patient in a prone positional vertigo (BPPV) during position until the nystagmus subsides. summer football camp and through the When the nystagmus subsided the high school football season. The first patient was then forcefully thrown to episode occurred during football camp the opposite end of the table to a in the summer. The patient was supine position. This process was originally seen by his family physician repeated twice and the patient was then who diagnosed him with BPPV. Care returned to a sitting position. If neither was transferred to the athletic trainer of these treatments worked, the patient working with his high school football was not allowed to compete until team. Symptoms included severe symptoms subsided. Many times the nystagmus, nausea, migraines and Epley maneuver resolved the dizziness. Patient had a positive Dix- symptoms. However, occasionally Hallpike maneuver test. Dix-Hallpike both treatments were used and maneuver test involves moving the unsuccessful. Signs and symptoms patient from an upright position to a subsided one week after football supine position with the head at 45 concluded. He is currently degrees rotation in cervical extension. participating in football at the Torsional upbeating nystagmus collegiate level with no recurrence of indicates a positive test. Differential symptoms. Uniqueness: In about 50- Diagnosis: Concussion, tinnitus, 70% of BPPV no specific cause is central nervous system disease, found. The incidence’s of BPPV vestibular neuritis, motion sickness, occurring in males and in a population vestibular migraines, or méniére’s under 55 is rare. Mean age of patients disease No diagnostic imaging was suffering from BPPV has been performed. Treatment: BPPV was reported as 51-57.2 years. This patient diagnosed based on the patient’s had no true onset or triggers for his symptoms and positive Dix-Hallpike episodes. The onset of symptoms maneuver test. Treatments included the occurred on the bus, after a hit to the Epley maneuver and Semont maneuver. helmet, or upon standing. There were The maneuvers were performed on the days that he did not have any symptoms sidelines, the athletic training room or and days when he couldn’t function in a doctor’s office. Both treatments because the symptoms were severe. involved displacing the patients head Conclusions: A high school player in order to dislodge the otholiths experienced vertigo and was able to (calcium crystals lodged in the continue playing football. The Epley semicircular canals) to allow the and Semont maneuvers were endolymph (fluid of the inner ear) performed to treat the patient. Vertigo movement in order to establish the is believed to be an older adult illness equilibrium of the athlete. The Epley leading to the lack of knowledge in the maneuver was performed by turning athletic population. Several factors can

S-110 Volume 48 • Number 3 (Supplement) May 2013 13192SC Kienböck’s Disease In A therefore, a radial osteotomy to outcomes from surgical intervention Collegiate Softball Player: A reduce pressure on the lunate was if detected early. As the disease Case Report performed. Surgery was postponed for progresses, individuals are more Benson SB, Norte GE, Ristic S: 6 months due to the athlete’s inability susceptible to irreversible arthritic State University of New York at to control her blood glucose levels. damage, which may yield long-term New Paltz, New Paltz, NY; St. Upon clearance from her treating disability. Early detection and referral Anne’s-Belfield School, endocrinologist, pre-surgery is essential in reducing the sequelae Charlottesville, VA; University radiographs demonstrated Stage III of injury associated with Kienböck’s of Virginia, Charlottesville, VA; progression with beginning stages of disease, and its presence should be lunate collapse. At this time, a 2 mm considered in the differential Orthopedic Associates of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Dutchess County, Poughkeepsie, radial shortening osteotomy was diagnosis of individuals presenting NY performed, 7 months after the initial with increasing chronic wrist pain. orthopedic examination. The athlete Background: A 20 year-old was immobilized immediately collegiate softball pitcher presented following surgery for 6 weeks and with diffuse, intermittent pain in her underwent a subsequent 6-week bout non-dominant wrist during pre-season, of physical therapy to restore range of which she explained had occurred for motion at the wrist. She is currently 6 one year at the collegiate level and four months post surgery, and pain free with years prior. Pain varied with a full active range of motion, but has systematic progression noted during been advised to cease competitive pre-season training. The athlete noted softball due to the progressive pain on physical examination with degeneration of the disease. active wrist extension and flexion and Uniqueness: Kienböck’s disease is localized tenderness to palpation over most commonly found in male the dorsal and volar radiocarpal joint. patients ages 20-40 years, with males Symptoms appeared to be idiopathic, twice as likely to develop the disease. as the athlete denied history of trauma The etiology is unknown, but is often or known mechanism of injury. The associated with repetitive microtrauma athlete had a history of type I diabetes. and commonly found in manual Differential Diagnosis: Extensor workers. Kienböck’s disease has been tenosynovitis, scapholunate instability, reported infrequently in the adolescent lunotriquetral instability, triangular athletic population, but has been seen fibrocartilage complex tear, scaphoid in those with prior trauma or repetitive fracture, Kienböck’s disease, ganglion stress, such as weight bearing in cyst, pisiform pathology, avascular gymnastics. This case involves an necrosis of the capitate, and posterior athlete’s non-dominant wrist, with no interosseous nerve compression history of trauma, but moderate syndrome were considered. repetitive stresses from utilizing the Treatment: The athlete’s pain ipsilateral hand to catch in softball. responded positively to a conservative Additionally, the athlete had advanced regimen of bracing and strengthening stages of the disease, but did not for one year and was able to maintain demonstrate the normal progression full sport participation. Pain increased of loss of flexion and extension, nor during the following fall off-season steadily increasing pain, which made training, and she was subsequently this case particularly difficult to referred to an orthopedic hand detect promptly. Prognosis is likely specialist. Plain film radiographs and time dependent, and the delay of MRI revealed avascular necrosis of the surgical intervention due to poor lunate (Stage II Kienböck’s disease). management of her type I diabetes may Repeat radiographs following 6 weeks have contributed to the allowed of conservative management progression of the disease. (immobilization) revealed no change Conclusions: Younger patients with in bone healing, and pain persisted; Kienböck’s disease yield positive

Journal of Athletic Training S-111 13280FC Paget-Schrotter Syndrome In pressure caused by the tight rare, PSS should be considered in the A Collegiate Volleyball Player: musculature surrounding the vein. differential diagnosis for upper A Case Study Myofascial release, massage, extremity conditions. Early correct Nakajima MA, Brandt MS, stretching, and postural rehabilitation diagnosis and prompt care is crucial Johnson KM: California State to correct the rounded shoulder were to the speedy recovery of the patient. University, Long Beach, Long performed. When symptoms did not Although rare, incidence of pulmonary Beach, CA improve, athlete was seen by another embolism associated with PSS has vascular surgeon who recommended been reported in as high as 30% of the Background: A 20-year-old Division I surgical intervention. (4/18/12). cases. Athletic trainers should During surgery (5/3/12), it was noted

male volleyball player presented with familiarize themselves with the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 a swollen, discolored right arm that that subclavius and middle scalene was different TOS conditions, as well as was cold to touch before a fall pre- hypertrophied two-times the normal treatment options for each of the three season training session. He had no size, and the anterior scalene muscle conditions. For PSS, thrombolysis previous upper extremity injuries, and was three-times the normal size. followed by 1st rib resection seems to there were no family history of Therefore, subtotal resection of be the standard of care for PSS and vascular disease. The athletic trainer subclavius, anterior, and middle acute subclavian vein thrombosis. performed shoulder and upper scalene muscles were performed, extremity evaluations and no structural along with resection of the first rib on damage was noted. He then proceeded the athlete’s right side through the with clinical tests to determine axilla. Two weeks post-surgery, thoracic outlet syndrome (TOS) which athlete was given clearance to begin were positive. Differential Diagnosis: rehabilitation without restrictions. A Neurologic thoracic outlet syndrome venogram procedure was performed (nTOS); venous thoracic outlet two weeks post-surgery (5/23/12) and syndrome (vTOS) otherwise known as findings showed normal blood flow Paget-Schrotte Syndrome (PSS); restoration. The athlete was given arterial thoracic outlet syndrome clearance to begin volleyball activity (aTOS); deep vein thrombosis (DVT); once strength and range of motion was brachial plexus injury, thoracic bilaterally equal (6/6/12). Today, discogenic pain dyndrome, cervical athlete is fully recovered and discogenic pain syndrome. Treatment: participating in NCAA Division I men’s Athlete was referred to the team volleyball team. Uniqueness: physician, who ordered diagnostic Approximately 95% of the cases of images to confirm TOS. Initial TOS are called the neurologic type, in ultrasound (12/7/11) was inconclusive which the brachial plexus are for TOS. Follow-up MRI (12/13/11) compressed by surrounding tissues. and MRA (12/14/11) was performed The PSS is a venous type TOS, in which of the right shoulder, which showed the vein is obstructed causing DVT in the right subclavian vein. The spontaneous axillosubclavian vein day after the test, a thrombolysis was thrombosis. It accounts for performed (12/15/11). Athlete was approximately 3-4% of TOS. The given clearance to return to activity etiology is similar, in which both cases when spring season practice started, are seen in patients who participate in which was two weeks post procedure. excessive upper extremity activities After one week of practice, symptoms with prolonged hyperabduction and started to return in the athlete’s right external rotation of the shoulder. arm accompanied with pain (1/5/12). However, in PSS patients, the strain This time, athlete was referred to a causes microtraumatization of the vascular surgeon, who ordered another venous intima that result in local MRA (1/13/12) and a CT scan (2/27/ coagulation and formation of venous 12) of the right shoulder and the chest. thrombosis. It is not know why certain The athletic trainers worked with the individuals develop one form of TOS athlete in effort to relieve the external over another. Conclusions: Although

S-112 Volume 48 • Number 3 (Supplement) May 2013 13340SC Klippel-Feil Deformity In A High with fusion of C6-C7, unfused C7 School Football Player spinous process, pseudosubluxation at Iannetta T, Smith J: Cleveland C3-C4, C4-C5, C5-C6. A MRI was Clinic, Cleveland, OH also ordered and results were fusion of the C6-C7 vertebral bodies with a Background: This is a 16 year-old rudimentary intervening vertebral disc. defensive back playing football who The right lamina of C7 is deficient. presented to the athletic training room Partial fusion of the left C6-C7 lamina the morning following the previous and spinous process. The canal and neural foramina are widely patent from night’s football game. His chief Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 complaint was bilateral neck and C1-2 to C7-T1. The final working trapezius pain with left being greater diagnosis is that of Klippel-Feil than right. He admitted that he may have deformity. Recommendation to the sustained a “stinger” in the game while athlete and his parents was to making a tackle which he did not report discontinue football due to his to the medical staff. Physical exam by congenital fusion. This would put him the ATC demonstrated full cervical and at a greater risk for a cervical spinal shoulder active range of motion with cord injury. The athlete was then no radicular symptoms bilaterally. referred to a spine specialist who had Negative Spurlings and brachial plexus the same recommendations after test. Cervical and shoulder strength 5/ examining and reviewing the athlete’s 5. Treatment consisted of rest, ice, x-rays and MRI. Uniqueness: Brachial gentle range of motion and flexibility plexus injuries and cervical sprains and exercises. The athlete completed the strains are not uncommon in the sport remainder of the season with no of football. This athlete had a single reported reoccurrence. Upon reported incident of a possible completion of the football season, he brachial plexus injury which resolved returned to the athletic training room quickly. However, other symptoms complaining of pain at the base of his were reported after starting weight neck and a headache after performing training which necessitated further a military press and bench press during evaluation. Although, these symptoms a weight training class. He denied any could have been something as common radiating pain at this time. The athlete as cervical strain or exertional was referred for further evaluation and headache other abnormalities needed diagnostic testing. Differential to be ruled out. Klippel-Feil deformity Diagnosis: Cervical sprain, cervical is usually associated with other strain, brachial plexus lesion, cervical disorders such as defects in other facet syndrome, herniated cervical organs including the inner ear, spinal disc, concussion, exertional headache, cord, heart and genitourinary tract. Klippel-Feil deformity. Treatment: This athlete did not present with any Physician workup for concussion-like of these defects. Conclusion: This symptoms was negative. Evaluation athlete was unable to continue showed mild suboccipital tenderness, collision sports such as football due no midline cervical tenderness, and to the risk of a cervical spinal cord full cervical range of motion with pain injury. However, through rehabilitation upon flexion, left lateral side bend and to maintain his range of motion, rotation. Upper extremity strength was flexibility and strength, he was allowed 5/5 and symmetric. Reflexes were to play baseball. He had a very symmetric at biceps, triceps and successful season without any further brachioradialis. No sensory loss in the exacerbation of his condition. upper extremities. Negative Spurlings maneuver. X-rays were ordered and showed rudimentary C6-C7 disc space

Journal of Athletic Training S-113 Free Communications, Oral Presentations: Prehospital Care of the Injured Athlete Tuesday, June 25, 2013, 11:00AM-11:45AM; Palm D; Moderator: Julianne Schmidt, MA, ATC 13368MOEM 13254OOEM Facemask Removal Of (Borg Scale 0-10). Two one-way (1x4) The Effects Of Equipment Commonly Worn Lacrosse repeated measures analyses of Design On Cervical Spine Helmets variance (ANOVA) and paired samples Motion, Removal Time, And Ryan C, Paden A, Tierney RT, t-tests were used to analyze significant Difficulty During Football Bright N, Higgins M: Temple differences (p < .05) in removal time Shoulder Pad Removal University, Philadelphia, PA, and and RPE between helmet types. Bric JD, Swartz EE, Al-Darraji Towson University, Towson, MD Results: The ANOVAs revealed SJ, Decoster LC, Mihalik JP: statistically significant differences for University of New Hampshire, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: In the event of a head or neck removal time, F(3,21) = 43.22, p < Durham, NH; New Hampshire injury in equipment-laden sports, it has .001, and RPE, F(3,21) = 6.96, p = Musculoskeletal Institute, been recommended to remove the .002. The CP (63.3 sec) facemask took Manchester, NH; University of facemask rather than the entire helmet 61%, 93%, and 108% longer to remove North Carolina, Chapel Hill, NC for access to the airway. Research than the WV (39.3 sec; p = .001), CC surrounding facemask removal, (32.7 sec; p = .001), and RR (30.5 sec; Context: Football equipment designs however, has focused primarily on p = .001), respectively. The WV continue to evolve, providing better football helmets, which are facemask took 29% longer to remove protection for athletes participating in structurally different than lacrosse compared with the RR (p = .002). The collision sports, including American helmets. To date, there has been participants found the CP (3.4) to be football. Recent shoulder pad limited published research regarding 59%, 100%, and 199% more difficult equipment designs depart men’s lacrosse helmet facemask than the WV (2.1; p = .049), RR (1.7; considerably from the traditional removal. Objective: To determine the p = .022), and CC (1.1; p = .005), equipment many football athletic effect of lacrosse helmet type on respectively. There were no other trainers (ATs) are familiar with. These facemask removal time and rate of statistically significant differences evolutions may affect cervical spine perceived exertion (RPE). Design: A identified. Conclusion: The CP injury management, when ATs are single factor repeated measure design. facemask was the most time required to intervene quickly and safely Setting: Controlled laboratory consuming and difficult to remove to provide resuscitation and advanced setting. Participants: Eight certified likely due to having five removal sites cardiovascular care. Objective: To athletic trainers (male = 4, female = versus three removal sites on the compare the amount of head 4; age = 24.13 ± 2.17 yr, experience = remaining three helmets. All of the movement, time to task completion, 1.75 ± .71 yr). No exclusionary criteria facemasks, however, were and perceived difficulty during removal existed. Interventions: Each subject successfully removed well within the of traditional and quick-release participated in a familiarization four-minute time limit for removal. shoulder pads. Design: Quasi- session and testing session for each These data suggest that lacrosse experimental. Setting: Research helmet. The familiarization session facemask removal for these helmets laboratory. Patients or Other consisted of watching a video is a viable option for lacrosse athlete Participants: Forty ATs free of demonstrating the removal technique airway access. physical pathology preventing them followed by two successful facemask from completing the required tasks removals for each helmet. Within a were recruited (males=21; females week, each subject returned for a =19; age=33.7±11.2 yrs; mass= testing session in which they 80.7±17.1 kg; height= 173.1±9.2 cm; participated in a timed facemask AT experience =10.6±10.4 yrs). removal and reported the RPE Interventions: The independent afterwards. All facemasks were variable was shoulder pad design required to be removed within a four- (Traditional or Riddell RipKordTM). minute time limit to be considered After familiarization, participants successful. The independent variable working in pairs conducted 8 was helmet type (Warrior Venom successful trials in random order (WV), Cascade CPX-R (CC), Cascade whereby they removed traditional Pro7 (CP), and Riddell Revolution (using the flat torso technique) or (RR)). Main Outcome Measures: RipKordTM shoulder pads from a live The dependent variables were facemask model (4 trials of each). An eight- removal time (seconds) and RPE camera three-dimensional motion S-114 Volume 48 • Number 3 (Supplement) May 2013 13007OOEM system and two three-point segment Athletic Training Services Coaches First-aid certified(CFAC), marker sets (head and torso) were used Associated With Emergency Vacuum Splints Available(VSA), Spine to capture head motion. Total time was Preparedness & Planning In SC Board Available(SBA), Cervical Collar recorded with a digital stopwatch. The High School Athletics Available(CCA), Facemask Removal difficulty for the task by the participant Wham GS, Saunders RP, Mensch Device Available(FRDA), AED was recorded after each trial using a JW: University of South Carolina, Available(AEDA), CPR Mask modified Borg CR-10 scale. Main Columbia, SC, and Lexington Available(CPRMA), Shoulder Sling Outcome Measures: Dependent School District 1, Lexington, SC Available(SSA), Crutches Available variables included head excursion in (CA), Blood Pressure Cuff/

degrees (computed by subtracting Context: Recent research suggests Stethoscope Available(BPSA), Latex/ Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 minimum position from maximum South Carolina(SC) schools with AT nitrile Gloves Available(LNGA), Ice position) in each of the three planes services provide higher levels of Bags Available(IBA), and First-aid Kit (sagittal, frontal, transverse) during medical care; however, no research has Available(FAKA). SPSS was used to shoulder pad removal, time to task examined the relationship between AT calculate descriptive statistics and completion, and difficulty rating. services and components of multiple comparison tests. Results: Trials for each team were ensemble emergency planning/preparedness. Significant differences existed averaged. Paired-samples t-tests were Objective: To examine the between schools with AT services and employed to evaluate differences relationship between existence of AT those without AT services for the between the two levels of our services in a school and compliance following components of emergency independent variable for each with recommendations for emergency planning/preparedness: EEAP [AT dependent variable. Results: Athletic planning/preparedness identified in the 2.48(.78) and no AT 2.11(1.02),F=5.5, trainers required significantly less Appropriate Medical Care for p<.02], EAPRA [AT 1.88(1.06) and no time to remove the RipKordTM Secondary School-aged Athlete AT 1.46(1.09),F=4.27,p<.04], EAPRP shoulder pads (21.96 ± 3.08 s) than (AMCSSAA) Consensus Statement/ [AT 1.85(1.03) and no AT 1.33 traditional shoulder pads (29.22 ± 4.45 Monograph. Design: Cross-sectional (1.08),F=7.32,p<.01], VSA [AT s) in our study (t19 = 9.80; P<0.001). study. Setting: Mailed/emailed 2.13(1.05) and no AT .86(1.05), There were no significant differences survey. Participants: 63% (166/263) F=41.71,p<.0001], SBA [AT in sagittal (t19 = 1.63; P=0.119), frontal of SC high schools. Intervention(s): 1.65(1.23) and No AT .70(.93),

(t19 = 0.80; P=0.435), or transverse (t19 SC high schools were surveyed F=18.98,p<.001], CCA [AT 1.77(1.20) = 1.10; P=0.285) cervical spine regarding existence of AT and No AT 1.04(.17), F= motion resulting from shoulder pad services(independent variable) and 12.46,P<.001], FRDA [AT 2.51(.91) removal between the two designs. existence of components of and No AT 1.75(1.25),F=16.83, There were no differences in difficulty appropriate medical care related to P<.001], CPRMA [AT 2.54(.82) and No reported by the ATs in removing the emergency planning/preparedness. AT 1.41(1.17),F=44.46,P<.001], SSA two shoulder pad designs (t19 = -0.80; After pilot-testing, data were collected [AT 2.54(.82) and No AT P=0.435). Conclusions: Our data via a systematic, modified-Dillman .80(.98),F=25.57,P<.001], CA [AT suggest that the new RipKordTM design approach. Test-retest reliability was 2.59(.74) and No AT 1.54(1.23), allows ATs to remove shoulder pads strong (r=.89). Main Outcome F=41.39,P<.001], BPCSA [AT more quickly, without compromising Measure(s): AMCSSAA Monograph 2.36(1.01) and No AT 1.18(1.24), cervical spine motion or introducing recommendations related to F=35.41,P<.001], LNGA [AT 2.88(.37) additional difficulty to the task. These components of emergency planning/ and No AT 2.42(1.01), F= results can only be generalized to the preparedness were identified, 17.91,P<.001]. No significant flat torso technique of shoulder pad summarized, re-phrased as policies or differences were identified between removal at this time. Future research practices, and included as survey items. schools with AT services and schools should examine the efficacy of such Items were scored 3, 2, 1, or 0 on a 4- without AT services for: CCAC, CFAC, shoulder pad designs in allowing for point scale. Higher scores indicated EAPPF, AEDA, IIBA, and FAKA. effective access to the chest as would more favorable provision of medical Conclusions: In SC high schools, be needed in cardiovascular care. Each component served as a schools without AT services were emergencies. Incorporating these dependent variable: Existence of found to lack many components equipment advances to other sports Emergency Action Plan(EEAP), EAP required to provide appropriate should be considered. This study was Reviewed Annually(EAPRA), EAP medical care related to emergency funded by the Eastern Athletic Reviewed Post-emergency(EAPRP), planning/preparedness. These results Trainers’ Association. EAP Posted in Facilities(EAPPF), provide guidance for decision-makers Coaches CPR/AED certified(CCAC), (school administrators and

Journal of Athletic Training S-115 legislators) and those who influence decision-makers (parents and athletes) in improving medical care provided for interscholastic athletes. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

S-116 Volume 48 • Number 3 (Supplement) May 2013 Spine Evidence-Based Forum Tuesday, June 25, 2013, 12:00PM-1:00PM, Palm D; Moderator: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Journal of Athletic Training S-117 Free Communications, Oral Presentations: Emergent Conditions in Athletes (Case Study) Tuesday, June 25, 2013, 1:15PM-2:30PM; Palm D; Moderator: 13080DCS Retrospective Clinical Case relieve swelling in his brain. Coaches 1, 2011-June 30, 2012 occurred Series Of Sudden Death performed cardiopulmonary resusci- during the fall of 2011. Three of the During Physical Activity In tation (CPR) on athlete B before he four deaths occurred during offseason The Collegiate Setting: was rushed to the hospital. Athlete C or preseason conditioning sessions July 2011 – June 2012 collapsed after complaining of vision where medical staff was not present (an Adams WM, Pryor RR, Pagnotta problems and cramps. He was rushed athletic trainer was only present at the KD, Vandermark LW, Stearns RL, to the hospital with an extremely football practice of athlete A with no Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Casa DJ: Korey Stringer Institute; elevated body temperature. After medical coverage during the University of Connecticut, Storrs, athlete D collapsed, he was taken to a conditioning sessions of athletes B, C, CT local hospital where his core body and D). The health and safety of temperature was initially recorded as collegiate athletes during offseason Background: We sought to 105.9°F and peaked at 107.9°F. He was conditioning sessions should be investigate all cases of sudden death treated for exertional heat stroke once further investigated. during National Collegiate Athletic he arrived at the hospital and later Association (NCAA) sanctioned treated for multi-organ failure. sporting events from July 1, 2011-June Throughout treatment, he had to be 30, 2012. An online LexisNexis and resuscitated five times and surgeons subsequent media search resulted in had to remove his right lung. Results: four student athletes, all of whom were Athlete A died due to complications male (2 basketball players, 1 football from a traumatic brain injury. The player, and 1 baseball player; cause of death for athlete B remains Mean±SD: age=20±1y, height= 187± unknown but is speculated to be the 7cm, weight=97±15kg), who died result of cardiac arrest. Lab results while participating in their respective were positive for the chemical JWH- sport. A 22-year-old Caucasian 018 in athlete C, which is used to make Division III football player (athlete A) synthetic marijuana. He died four days collapsed during an August football after being admitted to the hospital. practice while being escorted off the Official cause of death is listed as drug field by the athletic training staff. He toxicity due to the presence of the was complaining of a headache from a synthetic chemical but it is speculated helmet-to-helmet collision. A 21- that the athlete either died of exertional year-old Division II African American sickling or exertional heat stroke. basketball player (athlete B) collapsed Three days after being admitted to the during an early September men’s hospital and treated for exertional heat basketball conditioning session and stroke and the resulting multi-organ later died at the hospital. A 19-year- failure, athlete D died due to resulting old Division III African American complications. The official cause of basketball player (athlete C) collapsed death is inconclusive but is speculated during preseason basketball practice to be from exertional heat stroke. that took place at the end of September. Uniqueness: Of the four-presented The fourth student athlete was a cases, three of the deaths occurred Division I Caucasian baseball player during conditioning sessions prior to (athlete D) who collapsed during an the start of their NCAA sport season. offseason conditioning session in late None of the deaths occurred during October, 2011 with seasonably warm game participation. Similar to previous temperatures (high of 64°F) that day. research, the majority (or all) deaths Treatment: Athlete A was being were males, conversely, the deaths evaluated by one of the school’s staff were evenly distributed between athletic trainers and upon collapse was Caucasian and African American rushed to the hospital where he athletes. Conclusions: The four cases underwent emergency surgery to of death in the NCAA level from July

S-118 Volume 48 • Number 3 (Supplement) May 2013 13056OC Sudden Collapse Of A Middle ventricle. The athlete was taken off completed and detected a mutated School Baseball Player intubation and awoke the next day. His abnormality in a gene with no known Williams SJ, Kamp A: University of repeat EKG was normal sinus rhythm correlation. It is unclear if a diagnosis Kentucky Orthopaedic Surgery and no delta wave. On the third day, the will ever be determined. and Sports Medicine and athlete experienced some delirium and University of Kentucky Department was combative. He was unable to have of Cardiology, Lexington, KY a cardiac MRI performed due to his mental status. Daily EKGs were Background: A 14 year old middle continued with no abnormalities. school baseball player with no Electroencephalography (EEG) was Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 contributory medical history suddenly performed and found to be normal. The collapsed following 30 minutes of athlete was then transferred to the drills at high school baseball Progressive Care Unit (PCU). After conditioning. He fell face first to the the cardiac MRI was performed, the ground and did not move. The athletic results were within normal limits. It trainer was called. When she arrived, was then recommended to have an the athlete had agonal breathing. epinephrine push to elicit CPVT. Carotid pulses were checked and the Cardiac catheterization was performed athletic trainer began cardiopulmonary and coronary artery origins and resuscitation (CPR). The coaches courses were normal. Endomyocardial activated the emergency action plan, biopsy results were normal and calling 911 and getting the automated adenosine administration demon- external defibrillator (AED). The strated no evidence of Wolff- athletic trainer administered CPR and Parkinson-White syndrome. Follow- used the AED during the 6 minutes ing exhaustive testing that was before paramedics arrived. The inconclusive, an implantable defibrillation detected a rhythm of cardioverter-defibrillator (ICD) was ventricular tachycardia. It is believed placed to detect any future cardiac that the patient did regain a pulse. EMS arrhythmia and to correct the arrived shortly thereafter and the arrhythmia with a shock. The athlete patient was again in ventricular was discharged from the hospital 12 tachycardia and received two more days after collapse. Uniqueness: The defibrillations. CPR administered by athlete had no personal or familial the Lewis device was continued in medical history to predispose him to progress to the emergency department a cardiac event. Allowing patients with where the patient had a pulse intact. ICDs to participate in sports has long Differential Diagnosis: Hyper- been contra-indicated. Recent trophic cardiomyopathy (HCM), research is showing that athletes with myocarditis, catechol-aminergic ICDs have no more risks during sports polymorphic ventricular tachycardia than patients who do not participate in (CPVT), drug or supplement use, moderate activities. Conclusions: A sudden cardiac arrest with 14 year old athlete’s sudden collapse indeterminate cause. Treatment: during a low intensity workout is Once at the emergency department, the uncommon. Athletic trainers should athlete continued to be in sinus understand how to first deal with a tachycardia with a good carotid pulse. sudden cardiac arrest, and also EKG performed showed evidence of understand the benefits and risks nonspecific ST and T wave changes. associated with having an athlete who His drug test was negative. He was participates in competitive sports with admitted to Pediatric Cardiology in the an ICD. Currently this athlete has Pediatric Intensive Care Unit. decided to discontinue playing Subsequent head CT was unremarkable baseball and has begun to play golf. He and echocardiogram showed no HCM is also involved in the ROTC program but a decreased filling of the left at his high school. Genetic testing was

Journal of Athletic Training S-119 13214MC Sudden Myocardial Infarction In (LAD) wall motion, resulting in a cleared to continue playing A 19-year-old Division I Football diagnosis of a myocardial infarction competitive football at the collegiate Lineman With No Prior (MI). The athlete underwent a cardiac level. Conclusions: To better prepare Indicators catheterization where a thrombus was for MI’s in young athletes, athletic Ward BL, Hanley M, Lopez R: detected in the LAD with mild left trainers should pay careful attention to East Carolina University, ventricular systolic dysfunction; this the patient’s personal and family Greenville, NC, and University of was cleared using an AngioJet device, medical histories with an anticipatory South Florida, Tampa, FL which left the athlete stable. mindset in diagnosing anomalies not Hematology was consulted for commonly attributed to this age group.

Background: In this case, a 19-year- hypercoaguability workup, and the Although return to play guidelines for Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 old African American male football athlete was found to have athletes with an MI should be player (6’7”, 326.8 lbs.) with no heterozygous Factor V Leiden individualized, it is imperative for significant previous medical history abnormality (evidence of lupus athletic trainers to be knowledgeable reported having chest pain associated anticoagulant), elevated serum of the guidelines for athletic with nausea, diaphoresis, shortness of homocysteine level, hyper- participation in order to reduce the breath, and a severe cough after a triglyceridemia, low HDL, elevated risk of arrhythmia-related morbidity winter evening workout. The initial LDL, and elevated lipoprotein. The or mortality. evaluation consisted of a standing/ athlete was hospitalized for three days. resting pulse, heart rate, and Following his initial hospital stay, the temperature. The immediate diagnosis athlete was placed on anti-coagulants was that the pain experienced was and underwent an exercise Cardiolite likely attributed to extreme physical at three months after his initial illness, exertion further aggravated by a a Multi-Gated Acquisition Scan previous upper respiratory infection. (MUGA) at five months, and was The athlete denied any family history administered a Holter Test at six of cardiac conditions. The athletic months, all of which were without trainer instructed the athlete to go to significant abnormalities. Eleven his dorm room to rest, and to call him months after the MI, the athlete had his immediately should his symptoms final hematology evaluation and the persist, or if he experienced any pain physician believed the dyslipidemia and/or numbness in his upper and homocysteinemia were resolved. extremities. The athlete’s pain The athletic training staff required a fluctuated for about four hours, after second opinion, which concurred that which he started having numbness in the athlete could return to activity with his extremities and back pain. The all appropriate risk factors and athlete subsequently drove himself to symptoms being monitored. The student health services, where he was athlete returned to competitive met by the athletic trainer and driven football and remained asymptomatic to the hospital. Differential while under increased care for the Diagnosis: Viral illness, exertional remainder of his collegiate career. sickling, hyperlipidemia, muscle Presently the athlete is doing well with strain, myocardial infarction, systemic no complications, but is still on disease. Treatment: Upon arriving at medication for his condition. the emergency room, the athlete Uniqueness: To our knowledge, there received nitroglycerin sublingually, is no other report of a young, elite which relieved his pain completely. African-American male athlete having Testing revealed the athlete had Factor V Lieden and having suffered abnormally high cardiac enzymes, an anterior ST elevation myocardial troponin’s (149.5), CK’s (3,410) and infarction. This case was unique to CK-MB (270.7). Also, the patient’s care for due to the lack of standardized EKG on admission showed ST management recommendations for elevation. A 2-D echocardiogram athletic trainers. MI’s are rare in this revealed hypokinesis (50%-55%) with age group, especially with no clear the left anterior descending artery etiology, and in an elite athlete who was

S-120 Volume 48 • Number 3 (Supplement) May 2013 13404SC Blunt Abdominal Injury In A surrounding hemorrhage. He was equipment modification and Collegiate Male Lacrosse Player admitted to the ICU at 1 am. Around 9 appropriate monitoring of signs and Sesma AR, Rooks Y: University of am, physicians met to discuss the symptoms during activity progression. Maryland, College Park, MD possibility of removing the spleen but decided to continue to monitor his A twenty year-old male Division 1 hemoglobin/hematocrit over 48-72 collegiate lacrosse player was hit in hours. After 36 hours, he was moved the abdomen by a defensive player at out of the ICU and was discharged after the beginning of practice but continued 72 hours with a stable hemodynamic status. The trauma surgeon instructed to play for 90 minutes. He reported Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 to the ATC at the end of practice that him to rest completely for 4 weeks he was having rib pain from the hit and with follow-up CT scan at 6 weeks. At some trouble breathing. On field 4 weeks he was allowed to start light assessment revealed tenderness over jogging and lifting. A CT scan at 6 the lower left ribs with no rebound weeks showed ongoing resolution of tenderness over the abdomen. Rib the hematoma. He was cleared to compression test was painful on the return to all non-contact activity left side. Upon further evaluation in the including stick drills and conditioning. athletic training room he reported An abdominal ultrasound was some pain with deep breathing and with performed at 10 weeks post injury, forceful expiration. BP and pulse were which showed that the hematoma had WNL. Kerr’s sign was inconclusive resolved completely. The athlete was secondary to labral repair surgery on allowed to return to full contact drills his left shoulder 1 year prior and and competition with a specialized reporting always feeling “achy” after protective abdominal shirt. He played practice. He was still point tender over in his first collegiate game 10 days the left 8-10th ribs and had some later and did not have any symptoms rebound tenderness over the abdomen. for the remainder of the season. Differential Diagnosis: Rib contusion, Uniqueness: There are no evidence rib fracture, liver contusion or based return-to-play guidelines laceration, spleen laceration or rupture regarding splenic injuries. A number Treatment: He was monitored in the of case reports show return-to-play in ATR for 30 minutes and symptoms as little as 3 weeks following were unchanged. He was allowed to splenectomy or 8-12 weeks following go home and he and his roommates laceration in football or hockey were instructed to call the ATC if his players but few cases involving symptoms worsened or if he lacrosse players. Some literature experienced any nausea, vomiting, suggests diagnostic ultrasound may dizziness, or increased difficulty provide a low cost and low radiation breathing. About 1 hour later, his alternative to CT for serial monitoring roommates called and said he had been of hematoma resolution. Conclusions: trying to vomit and appeared to be pale. Early recognition of abdominal The athlete spoke with the ATC and said injuries is vital. They may appear stable he felt extremely nauseous and had but symptoms can worsen in a short increased abdominal pain. He was amount of time making it imperative brought to the ER within 15 minutes. to give student-athletes and the people A chest/abdominal x-ray was negative around them detailed instructions. and discharge from the ER was Given the limited information considered, however upon an increase available regarding return-to-play in symptoms an abdominal CT scan guidelines, decisions must be made on was ordered and revealed a grade III a case-by-case basis with careful laceration of the spleen involving the collaboration by the sports medicine anterior/inferior aspect with team. Considerations include

Journal of Athletic Training S-121 13024FC Blunt Trauma Carotid Artery injury, basilar skull fracture, facial recognition of the exact mechanism of Injury Resulting In Death In A fracture, spinal fracture, seizure, injury and subsequent symptoms, Collegiate Male Lacrosse vasovagal syncope, carotid artery combined with accurate diagnosis and Player: A Case Report injury, subarachnoid hemorrhage, treatment are the key to patient Stavinski-Ciocco MM, Zawadzki- cluster headaches, migraines, horner’s survival. ATs need to be aware of carotid Brzoska A: King’s College, Wilkes- syndrome, stroke, syncope, and artery injuries and their severity which Barre, PA cervicoephalic arterial dissections. can result in death. Treatment: Referral to ER by the Background: A 19 year old male Certified Athletic Trainer (AT). A computed tomography (CT) scan of division III collegiate lacrosse athlete Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 was struck on the left lateral neck with the head was performed at the ER and a thrown lacrosse ball during practice. was read as negative. Because of the The patient had a whiplash like patient’s decreased neurological and mechanism when struck and initially mental status, and the normal reading complained that his “body went numb” of the head CT scan, a diagnosis of and he fell to the ground in a seated concussion was made. The patient was position. He was able to walk off the then released from the ER that same playing field and into the athletic evening. The patient suffered a stroke training room with the help of a the following day and was re-admitted. teammate. At that time, the patient A second CT was performed and complained of pain with swallowing, showed carotid artery dissection. The trouble with swallowing, the taste of cause of the stroke was a blood clot blood in his mouth, headache, from the dissected area. The patient dizziness, nausea, fatigue, neck pain at was taken to a trauma hospital where a the site of impact and blurred vision. stent was inserted to control the The patient’s neurological status was swelling. Increased swelling caused evaluated and his cervical dermatomes brain stem herniation resulting in and myotomes were normal at the time clinical brain death. The patient was of the exam, but the patient removed from life support five days complained of intermittent decreased post injury and died shortly thereafter. sensation in his right arm and hand. Uniqueness: The patient presented The patient had a past medical history with concussion-like signs and of concussion and post- concussion symptoms and was initially sent home syndrome, but with no current issues from the ER diagnosed with a related to this. The patient was concussion. Within 24 hours, he becoming increasingly confused as the suffered a stroke resulting from a clot evaluation continued. The patient formed from a carotid artery presented with concussion-like signs dissection. The patient’s symptoms and symptoms. He was not oriented were exacerbated to death within 1 to time and place and had memory week. Conclusions: A 19 year old male deficits, not even being able to division III lacrosse player presented recognize his teammates or coach. The with concussion-like signs and patient was sent to the Emergency symptoms after being struck in the Room (ER) and initially diagnosed with neck with a thrown lacrosse ball. Even a concussion and sent home. Within though proper referral was made in this 24 hours, the patient suffered a stroke case, blunt carotid artery injuries can and was transported back to the ER for result in death if unrecognized or further evaluation. The patient was untreated in a timely manner by further then diagnosed with a carotid artery advanced personnel. Diagnosis is often dissection. He was referred to a delayed due to a failure to suspect trauma hospital where his symptoms serious injury caused by trauma or a progressed to death within one week. delay in symptom manifestation, Differential Diagnosis: Closed head especially neurological deficits. Early

S-122 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Assessment of the Throwing Athlete Tuesday, June 25, 2013, 2:45PM-3:45PM; Palm D; Moderator: Steve Tucker, PhD, ATC 13006OODI 13456FODI Reliability And Validity Of [ICC (3,k)] for the average of three Blood Flow Of The Brachial Musculoskeletal Ultrasound For measurements representing the size Artery: A Bilateral Comparison Identification Of Humeroradial of the articular surface of two images Among Baseball Pitchers And Joint Chondral Lesions representing the same location. Intra- Position Players Lohman CM, Smith MP, Dedrick rater reliability was calculated using Selkow NM, Laudner K, Lynall R, GS, Jarman NF, Atkins LT, Brismée Cohen’s Kappa for the agreement of Meister K: Illinois State University, JM: Texas Tech University Health the presence of chondral lesions on a Normal, IL, and Texas Metroplex Sciences Center, Lubbock, TX ; single image. Validity values were Institute for Sports Medicine and The Sage Colleges, Troy, NY; calculated of sensitivity, specificity, Orthopedics, Arlington, TX Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Campbell University, Buies Creek, positive likelihood ratio (+LR) and NC negative likelihood ratio (-LR) using Context: Vascular pathologies, such the agreement of MUS images and as thoracic outlet syndrome and deep Context: Epicondylalgia is a common gross macroscopic examination. vein thrombosis, are of a growing condition with pain generating Results: The data indicated high intra- concern among baseball players, structures including tendon, neural and rater reliability for reproducing an particularly pitchers. Adaptive chondral tissue. Current non-invasive image (ICC=0.88 [95% confidence changes to the musculoskeletal reference standard for identifying interval {CI}, 0.77, 0.94]) and system overtime may increase the risk chondral lesions is Magnetic excellent agreement for evaluating a of vascular pathologies and the Resonance Imaging (MRI). single image (Kappa=0.93 [95% CI, subsequent time lost from Musculoskeletal Ultrasound (MUS) 0.80, 1.06]). Identification of chondral competition. Objective: To measure may be an inexpensive and effective lesions on all HRJ surfaces with MUS brachial artery blood flow between the alternative. Objective: Examine the displayed: sensitivity=0.93, dominant and non-dominant arm of reliability and validity of an athletic specificity=0.28, +LR=1.28 and - professional baseball pitchers and trainer utilizing MUS for LR=0.27. The low specificity and +LR position players. Design: Cross- identification of chondral lesions in demonstrated that this method may sectional. Setting: Professional the humeroradial joint (HRJ). Design: not be ideal for ruling-in a chondral baseball athletic training room. Cross-sectional study. Setting: lesion with a positive examination. Patients or Other Participants: Clinical anatomy research laboratory. However, the high sensitivity and low Twenty-six professional baseball Patients or Other Participants: -LR indicated that MUS could pitchers (Age: 21.0±1.8 years; Height: Twenty-eight embalmed cadavers accurately rule out HRJ chondral 172.5±8.3 cm; Weight: 72.6±12.0 kg) (mean age=79.5±8.5 years, 14 males). lesions with a negative examination. and 29 position players (Age: 20.4±1.8 Intervention(s): An athletic trainer These values vary with different years; Height: 169.1±8.1 cm; Weight: with two years of hands-on MUS surfaces and different grades of 67.8±11.5 kg) participated. experience but no formal MUS training chondral lesions. Of interest are the Interventions: Pitchers and position performed MUS evaluation of each sensitivities and -LRs for the radial players who reported for spring anterior and distal-posterior head (0.94, 0.07), anterior surface of training had their bilateral brachial capitellum and radial head to identify the radial head and capitellum (0.94, artery blood flow measured, using chondral lesions. The examiner was 0.18) and grade 4 lesions (1.00, 0.00). diagnostic ultrasound, while in two blinded during analysis of the MUS This indicates a negative examination separate shoulder positions. The first images. Each elbow was then dissected with MUS in these areas should position was at rest with the player’s of all soft tissues and disarticulated for provide confidence in ruling out the arm by his side. For the second gross macroscopic examination of the presence of a chondral lesion. position an investigator passively articular surfaces of the HRJ. The Conclusions: Musculoskeletal moved the test shoulder into 90° of reference standard was identification ultrasound is a reliable and sensitive abduction, which was monitored with of chondral lesions by gross tool for a clinician to rule out HRJ the use of a digital inclinometer, and macroscopic examination. A chondral chondral lesions with relatively little end range external rotation. This lesion was confirmed and graded by experience and training. These results position was chosen due to the visualization of ulceration or may assist with clinical assessment similarity to the late cocking phase of eburnation. Main Outcome and decision-making in patients with the throwing motion. While in each of Measure(s): Intra-rater reliability for lateral epicondylalgia to rule out HRJ these positions a second investigator reproducing an image was calculated chondral lesions. used an ultrasound probe to find the using intraclass correlation coefficient brachial artery, while a third

Journal of Athletic Training S-123 13283FOMU investigator recorded blood flow Dominant Vs. Non-Dominant determined when the subject’s scapula volume and peak flow using the Shoulder And Elbow Range-Of- began to aid humeral motion or a firm ultrasound software. Main Outcome Motion Differences In Softball end-feel was achieved. For EEX, the Measures: Brachial artery blood flow Pitchers goniometer was placed with the axis volume (ml/min) and peak flow (cm/ McDonald LM, Kaminski TW, at the lateral epicondyle as the elbow sec) were measured once for each Werner SL: University of was moved to the subject’s extension position. Separate 1-way analyses of Evansville, Evansville, IN; end range-of-motion. ECA was covariance for blood flow volume and University of Delaware, Newark, measured with the subject standing, peak flow were conducted. Effect DE; Sport Science Unlimited, arms relaxed at side, and axis of the sizes were calculated to provide an Arlington, TX goniometer at the cubital fossa. Main Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 indication of clinical meaningfulness Outcome Measures: Three trials Results: Pitchers had significantly Context: Shoulder and elbow range- were performed for each range-of- less blood flow volume (p=0.02, of-motion in softball pitchers are not motion and averaged to obtain a final effect size=0.73) and peak flow well documented. Side-to-side value in degrees. Paired t-tests were (p=0.03, effect size=0.78) when in the comparisons of baseball pitchers have conducted to compare dominant and abducted and externally rotated demonstrated glenohumeral internal non-dominant sides for each position of the dominant arm rotation deficits (GIRD) with measurement. Results: At the (5.7±0.43 ml/min and 16.8±4.3 cm/ concurrent increases in external shoulder, SER demonstrated sec) compared to the non-dominant rotation, as well as changes at the significance (p<.001) between the arm (7.3±2.2 ml/min and 20.1±4.3 cm/ elbow. Rehabilitative strategies are dominant (84.5°±7.4°) and non- sec). The position players did not have typically implemented to prevent dominant (78.9°±6.8°) shoulders. SIR any bilateral difference in blood flow related pathology in these athletes. was also significantly different volume (p=0.85, effect size=0.03) or Despite softball pitchers delivering (p=.012) between the dominant peak flow (p=0.70, effect size=0.11) the ball underhand, range-of-motion (71.3°±12.3°) and non-dominant (8.6±2.9 ml/min and 16.8±4.3 cm/sec differences may exist that can drive (77.5°±8.9°) sides. At the elbow, ECA for the dominant arm and 8.7±2.9 ml/ preventative or rehabilitative treatment was significant (p=.002) between sides min and 17.0±4.6 cm/sec for the non- decisions for clinicians. Objective: (dominant: 8.4°±2.5; non-dominant: dominant arm). Conclusions: Blood Compare dominant and non-dominant 10.3°±2.8°). Conclusions: Though flow volume and peak flow in the passive range of motion (PROM) for softball pitchers are not typically dominant arm of pitchers was shoulder internal rotation (SIR), associated with the same pathologies significantly less than the non- shoulder external rotation (SER), that occur in baseball pitchers, these dominant arm when placed in passive elbow extension (EEX), and elbow results suggest that side-to-side shoulder abduction and external carrying angle (ECA) in softball differences in shoulder and elbow rotation. Our results suggest that pitchers. We hypothesized no range-of-motion exist. Unlike adaptations from pitching may differences between sides. Design: baseball, a softball pitcher may play increase the risk of vascular Within-subjects comparison. Setting: other positions. Further research is pathologies in the throwing arm. These Climate-controlled biomechanics necessary to determine if these range- results may help explain the laboratory. Patients or Other of-motion differences manifest as a occurrence of “dead arm syndrome” in Participants: Forty-three female result of underhand pitching or the pitchers, which has been described as softball pitchers (17.2±2.1 yrs.; overhand throwing necessary in field arm fatigue, decreased ball velocity 164.7±6.7 cm; 65.6±11.4 kg) were positions. Regardless of the source, it and decreased ball control while recruited to participate. All subjects is important for clinicians to be throwing. Clinicians should consider were injury free at time of collection. cognizant of side-to-side range-of- incorporating therapeutic exercise and Two pitchers were left-handed. motion differences in softball pitchers stretching to decrease risk of Interventions: PROM was assessed and consider implementing injury developing vascular pathologies. using a standard goniometer. SER and prevention strategies as they would SIR were measured supine with the with a baseball pitcher. humerus abducted to 90° and the elbow flexed 90°. Start position (0°) was defined as the forearm perpendicular to the table. For both measurements, the humerus was moved passively to the subject’s end range-of-motion. End range was

S-124 Volume 48 • Number 3 (Supplement) May 2013 13381DOIN The Effect Of Intrinsic anterior, and supraspinatus. Range of factors may differ between baseball Musculoskeletal Characteristics motion (ROM), flexibility, and and softball. In addition, flexibility may On Shoulder Complex Injury In postural variables included: be a better indicator of SCI risk than Collegiate Baseball And Softball glenohumeral IR and ER, pectoralis strength. Future research should Players major flexibility, pectoralis minor explore if these results can be Varnell MS, McFate DA, Keenan length, posterior shoulder tightness replicated with large sample size and KA, Heebner NR, Salesi T, Csonka (PST), and forward head (FHP) and other populations. J, Kido Y, Schreppel B, Sell TC: forward shoulder posture (FSP). The Neuromuscular Research average of three trials was used for Laboratory, Department of Sports analysis. Participants were followed Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Medicine and Nutrition, School of for a single season for SCI as Health and Rehabilitation documented and reported by each Sciences, University of Pittsburgh, team’s Certified Athletic Trainer. Pittsburgh, PA; Department of Mann-Whitney U tests were used to Athletics, University of Pittsburgh, compare injured (Inj) and uninjured Pittsburgh, PA (NInj) athletes by sport. Statistical significance was set at p<0.05 a Context: Preventable shoulder priori. Main Outcome Measures: complex injuries (SCI) are a persistent Mean peak force normalized to body and principal health concern for weight (%BW) for isometric strength collegiate baseball and softball measurements. Mean values in degrees athletes and the clinicians who care for for glenohumeral IR/ER rotation, PST, them. Multiple epidemiological FHP and FSP. Mean values in studies have been conducted in this millimeters were analyzed for population; however, there is a lack of pectoralis minor length. Results: Over prospective studies examining the season, two baseball players (15%) modifiable musculoskeletal risk and five softball players (50%) factors for SCI. Objective: To sustained a SCI, with all injuries except prospectively identify intrinsic risk one sustained on the dominant factors for SCI in collegiate baseball shoulder. No athlete incurred more and softball players. Design: than one injury. All injuries reported Prospective cohort study. Setting: were classified as overuse, with five Athletic Training Room Participants: sustained through a throwing Data were collected on thirteen mechanism and two the result of collegiate baseball (age:19.7 repetitively diving while fielding. No ±0.9years, height: 72.8± 2.8in, significant differences in strength mass:89.2±9.1kg) and ten collegiate were demonstrated between Inj and softball (age: 19.8± 1.5years, height: NInj groups in either team. Injured 65.1±1.9in, mass:69.8±11.9kg) baseball players demonstrated players. All athletes were cleared for significantly greater bilateral full participation and had no history of glenohumeral external rotation ROM shoulder injury in the past month. (dominant ER: Inj=120°±1.9°; Interventions: All tests were NInj=104°±10.7°; p=0.026 and non- performed preseason. Strength dominant ER: Inj=119°±3.7°; assessments were performed NInj=101°±6.6°; p=0.026). However, bilaterally using isometric “make Inj softball players demonstrated tests” (5 seconds) in standard grade 5 significantly greater dominant PST manual muscle testing positions using (Inj=119°±7.9; NInj=105°±4.9; hand-held dynamometry. Muscles p=0.032) and less non-dominant tested included: biceps, triceps, pectoralis minor length glenohumeral internal and external (Inj=59.5mm±3.6mm; rotators (IR, ER), pectoralis major NInj=73mm±6.7mm; p=0.008). (upper, lower fibers), trapezius (upper, Conclusions: Based on the findings middle, lower), rhomboids, serratus of this study in a small cohort, SCI risk

Journal of Athletic Training S-125 Free Communications, Oral Presentations: Manual Therapy Wednesday, June 26, 2013, 8:00AM-9:00AM; Palm D; Moderator: Tricia Hubbard Turner, PhD, ATC 13424FOTE Effect Of A 1-Week Mobilization- lunge test, dynamic balance was clinical measures of function requires With-Movement Intervention measured using the anterior direction further investigation. On Range Of Motion, Dynamic of the Star Excursion Balance Test, and Balance, And Self-Reported self-reported function was measured Function In Those With Chronic using the Foot and Ankle Ability Ankle Instability Measure-Sport (FAAM-Sport). These Hoch MC, Gilbreath JP, Gaven assessments were measured one week SL, Van Lunen BL: Old Dominion before the intervention (baseline), University, Norfolk, VA prior to the first treatment (pre- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 intervention), and 24 hours following Context: A single talocrural the final treatment (post-intervention). mobilization-with-movement (MWM) Separate one-way ANOVAs examined treatment has increased dorsiflexion changes in dorsiflexion ROM (cm), range of motion (ROM) in individuals normalized anterior reach distance with chronic ankle instability (CAI). (%), and the FAAM-Sport (%). The Examining the effects of multiple independent variable was time MWM treatments on dorsiflexion (baseline, pre-intervention, post- ROM and other aspects of function intervention). Post-hoc paired t-tests would further elucidate the clinical were calculated in the presence of applications of using MWM for CAI significant time effects. Alpha level rehabilitation. Objective: To examine was set at pd”0.05 for all analyses. the effects of a one-week talocrural Results: No significant time effects MWM intervention on dorsiflexion were detected for dorsiflexion ROM ROM, dynamic balance, and self- (baseline: 7.39±2.38, pre-inter- reported function in adults with CAI. vention: 7.48±2.54, post-inter- Design: Repeated-measures. Setting: vention:7.77±2.57; p=0.69) or Laboratory. Participants: Eleven anterior reach distance (baseline: adults (5 males, 6 females; age= 71.36±7.88, pre-intervention: 71.55± 20.8±1.2 years; height=179.4±4.9 cm; 7.19, post-intervention:71.54±7.15; mass=87.3±14.9 kg) with CAI p=0.99). A significant time effect was volunteered to participate. Participants detected for the FAAM-Sport reported a history of at least one ankle (p=0.01). FAAM-Sport scores were sprain, two episodes of the ankle significantly greater post-intervention “giving way” in the past three months, (86.82±9.18) compared to baseline and a Cumberland Ankle Instability (77.27±11.09; p=0.01) and pre- Tool score of d”25. Intervention: The intervention (79.82±13.45; p=0.04) MWM intervention consisted of three but no difference was present between treatment sessions performed within baseline and pre-intervention one week by the same clinician. The (p=0.20). Conclusion: The one-week MWM treatment was performed by talocrural MWM intervention which applying posterior-to-anterior glides targeted the posterior noncontractile of the tibia over the talus with the structures of the ankle did not improve participant in a kneeling lunge position dorsiflexion ROM or dynamic balance with the involved limb in a weight- in individuals with CAI. However, the bearing stance. Each treatment MWM intervention did have a positive consisted of two sets of four glides. effect on self-reported function as Each glide was sustained for 30 measured by the FAAM-Sport. seconds at the point of maximal Therefore, it appears three treatments dorsiflexion ROM. Main Outcome of MWM had a positive impact on Measures: Dorsiflexion ROM was patient-centered aspects of function measured using the weight-bearing but the effects of this intervention on

S-126 Volume 48 • Number 3 (Supplement) May 2013 13240DOBI 13F05MONE Increasing Ankle Dorsiflexion minutes), triceps surae stretching Immediate Effects Of A Posterior Range Of Motion Does Not Alter using a slant board with the knee Talar Joint Mobilization On Lower Extremity Kinematics extended and flexed (2-minutes), and Spinal-Reflexive And During A Single Leg Squat repeated foam rolling (1-minute). The Corticospinal Excitability In Begalle RL, Dill KE, Frank BS, control group sat in a chair for the Individuals With Chronic Ankle Zinder SM, Padua DA: Sports same duration of time (5-minutes) Instability Medicine Research Laboratory, prior to post-testing. Main Outcome Harkey MS, Wells AM, McLeod University of North Carolina at Measures: The averages of three trials MM, Tevald MA, Gribble PA,

Chapel Hill, Chapel Hill, NC, and were used for DFEXT and DFFLX Pietrosimone BG: University of Department of Orthopedics, measures. Joint displacements were Toledo, Toledo, OH Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 University of South Florida, calculated for sagittal plane ankle and Tampa, FL three-dimensional knee and hip joints Context: Neuromuscular function is as the difference between peak joint altered in people with chronic ankle Context: Limited ankle dorsiflexion angles and the joint angles at the instability (CAI). One hypothesis is range of motion (DF ROM) is initiation of movement. Separate 2x2 that decreased dorsiflexion, associated with altered lower (time x group) mixed model, repeated potentially caused by aberrant ankle extremity kinematics and increased measures ANOVA were performed. arthrokinematics from an anteriorly risk of a variety of lower extremity Tukey’s post-hoc testing was displaced talus, affects neuromuscular injuries. Interventions to increase DF performed to identify location of control of stabilizing muscles around ROM may alter lower extremity significance. Results: We observed a the ankle. Joint mobilizations are kinematics and ultimately reduce the significant main effect of Time for indicated for restoring proper risk of lower extremity injury in those DFFLX (F(1, 18)=19.08, P<0.001, arthrokinematics and restoring range with limited DF ROM. However, Pre=8.52, Post=9.80) and a significant of motion; yet, it remains unknown if research has not addressed this Time x Group interaction for DFEXT mobilization will alter neuromuscular question. Objective: To determine if (F(1, 18)=7.65, P=0.013, Control: excitability around the ankle. ankle DF ROM and lower extremity Pre=1.33±2.98, Post=1.93±4.34, Objective: Determine the immediate kinematics during a single leg squat are Stretching: Pre=1.93±2.23, Post= effects of a grade III posterior talar altered following a flexibility 4.60±1.93). Post-hoc analysis of the mobilization on spinal-reflexive and intervention in individuals with limited Time x Group interaction for DFEXT corticospinal excitability in the DF ROM. Design: Randomized indicated the stretching group had fibularis longus(FL) and soleus(SOL), Control Trial Setting: Research significantly greater increases in as well as ankle dorsiflexion range of laboratory. Patients or Other motion than the control group. No motion (DF) in patients with CAI. Participants: Twenty physically significant main effects or Design: Single-blinded, randomized active participants were randomized to interactions for time or group were control trial. Setting: Research the stretching (n=10, 19.40±1.84 observed for any kinematic laboratory. Patients or Other years, 171.10±6.89 cm, 72.08±14.34 displacement variables (P>0.05). Participants: Fourteen participants kg) or control (n=10, 19.50±0.85 Conclusions: An isolated stretching with CAI were randomized into the years, 171.13±10.46 cm, 68.76±10.86 approach was effective in improving mobilization group (11M/3F; kg) group. All participants had limited ankle DF ROM in healthy individuals 21.3±3.6years; 175.6±7.6 cm; DF ROM, which was defined as DF with restrictions, but did not alter 80.0±13.8kg; FADI:77.6±15.7; ROM d”5° (assessed with knee lower extremity kinematics during the FADIs:60.6±17.4) and fifteen extended). Interventions: Gonio- single leg squat. Implications of these participants served as controls (3M/ metric assessments of passive ankle findings suggest isolated acute DF 12F; 21.1±2.1years; 168.6±8.8cm; dorsiflexion with the knee extended ROM increases do not promote 68.9±20.9kg; FADI:82.7±8.4; FADIs: changes in movement patterns. Future 62.3±17.8). Interventions: Follow- (DFEXT) and knee flexed (DFFLX) were recorded pre- and post- intervention. research should investigate a longer ing baseline measurements, the In addition, electromagnetic motion- duration or integrated intervention mobilization group received 3, 60- capture recorded lower extremity approach to influence these changes. second Maitland grade III posterior kinematics on the dominant limb talar mobilizations from a certified during the single leg squat at both time athletic trainer, while the control group points. The stretching group sat quietly for 5 minutes. Outcome performed a single 5-minute session measures were conducted by a blinded of foam rolling over the triceps surae investigator prior to and immediately muscles with the knee extended (2- following the intervention. Main

Journal of Athletic Training S-127 13166MOTE Outcome Measures: Peripheral The Effects Of The Graston Technique(G-GT), Local Graston electrical stimulation of the sciatic Technique® On Knee Extension Technique(L-GT), and a control group. nerve was used to elicit Hoffmann Angle The G-GT group received the standard reflexes (H-reflex) and maximal Toepper BW, Docherty CL, GT protocol with specific muscle responses (M-response) of the Donahue M, Kingma J, Schrader mobilization over the posterior thigh, fibularis longus and soleus muscles. J: Indiana University, Bloomington, leg, and plantar surface of the foot. The Spinal-reflexive excitability was IN L-GT group received the standard GT defined as the maximum H-reflex protocol with specific mobilization normalized to the maximum M- Context: Hamstring dysfunction may only over the posterior thigh. The response (H:M ratio). Corticospinal increase the likelihood of injury and control group received a 15-minute Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 excitability was evaluated by present with symptoms not associated sham electrical stimulation treatment. measuring active motor thresholds with the hamstring muscles; For each group, treatment occurred on (AMT) using Transcranial Magnetic interventions designed to lengthen the four separate days with a minimum of Stimulation (TMS). AMTs were hamstrings can decrease likelihood of 48 hours between treatments. Post- determined by finding the lowest TMS injury and resolve many associated testing occurred in the same manner intensity that elicited measurable symptoms. Objective: To evaluate the as the pre-test at the end of the four motor evoked potentials (MEPs effects of an instrument assisted soft treatment sessions. A RMANOVA was >100μV) in five out of ten consecutive tissue mobilization technique on knee calculated to determine differences trials. Active DF range of motion was extension angle. Design: Cohort between the groups. Tukey post hoc measured with the patient positioned study. Setting: Research laboratory. tests were completed on any supine with an inclinometer. Separate Patients or Other Participants: 32 significant findings. Alpha level was 2x2 repeated measures ANOVAs were physically active males with limited set at P<.05. Main Outcome performed to investigate the hamstring flexibility (21.6±2.2yo; 1.8 Measures: Knee Extension Angle(°). differences between groups and time ± 0.7m; 80.8±11.6kg) volunteered to Results: A significant test by group (pre, post) for all outcomes measures. participate in this study. Participants interaction was identified (F(2,21)=4.16, Dependent t-tests were used to had no acute lower extremity injury in p=0.01). Specifically, the G-GT group evaluate individual group differences the last 12 months, no current low back had improved range of motion over time in the presence of a pain, no history of diabetes, and were following treatment (pretest significant interaction. Alpha level was not taking anticoagulant medication. =156.3°±10.7°, posttest= 163.0°± set a priori at P<0.05. Results: There Interventions: All participants were 11.0°, mean difference=6.8°), were no significant differences in pre-tested using the passive knee however, neither the L-GT group spinal-reflexive or corticospinal extension test. To conduct this test, (pretest=156.8°±7.0°, posttest= excitability for either muscle in the subjects were asked to lay supine, flex 160.6°±10.0°, mean difference=3.8°) mobilization or control group the hip to 90p and allow a standardized or the control group (pretest (P>0.05). There was a significant weight to slowly extend the knee. A =155.5°±9.6°, posttest= 154.5°± interaction effect for DF (F1,27=4.10, digital inclinometer (ACUMAR 13.8°, mean difference=1.0°) resulted P=0.05), with the t-test revealing an Datacapture 5.0 Digital Inclinometer, in significant improvements. increase in DF immediately following Lafayette Instrument Co., Lafayette, Conclusions: The use of the Graston the joint mobilization (Pre IN) was placed on the shaft of the tibia Technique® can improve knee DF:16.4±5.3º, Post DF:19.1±5.6º; t=- to record maximal knee extension extension angle when the treatment 2.15, P=0.05) while no difference was angle. Three trials were completed. area includes the entire posterior found for controls (Pre DF:18.2±5.6º, Instrument assisted soft tissue thigh, leg, and plantar surface of the Post DF:17.8±4.1º; t=0.39, P=0.70). mobilization treatment was employed foot. This evidence may support the Conclusions: A single joint using the Graston Technique® (GT). current concepts of fascial slings mobilization treatment was efficacious This technique utilizes stainless steel suggested by Thomas Myers. at restoring DF range of motion in instruments to assess and treat soft participants with CAI, but excitability of tissue adhesions. A standard GT spinal-reflexive and corticospinal protocol was followed, which included pathways at the ankle were unaffected. an active warm-up, soft tissue Future research should evaluate the mobilization using the instruments, effect of mobilizations over multiple low load high repetition exercises, and treatment sessions to determine its true stretching. Participants were neuromuscular therapeutic capabilities. randomly assigned to one of three treatment groups: Global Graston

S-128 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: What Cryotherapy Cannot Do Wednesday, June 26, 2013, 9:15AM-10:15AM; Palm D; Moderator: 13252MOTE Comparing Interventions For elbow flexion and extension, pain using rehabilitation should be used for Delayed Onset Muscle Soreness the Brief Pain Inventory (BPI: scale 1- optimal outcomes. In College Aged Subjects: 10), muscle tenderness using pressure Nintendo® Wii Boxing, Ice And pain thresholds (PPTs), and functional Light Concentric Exercise disability (QuickDASH). Change Chang SD, Naugle KM, Parr JJ, scores (post-pre) were created for Naugle KE: University of Florida, each measure and analyzed with Gainesville, FL between-subjects 1-way ANOVAs. Results: On Day 1, the Wii group Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Delayed-onset muscle [M=1.52o(SE=.83); 95% confidence soreness (DOMS) induced by intervals (CI): -0.25,3.29] exhibited eccentric exercise occurs in athletes improvements in TA ROM during and causes discomfort and potentially elbow flexion compared to the LCE a decline in physical performance or [p=.021; M=-1.23o(SE=.73); 95% CI: loss of practice time. Modalities such -2.75,0.29] and control group [p=.008; as ice and massage exist to combat this M=-1.47o(SE=.73); 95%CI: -2.99, discomfort and pain, but outcomes vary 0.56]. On Day 2, the ice group [M=- in effectiveness. Active gaming has 9.09(SE=4.31); 95%CI: -21.06,2.88] become a trendy rehabilitation tool in reported improvements in functional athletic training facilities; however, no disability compared to the Wii studies have investigated whether [p=.011; M=1.29(SE=2.15); 95%CI: active gaming for sore muscles is -3.97,6.56], LCE [p=.021; M= superior to commonly used treatments 0.16(SE=0.80); 95%CI: -1.79,2.12] for DOMS. Objective: The purpose of and control group [p=.012; this study was to compare the M=0.85(SE=2.46); 95%CI: -4.97, effectiveness of active gaming, 6.68]. On Day 2, the ice group [M=- specifically Wii boxing, compared to 1.2(SE=.58); 95% CI: -2.82,0.42] standardized light concentric exercise, reported greater reductions in pain and ice bag treatment in alleviating compared to the Wii [p=.021; DOMS. Design: Randomized- M=0.43(SE=0.37); 95%CI: -0.47, controlled trial. Setting: Controlled 1.33], LCE [p=.008; M=0.71 research laboratory. Patients or (SE=0.61); 95%CI: -0.77,2.20] and Other Participants: Twenty-eight control group [p=.049; M=0.13 college-aged volunteers (19.52 (SE=0.13); 95%CI: -0.17,0.42]. Also ±0.79yrs). Interventions: Partici- on Day 2, the ice group [M= pants performed an eccentric exercise 0.72(SE=.12); 95% CI: 0.44, 1.00] protocol of the non-dominant elbow exhibited reduced muscle tenderness flexors to induce DOMS. Participants compared to the Wii [p=.004; M=- were randomized into one of four .02(SE=0.10); 95%CI: -0.33,0.30], conditions: Wii Boxing (n=7), light LCE [p<.001; M=-0.25(SE=0.15); concentric exercise (LCE; n=8) 95%CI: -0.62,0.12] and control group consisting of elbow flexion and [p=.002; M=-0.09(SE=0.19); 95%CI: extension with minimal weight -0.56,0.39]. Conclusions: These resistance, ice bag treatment (n=5), or results suggest that light exercise control group (natural history; n=8). using Wii Boxing temporarily On follow-up Days 1 and 2, improves ROM following an induced participants completed 20 minutes of bout of DOMS. However, ice bag their selected intervention. Main treatment was superior in improving Outcome Measures: Measurements pain, functional disability, and muscle were taken on Day 0 prior to DOMS tenderness compared to all other and pre and post intervention on Day 1 conditions. Clinically, this suggests a and 2: total active (TA) ROM during multiple intervention strategy to

Journal of Athletic Training S-129 13328FOTH 13032DOTH Better Together Or Apart: (mmHg) at which each subject Cryotherapy Does Not Alter Effects Of Simultaneous And indicated a perceived pain rating of “6” Passive Dorsiflexion Range Of Individual Application Of on a Visual Analog Scale (VAS). VAS Motion And Plantarflexor Therapeutic Cold & ESTIM On was used to assess pain level at various Musculotendinous Stiffness Pain Perception time periods over a twenty-minute Akehi K, Long BC, Conchola EC, Tsang KKW, Cordova MM, Kuei treatment application and twenty- Palmer TB: Oklahoma State CY: California State University minute post-application. Main University, Stillwater, OK Fullerton, Fullerton, CA Outcome Measures: Dependent variable was VAS score (mm). Separate Context: Cryotherapy is commonly repeated measures ANOVA was used Context: The therapeutic effects of used in health care. Its influences on Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 cold modalities and electrical to assess differences between tissue extensibility, elasticity, and joint stimulation (ESTIM) as individual treatment mode on VAS score at range of motion (ROM), however, are treatments in the management of various time points (minute 0, 6, 10, not well understood. Objective: The musculoskeletal injury are well 20, 26, 40). The level was set a priori purpose of the study was to determine documented in the research literature at .05, interactions were analyzed if a 20-minute crushed ice bag and commonplace practice in the using post-hoc testing. Results: All application to the plantarflexor muscle clinical setting. Although the values presented as mean ±SD (mm). group influenced passive ankle simultaneous application of both Analysis revealed no differences dorsiflexion ROM, passive modalities is empirically accepted and between treatment mode at any given plantarflexor torque (PPT), and passive practiced, the effects of these time period: minute 0 (P = .81), CP musculotendinous stiffness (MTS) at (54.23 ±6.8), IFS (53.42 ±8.4), IC treatments have not been demonstrated 4 joint angles (˜1,2,3,&4). Design: in the research literature. Objective: (54.52 ±9.4); minute 6 (P = .08), CP Randomized controlled study. The purpose of this study was to (46.05 ±16.1), IFS (51.71 ±18.9), IC Setting: Controlled laboratory examine if these therapeutic (42.19 ±16.8); minute 10 (P = .06), setting. Participants: Twenty modalities are more effective when CP (45.23 ±20.7), IFS (48.95 ±18.8), recreationally active college-aged applied simultaneously or singularly in IC (39.28 ±19.1); minute 20 (P = .18), participants (male: n=9, age= the treatment of pain. Design: CP (42.47 ±24.4), IFS (43.23 ±20.7), 21.63±2.00yrs, ht=178.31±6.72cm, Crossover study. Setting: Research IC (36.28 ±24.6); minute 26 (P = .41), mass=78.54±32.89kg; and female: laboratory. Patients or Other CP (45.33 ±24.7), IFS (45.33 ±23.2), n=11, age=19.5±0.52yrs, ht= 166.46 Participants: 21 participants (9 males, IC (41.28 ±23.3); minute 40 (P = .21), ±9.41cm, mass= 67.58± 8.31kg) with 12 females) (mean: age = 22.3 ±2.8 CP (50.66 ±23.6), IFS (49.0 ±26.2), no known lower extremity injuries in years; height = 171.5 ±9.6 cm; mass = IC (45.33 ±26.4). Conclusions: Our the 6 months prior to data collection 68.5 ±13.6 kg) with no history of results indicate the simultaneous volunteered. Interventions: A current or recent musculoskeletal application of ESTIM and cold 2x2x2x5 cross-over measure was injury. Interventions: Independent modality does not provide better pain conducted on all factors. Independent variable was treatment mode: cold pack relief than separate applications. The variables were treatment (a 2-kg (CP), electrical stimulation (IFS), and clinical practice of combined crushed ice bag or nothing), gender electrical stimulation/cold pack (IC). modalities application should be (male and female), day (1st and 2nd), Operational definitions: IFS revisited for considerations of and time (pre-treatment, immediate (interferential stimulation: carrier evidence-based practice and effective post-, 10, 20, & 30 minutes post- frequency 4000 Hz, beat frequency 80/ resource management. treatment). Subjects were randomly 150 Hz) (Intelect Legend XT, assigned to a treatment order after Chattanooga Group, Vista, CA), CP signing the IRB approved informed (Moji, Glenview, IL). A repeated consent. On the first day, we obtained measures design was utilized, each subject demographics and conducted participant completed three treatment the familiarization session. On the sessions over a three-day period. The second and third day, subjects warmed order of treatment mode was up on a stationary cycle for 5 minutes. randomized for each participant. A Subjects were then positioned on the modified pneumatic tourniquet was chair of an isokinetic dynamometer for used to induce perceived pain during passive ankle dorsiflexion and passive each session. A baseline pain threshold torque measures. Passive dorsiflexion was established at a pressure level measures were taken twice at 5°/s, starting at 20° of plantarflexion. The

S-130 Volume 48 • Number 3 (Supplement) May 2013 c13034MOTH pre-determined treatment was then Effect Of Different Compositions minutes for 30 minutes following applied for 20 minutes. Post- Of Ice Bags On Circulation In treatment removal. A mixed design treatment measures were taken The Femoral Artery In Healthy repeated measure analysis of variance immediately and at 10, 20, and 30 Males (ANOVA) compared blood velocity minutes after both treatments. Passive Teblum JB, Boucher TM, between the different ice bag MTS was examined based on passive Greenwood LD: Baylor University, compositions across the time points. angle-torque curves. We also Waco, TX; University of Louisiana Four separate repeated measures measured surface interface at Monroe, Monroe, LA; Texas ANOVA’s were performed testing temperature every minute in pre-, A&M University, College Station, each individual ice bag composition’s during, and post-treatment measures. TX effect on blood flow in relation to time Main Outcome Measures: We elapsed. Results: Among the four Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 assessed maximum passive ankle Context: Many studies have different types of ice bag dorsiflexion ROM, maximum PPT, investigated the effectiveness of compositions there was not any and passive MTS at 4 joint angles (˜ 1- different cryotherapy agents, including significant difference in blood flow ) separated by 5° on 5 different time 4 different compositions of ice bags, in velocity (P = .63). Individually, there and 2 different days. Results: As lowering tissue temperatures. was no significant difference in blood expected, cryotherapy decreased However, there is no current research velocity over the eight time points for surface temperature at each post- that has investigated the effect of ice the wet crushed (57.9 to 62.67 cm/sec, treatment measure (Pre: 29.68± bag composition on blood flow P = 0.66), cubed (60.4 to 59.9 cm/sec, 1.10°C, Post: 8.52±3.37°C, 10 : post velocity. Objective: To investigate P = 0.72), and wet cubed ice bags (65.1 21.02±1.57°C, 20 : 23.25± 1.84°C, post different compositions of ice bags on to 63.0 cm/sec, P = 0.64). However, and 30 : 24.21± 1.50°C; Tukey- post blood flow velocity in the femoral there was a significant decrease in Kramer, P<.01). Control group and artery. Design: A repeated-measures blood velocity (74.2 to 62.8 cm/sec) ambient air temperature fluctuated less counterbalanced design. Setting: relative to time with the crushed ice than 2°C. Cryotherapy did not University Laboratory Setting. bag (P = .006) and pairwise comparison influence ROM (Ice : 33.89±4.55°, male Patients or Other Participants: revealed the significant difference Controlmale: 32.60±5.20°, Icefemale: Male subjects 18 to 35 years old were between pre-application baseline and 32.36±10.86°, Controlfemale: 33.35± recruited on a volunteer basis from the all post ice application velocities. This 9.91°; Tukey-Kramer, P>.85). There surrounding area. Fifteen healthy male significant difference was attributed to was no main effect difference between participants (age = 20.3 ± 1.2 years, the average pretreatment blood flow times for ROM, PPT, or MTS for each height = 181.3 ± 7.9 cm, mass = 75.3 velocity for this group being treatment (Tukey-Kramer, P>.05). ± 13.9 kg) with no circulatory significantly different from the other Males, however, had higher PPT (Ice: conditions or current lower extremity three. Conclusions: Ice bag 76.91±20.28Nm, Control: 74.01± injuries completed the study. composition and the influence of a 15.42Nm; F1,360=718.72, P<.01) Interventions: Ice bags made with melted ice state do not affect blood compared to female PPT (Ice: crushed, cubed, wet crushed, or wet flow velocity and are an equally 26.46±10.18Nm, Control: 30.46± cubed ice were prepared with effective application of cryotherapy to 12.92Nm). This was also true at each standardized procedures and applied to be used clinically. of the MTS˜1-4 (Tukey-Kramer, the right upper thigh for 15 minutes. P<.05). Conclusions: Decreasing The wet bag composition simulated plantarflexion temperature with a 20- melting that often occurs clinically minute crushed ice bag does not appear prior to application. The ice to influence passive ankle dorsiflexion composition selection was randomly ROM, maximum PPT, or passive MTS. assigned and administered on four Regardless of cryotherapy application, separate test sessions, with at least 24 males had greater passive PPT and hours in between sessions. The blood MTS than female. flow (cm/sec) was measured via spectral Doppler ultrasonography (SonoSite M-Turbo, SonoSite, Inc., Bothell, WA). Main Outcome Measures: Blood flow velocity of the right femoral artery was measured prior to ice application and every 5

Journal of Athletic Training S-131 Modalities Evidence-Based Forum Wednesday, June 26, 2013, 10:30AM-11:30AM; Palm D; Moderators: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

S-132 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Taping/Bracing/Orthotic Interventions Thursday, June 27, 2013, 8:00AM-9:30AM; Palm D; Moderator: Mitchell Cordova, PhD, ATC 13170MONE 13091SOBI Effect Of Lace-Up Ankle Braces the mean amplitude during quiet Effect Of Over-The-Counter On Electromyography Measures standing. A negative value for time of Foot Orthotic Devices On Multi- During Walking In Subjects onset represents muscle activation Segment Foot Biomechanics With Chronic Ankle Instability prior to initial contact. Percent of Kimmel W, Hettinga BA, Ferber R: Barlow G, Donovan L, Hart JM, activation was calculated as the Faculty of Kinesiology, University Hertel J: University of Virginia, proportion of the total time across the of Calgary, Calgary, Canada Charlottesville, VA stride cycle that the amplitude was greater than the previously described

Context: Over-the-counter (OTC) Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Injuries to the ankle are one threshold. Paired t-tests were foot orthoses are thought to be a cost- of the most common musculoskeletal performed for each dependent variable effective alternative to custom-made injuries in athletics with a high rate of to compare groups. The level of devices. However, few studies have recurrence and prolonged dysfunction. significance was set a priori at compared OTC devices and most Previous studies have shown a Pd”0.05 for all analyses. Results: The biomechanical research involving reduction in ankle sprains among those pre-contact amplitude of the PL was orthoses has focused on rearfoot with previous ankle injury while significantly lower in the braced biomechanics. Objective: To braced, however, ankle braces have not condition (0.16±0.08) when compared determine changes in multi-segment been shown to decrease the severity to the shod condition (0.20±0.10mV, foot biomechanics during shod of injury, It may thus be implie that the p=0.01). The AT, PL, RF, and GM were walking in three commercially mechanism by which a brace decreases activated significantly later relative to available OTC devices: SOLE, injury risk goes beyond restricting contact in the braced condition when SuperFeet (SF), and Powerstep (PS) range of motion and may also affect compared to the shod condition (AT: - compared to no orthotic (NO). Based the neuromuscular control of the 0.32±0.02 vs. -0.36±0.16ms, p=0.02; on a previous SOLE study, and ankle. Objective: To determine the PL: 0.02±0.12 vs. -0.07±0.10ms, construction of the OTCs, we effect of a lace-up ankle brace on p=0.02; RF: -0.07±0.06 vs. -0.14± hypothesized significantly reduced lower extremity muscle function in 0.15ms, p=0.03; GM: 050±.082 vs. - plantar fascia strain (PFS) for SOLE subjects with chronic ankle instability 0.08±0.10ms, p=0.009, respectively). and SF compared to NO. We also (CAI). Design: Crossover. Setting: The PL and RF were activated for a hypothesized that SF and PF would Laboratory. Patients or Other significantly shorter percentage across significantly reduce rearfoot eversion Participants: Fifteen adults with CAI the stride cycle in the braced condition (RFEV), tibial internal rotation (ROT), (height=173±11cm, mass=72±14kg, when compared to the shod condition and medial longitudinal arch age=23±4, sex=M:5 F:10) parti- (PL: 28.67±9.35 vs. 36.04±10.26%, deformation (MLAD) compared to cipated. Intervention(s): Condition p=0.002; RF: 30.79±18.86 vs. NO. Design: Crossover, repeated order was randomly allocated to 36.90±24.52%, p=0.05, respectively). measures. Setting: Clinical research condition order (lace-up brace or no Conclusions: Lace-up ankle braces laboratory. Patients or Other brace). Surface EMG electrodes were caused an alteration in lower extremity Participants: Eleven healthy placed over the anterior tibialis (AT), muscle activation in individuals with individuals (3 males, 8 females: age= peroneus longus (PL), lateral CAI. These alteration in muscle 31.3 ±6.7yrs, height= 167.5±8.4cm, gastrocnemius (LG), rectus femoris activation due to bracing may mass= 65.1±12.8kg) volunteered (RF), biceps femoris (BF) and gluteus contribute to the decrease the through informed consent. medius (GM). The protocol consisted recurrence of ankle sprains in people Interventions: Retroreflective of 30 seconds of treadmill walking at with CAI by providing a more efficient markers were placed on the right limb 3 mph during each condition. Main muscle activation patterns. to represent forefoot, midfoot, Outcome Measures: Normalized rearfoot and shank segments. 3D EMG amplitude 100ms pre- and kinematics were recorded using 8- 200ms post initial contact, time of cameras (Vicon, Oxford, UK: 120Hz) activation relative to initial contact, placed around a treadmill while and percent of activation across the subjects walked in a neutral shoe at 1.1 stride cycle were calculated for each m/s. The order of the 4 conditions was muscle across 9 steps. Muscle randomized. Main Outcome activation was determined for each Measures: 3D marker trajectories muscle if the amplitude was 10 SD over were calculated using custom-written

Journal of Athletic Training S-133 13234FOPR Matlab software (Natick, USA). RFEV, Effect Of Prophylactic Ankle variables were counter-balanced to MLAD, and ROT were measured in Support On Actual And minimize the effects of fatigue degrees. PFS (unitless) is calculated Perceived Dynamic Balance associated with the testing procedures. by approximating the plantar fascia Gear WS, Bookhout JL, Solyntjes A Repeated measures ANOVA was spanning between the first metatarsal AL: University of Minnesota- used to analyze the difference between head and calcaneus and determined as Duluth, Duluth, MN, and Marywood barefoot, ankle tape, and ankle brace change in relative marker position. University, Scranton, PA for medial-lateral and anterior- Between-condition differences were posterior dynamic stability indices and determined using 1 (group) x 4 Context: Ankle injuries are the most perception of stability. All tests of (condition) repeated measures common injury associated with sports significance were carried out at an

ANOVAs and a priori post-hoc testing participation. Taping and bracing are alpha level = 0.05. The Bonferroni Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (P<0.05). Results: There were no commonly used measures to prevent post hoc test was used for all paired significant differences in peak RFEV ankle injury. Patients often report a comparisons. Results: Significant for any OTC (SOLE: F1,7=2.11; feeling of increased stability due to differences were not found for medial- 10.60±4.63deg; P=0.11, SF: Prophylactic Ankle Support, however lateral stability (Barefoot = 1.24 ±

F1,7=3.01; 10.10±5.64deg; P=0.09, previous studies have produced 0.63, Taped = 1.21 ± 0.72, Braced =

PS: F1,7=1.87; 11.72±5.30deg; conflicting results. Objective: The 1.38 ± 0.71) nor anterior-posterior P=0.24) compared to NO (13.31 purpose of this study was to examine stability (Barefoot = 1.70 ± 1.07, ±5.19deg). There were no significant the actual and perceived effect of Taped = 1.50 ± 0.89, Braced = 1.47 ± differences in peak ROT for any OTC taping and bracing on dynamic stability. 0.74). Significant differences were

(SOLE: F1,7=0.99; 0.28±7.37deg; Design: Repeated measures design. found for perception of stability

P=0.42, SF: F1,7=1.79; -1.26± 5.14 Setting: Controlled laboratory (Barefoot = 2.57 ± 0.60, Taped = 3.32 deg; P=0.29, PS: F1,7=1.81; -1.67 setting. Patients or Other ± 0.67, Braced = 2.90 ± 0.76; p = ±5.76deg; P=0.24) compared to NO Participants: 21 physically active 0.000). The taped condition was (-0.21±3.43deg). There were no subjects [12 females (age = 20.33 ± significantly different from both significant differences in peak MLAD 1.44 years, height = 165 ± 0.05 cm, barefoot and braced conditions (p = for any OTC (SOLE: F1,7=0.97; mass = 68.76 ± 12.69 kg), and 9 males 0.000 and p = 0.021 respectively). 155.55±7.46deg; P=0.41, SF: (age = 21.33 ± 1.66 years, height = Conclusions: The use of ankle taping

F1,7=1.01; 158.04±8.25deg; P=0.30, 180 ± 0.10 cm, mass = 86.54 ± 9.46 and bracing had no influence on

PS: F1,7=0.99; 154.88±7.47deg; kg)]. Interventions: Dynamic dynamic stability measures in this P=0.33) compared to NO (156.25 stability and perception of stability study. Ankle taping did cause an ±7.03deg). There were no significant were assessed barefoot and with the increased perception of stability differences in PFS for PS (F1,7=1.78; ankle taped and braced. The taped ankle suggesting that ankle taping may have 0.008±0.004; P=0.29) compared to condition used a standard preventive more of a placebo effect in uninjured NO (0.009±0.001). Significant tape application including two anchors, ankles. decreases in PFS were measured for three stirrups, close downs,

SOLE (F1,7=7.65; 0.001±0.009; horseshoes, two heel locks per side

P=0.02) and SF (F1,7=3.55; and two figures’ of eight. During the 0.004±0.007; P=0.05) compared to braced condition, participants were NO. Conclusions: Supporting the fitted with a Swede-O Inner Lok 8 hypotheses, a SOLE OTC orthotic ankle brace per manufacturer does not control RFEV or MLAD but guidelines. Main Outcome does reduce PFS compared to walking Measures: The Biodex Balance without an orthotic device. Partially System SD was used to measure supporting the hypotheses, SF also medial-lateral and anterior-posterior reduces PFS. Contrary to the stability. Dynamic balance was hypotheses, PS and SF do not control assessed in a single leg stance during rearfoot or tibial kinematics nor reduce three 20-second trials at stability level MLAD. SOLE and Powerstep donated 4. A 30 second rest period was their devices. Funded by SOLE and provided between trials. Perception of Alberta Innovates: Health Solutions. stability was assessed using a 4-point Likert scale (1 = very unstable, 2 = unstable, 3 = stable, 4 = very stable) after each test session. Independent

S-134 Volume 48 • Number 3 (Supplement) May 2013 13348DOPR 13090FOPR Plantar Flexion Motion Allowed degrees of plantar flexion allowed by The Effects Of Load Range And By Different Ankle Taping select ankle taping combinations Brace Support In Ankle Complex Combinations Assessed By which were selected using a TM Stability The Taguchi Method orthogonal array 4. Alpha was set at Kovaleski JE, Gurchiek LR, Boscolo MS, Zhu W: University <0.05. Using TM procedures low Heitman RJ, Liu W, Mitchell SM, of Illinois at Urbana Champaign, contributing factors were pooled to Hollis JM: University of South Urbana, IL become error variance and ANOVA Alabama, Mobile, AL was rerun. The optimal combination Context: There are many taping was determined based on the signal to Context: Stabilization against an techniques used by athletic trainers, noise ratio (S/N) Smaller is Better, and inversion injury is a major function of

but it is yet unknown if one taping then confirmed with collected data. an ankle brace. No comprehensive Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 technique is better than another. Taping Results: In the traditional means analysis concerning the effectiveness technique can be broken down into analysis W (F1,136 = 23.36; p=0.001), of brace support on ankle-complex components and these components can H (F1,136 = 6.61; p=0.01) were found behavior across a load range has been be systematically varied (i.e., one or to be significance, but T (F1,136 = 0.94; reported. Objective: To evaluate the three layers thick of tape) and studied p=0.33) was not. In the initial S/N ratio effect of different types of brace for effectiveness. No ankle taping analysis W accounted for 74.45%, H support on ankle-complex inversion studies have systematically explored 20.70% and T 5.85% of the variance. rotation and stiffness. Design: Cross- systematic optimization of tapping After T was pooled error variance sectional. Setting: Research techniques. Objective: To determine accounted for 5.85%, W 73.45% and laboratory. Participants: The the optimal ankle taping combination Height 20.70% of the variance. The dominant ankle of 22 female for reducing plantar flexion using the optimal combination (W2-H2) collegiate athletes (20.7±1.2 years, Taguchi Method (TM) model. Design: estimation was 40.11 ± 11.77 º of 70.2±8.7 kg, 173.2±9.0 cm). A repeated measures design was used allowed plantar flexion. Confirmatory Interventions: Maximal inversion where each participant was tested in analysis on n=35 participants shows load-displacement curves were each of the four ankle taping the average results for all collected using a six degrees-of- combinations. Setting: Research combinations containing W2-H2 was freedom linkage-instrumented ankle laboratory. Patients or Other 40.97 º which is within the 95% CI. arthrometer. With the subject wearing Participants: Thirty-five female Conclusions: The results provide her own low-top athletic shoe all participants (aged=24.7±4.91 years; evidence of the optimal ankle taping ankles underwent loading at 15° 160.17±11.93 cm; 61.62±5.83 kg) combinations for limiting ankle plantar-flexion (PF), which was with no ankle injury in the past year plantar flexion. Further research is defined as the zero-load/zero-moment volunteered for this study. needed to determine what effect unloaded position. Main Outcome Interventions: Ankle taping factors exercise has on the various Measurements: Inversion ROM was Weight (W), Tape Height (H) and pre- combinations used in this study. measured from zero to 4-Nm with the wrap Thickness (T) were loading portion of the moment-angular systematically varied. Each parameter displacement curve divided into low- had two levels: W1 = one tape layer load (0-2 Nm) and high-load (2-4 Nm) thick; W2 = three tape layers thick; H1 segments. Rotation was measured and = 20% of fibular height; H2 = 35% of secant stiffness for each load-range fibular height; T1 = one pre-wrap layer calculated. Repeated measure ANOVA thick; T2 = three pre-wrap layers thick. was used to compare rotation values 2” Crammer Underwrap™ and 1.5” among the no brace and braced ankles Coach™ athletic tape was applied (soft-shell [Zoom™]; lace-up down to the middle of the arch using a [ASO™]; rigid [Active Ankle T2™]) at predefined technique. Taping 4-Nm. Separate t-tests compared combination order was randomized differences in rotation and stiffness for each participant. The Inman ankle between low-load and high-load machine, with an attached wireless ranges. Significance was set a priori inclinometer, was used to measure at P < .05. Results: At the 4-Nm load, plantar flexion and has been found bracing (soft-shell: 21.5±4.9°; rigid: reliable and valid in previous studies. 22.3±6.7°; lace-up 24.5±7.6°) Main Outcome Measures: A one way produced a significant reduction in ANOVA was used to analyze the ROM when compared to the no brace

Journal of Athletic Training S-135 13163MOPR trial (47.1±9.7°; P<.001), with no Ankle Bracing Enhances posterior (AP) and medial-lateral (ML) ROM differences between braced Mediolateral Postural Stability In directions were calculated based on conditions (P>.05). Across the two Those With And Without A the center of pressure position and load ranges, bracing restricted ROM History Of Ankle Sprains velocity in relation to the boundaries more in the 0-2 Nm load range than in Goodrich ME, Oyama S, Goto S, of the foot. The mean and standard the 2-4 Nm load range [soft-shell Myers JB, McKeon PO, Zinder deviation of TTBML and TTBAP were (8.7±2.7°,12.8±3.0°; P<.001), rigid SM: Department of Exercise and compared using separate group (AS/ (8.1±3.5°,14.2±3.9°; P<.001), lace- Sport Science, University of North control) by condition (brace/no-brace) up (9.6±4.5°,14.9±3.9°; P<.001). Carolina at Chapel Hill, Chapel Hill, mixed-model ANOVAs. Alpha level Whereas, in the NB condition, greater NC was set a priori at p<0.05. Results: ROM occurred between the 0-2 Nm There were no significant group by Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 load range than in the 2-4 Nm load Context: Ankle braces have been condition interactions for any TTB range (33.0±9.1°,14.1±2.2°, P<.001). shown to reduce the risk of both first- variables. There were significant Bracing produced greater stiffness in time and recurrent sprains. Since condition main effects in which all the 0-2 Nm load range than in the 2-4 deficits in postural stability have been participants exhibited significantly Nm load range [soft-shell (.259±.11 linked to an underlying mechanism for increased mean TTBML (mean Nm/°, .165±.04 Nm/°; P<.001), rigid increased ankle sprain risk, it is difference=0.29±0.74, 95%CI: 0.04- (.303±.16 Nm/°, .151±.04 Nm/°; theorized that the effectiveness of 0.53, p=0.02), and standard deviation P<.001), lace-up (.299±.22 Nm/°, ankle braces in reducing ankle sprain of TTBML (mean difference .145±.05 Nm/°; P=.001). Whereas, in risk is attributed to its ability to =0.51±1.16, 95%CI: 0.12-0.89, the NB condition, less inversion improve postural stability. However, p=0.01) during the braced condition, stiffness was found in the 0-2 Nm load the effects of ankle bracing on postural regardless of group. No significant range (.066±.02 Nm/°) than the 2-4 stability have been inconclusive, group main effects were found for any Nm load range .145±.02 Nm/°, especially in those with a history of of the TTB measures. Conclusions: P<.001). Conclusions: The braces we ankle sprain. Time to boundary (TTB) The increased mean TTBML in the tested lead to a significant reduction is a relatively new method to assess braced condition reflects an improved in maximal inversion rotation. The spatiotemporal postural stability. ability to maintain single limb balance. largest effects of the braces on Assessing balance performance using An increase in the TTBML standard inversion ROM of the ankle complex TTB may elucidate the effects of ankle deviation reflects a less constrained occurred in the low-load range. The braces on postural stability. sensorimotor system and an enhanced relative contribution of the brace to Objective: To examine the effects of ability to adapt to ML balance total stiffness in this region was high. ankle bracing on single limb balance perturbations. These improvements However, towards the extremes of in individuals with and without a history can potentially be attributed to motion, the ankle becomes greatly of ankle sprain using TTB measures. enhanced mechanical support in the stiffer than in its neutral zone. Design: Matched crossover design. mediolateral direction as well as Therefore, the relative contribution of Setting: Research laboratory. augmented proprioceptive feedback the brace to the total stiffness in this Patients or Other Participants: from cutaneous mechanoreceptors region is diminished. Objective Nineteen individuals with a history of while wearing the brace. Therefore, information on the amount and nature ankle sprain (AS) (20.4±1.9yrs, regardless of a history of ankle sprain, of passive support may assist athletic 170.2±7.0cm, 74.7±13.6kg), and 19 use of an ankle brace has a potential to trainers when recommending braces to age-, height-, and gender-matched improve balance performance. This their patients. control subjects (20.8±2.0yrs, may be one of the underlying 169.5±6.4cm, 75.6±15.9 kg) mechanisms for the prophylactic participated. Interventions: Each benefit of ankle bracing for new and/ participant attended two testing or recurring ankle injuries. sessions. Balance was assessed while wearing an ASO® brace in one session and without brace in the other. The order of testing was counterbalanced within each group. All participants performed 3 10-second trials of single-leg balance on their affected limb with eyes closed. Main Outcome Measures: TTB in anterior-

S-136 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Oral Presentations: Elbow Injury Case Thursday, June 27, 2013, 12:00pm-12:45pm; Palm D; Moderator: Ned Bergert, ATC, PTA/ 13183SC Osteochondral Lesion Of The Rotatary Instability, Olecranon Stress as the primary factor. Additionally, Elbow Trochlea In Collegiate Fracture, Triceps Tendonitis, ligament laxity has been speculated in Basketball Player Ostechondral lesion. Treatment: previous literature but was not relevant Yeargin BE, Rettig LA, Yeargin Athlete was referred back to the team in the current case. Conclusions: SW: Drayer Physical Therapy, orthopedist for follow up evaluation Terminal extension pain, a “catching” Columbia, SC; Methodist Sports after the competitive basketball sensation and lack of resolution with Medicine, Indianapolis, IN; season. X-rays were obtained and conservative treatment are key University of South Carolina, showed chondral changes within the indicators for a chondral injury. Columbia, SC trochlea. An MRI scan of the elbow Previous literature indicates the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 identified small loose bodies along possibility of increased range of Background: A 19yo Division I with chondral changes involving the motion losses when diagnosis is collegiate basketball point guard posterior trochlea of the humerus. The delayed. This was prevented in the presented with a 4 month history of patient underwent arthroscopic current case with follow up increasing elbow pain during the debridement of the osteochondral evaluations and imaging resulting in a competitive season. Pain was insidious lesion with microfracture and removal diagnosis. Arthroscopic debridement in nature and occurred with forced of loose bodies. Athlete was placed in and microfracture of the trochlea may terminal extension involving the right- a removable elbow brace for four be a viable option in these rare lesions dominate shooting arm. Outside of weeks. Rehabilitation included elbow and increase the likelihood of long basketball, pain occurred during active ROM exercises at day 1 post op term success. weight lifting while loaded in elbow and Scapulothoracic stabilization flexion > 90 degrees (e.g. bench press, exercises. Athlete was progressed to hang cleans) as well as with heavy elbow specific strengthening exercises single arm rows. Examination at 6 weeks. He regained full range of demonstrated loss of terminal elbow motion and strength by 8 weeks extension with reproducible pain along following the arthroscopic procedure. the posterolateral joint line. At 3 months post-op, the patient Tenderness and pocket effusion were returned to full court participation. evident over the same region. The Clinical evaluation at two years post- athlete described an occasional op, demonstrated maintenance of full “catching” sensation. There was no range of motion of the elbow without visual deformity or incongruence of pain or effusion. Final follow-up anatomical landmarks. The cubital radiographs were unremarkable. carrying angle was normal for a male Uniqueness: Osteochondral injuries and there was no previous elbow, nor involving the elbow are most shoulder, trauma. Collateral commonly identified within the ligamentous tests were negative. capitellum. Trochlear osteochondral Neurological screen was normal. defects are uncommon. The area is Within the first month of pain hypovascular due to lack of artery presentation, the athlete was evaluated anastomosis. Previous case studies by the team orthopedist. Although an typically involve males but occur osteochondral injury was suspected, earlier in adolescence. Predisposing xrays taken at the time were factors in the current case were unremarkable. After educating the minimal, with only repetitive extension athlete about the suspected injury, he decided to treat conservatively and re- evaluate after the season. During the 4 months of conservative treatment, attempts to manage symptoms were made with modalities and weight room modifications. Differential Diagnosis: Valgus Extension Overload Syndrome, Posterolateral

Journal of Athletic Training S-137 Chronic Elbow Injury in who ordered an MRI which revealed competitive pitching. Conclusions: Intercollegiate Baseball Pitcher marrow edema, with a coronoid This case highlights extensive Whetstone JM, Felton SD, process fracture. Conservative treatment and rehabilitation of an Mullaney KP, Albritton, DL: Florida treatment was initiated without athlete suffering from chronic stress Gulf Coast University, Fort Myers, success; thus, Team Physician fractures of the coronoid process. This FL proceeded with surgical intervention. case is extremely unique due to the Surgery identified coronoid as an low incidence of initial and recurring Background: A 20-year-old intact structure and three coronoid process stress fractures. This collegiate left handed baseball pitcher microfractures were drilled into case exhausted both conservative and presented at beginning of academic coronoid to initiate a healing process. surgical treatment options with Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 year to Certified Athletic Trainer Following surgery he was immobilized minimal success. The case (ATC) stating he suffered a coronoid for 10 days, with restriction from demonstrates need for ATCs to stress fracture during summer league active biceps activities for 1 month. He appreciate complexity of injuries participation. ATC evaluation revealed began rehabilitation, restoring ROM associated with elite throwing athletes no edema, full active ROM compared and strength. Approximately 3.5 and understand that although bi-laterally; however, athlete presented months post-surgery, he was cleared conventional rehabilitation would be with a 10 degree extension lag. Athlete for throwing. Athlete completed ITP successful with most athletic had full strength with no reported and was granted full clearance. He had populations, the demands of the sport neurological or circulatory issues a successful fall and spring training, ultimately played an essential role in noted. Valgus and Varus Stress tests and started second game of the season, determining final outcome of this case. were (-) with solid endpoints, (+) but felt pain in his elbow. ATC Athlete was unable to continue sports Valgus Extension Overload test. In examination revealed swelling over participation and efforts were focused consultation with Team Physician, posterior elbow, pain with ROM, on maintaining activities of daily rehabilitation program was initiated. AROM 30-100 degrees, (-) living. Differential Diagnosis: Lateral ligamentous stress tests. Athlete Epicondylitis, Osteochondritis referred to Team Physician who Dissecans, Valgus Extension ordered MRI revealing marrow edema Overload, Olecrannon Stress Fracture, involving coronoid process. He was Process Stress Fracture. Treatment: withheld from participation for 6 Initial treatment included six weeks of weeks and began another rehabilitation non-activity. During this time, an program. After 6 weeks, athlete had full extensive and detailed rehabilitation elbow ROM and strength. ATC could focused on ROM and strengthening not elicit pain with special tests. At this exercises. Exercises included wrist time, he began ITP, reporting minimal flexion/extension, pronation/ soreness. Athlete returned for last supination, grip strength, and elbow game of season pitching successfully. flexion/extension exercises steadily However following game, athlete progressing resistance each week. reported to ATC complaining of Shoulder exercises included scapular similar pain as initial evaluation. stabilization, proprioception, and Uniqueness: Coronoid fractures are rotator cuff exercises with weekly typically associated with posterior progression. After six weeks of pain elbow joint dislocations with an free rehabilitation, he was cleared for occurrence rate of approximately the interval throwing program (ITP) 10%. Through an extensive literature and light strength training. After search, a coronoid stress fracture is completing ITP, no edema or pain extremely rare and data supporting noted. ROM and strength were WNL their occurrence is limited. This case and was granted full clearance. While highlights the challenges of a coronoid scrimmaging one week later, he stress fracture in an elite throwing reported similar pain as initial injury athlete when applying conventional to ATC were examination revealed stress fracture protocols. Athlete posterolateral pain with extension. would respond well to rehabilitation Athlete referred to Team Physician until his scheduled return to

S-138 Volume 48 • Number 3 (Supplement) May 2013 13043FC Dynamic Ulnar Impaction ulnar impaction syndrome. impaction syndrome should be Syndrome In A Collegiate Treatment: Six months after the considered in patients with ulnar-sided Baseball Player: A Case Report second arthroscopic surgery, another wrist pain, especially in athletes who Baer DJ: University of Pittsburgh, MRI revealed grade 4 chondrosis of participate in club or racquet sports. Pittsburgh, PA, and West Chester the proximal lunate. Because all Recognition and understanding of University, West Chester, PA previous X-rays had shown normal ulnar impaction syndrome and dynamic ulnar variance with the forearm in a ulnar impaction syndrome may lead to Background: A 20-year-old NCAA neutral rotation, a pronated grip X-ray more effective treatment and diagnosis Division-I male baseball player was also taken, revealing a positive of patients who suffer from ulnar- reported a gradual onset of dorsal ulnar variance in that position. To sided wrist pain. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 ulnar-sided left wrist pain in the spring avoid compromising the integrity of 2007 baseball season. Chief the distal radioulnar joint (DRUJ) and complaints included pain with the TFCC with another arthroscopic pronation, supination, and ulnar surgery, an extra-articular procedure deviation, as well as increased pain with called an ulnar shortening osteotomy batting, due to the excessive and was performed to decompress the forceful ulnar deviation during this ulnocarpal joint and tighten the motion. Strength and range of motion extrinsic ulnocarpal ligaments to (ROM) were equal bilaterally. An MRI provide additional stability to the revealed soft tissue edema near the DRUJ. After this third surgery, the base of the third metacarpal and bone patient was able to return to full marrow edema at the triquetrum and participation in baseball practice and lunate. There was no radiographic training until a knee injury prevented evidence of a triangular fibrocartilage his return to competition. complex (TFCC) tear. Following Uniqueness: Using traditional X-ray unsuccessful conservative treatment, with the wrist and forearm in a neutral the patient opted for exploratory wrist position, the patient showed no arthroscopy in which a large chondral indication of positive ulnar variance, defect was found and debrided from which is usually an underlying cause the lunate. Following rehabilitation and of ulnar impaction. Although positive full return to play, the patient ulnar variance is often congenital, this continued to experience persistent case presents strong evidence that it ulnar-sided left wrist pain with wrist can also occur during functional or flexion, ulnar deviation, and forearm dynamic tasks, as the space between pronation during batting and fielding. the distal ulna and the carpal bones Fourteen weeks after the first surgery, diminishes with pronation and a second exploratory wrist arthroscopy gripping. X-rays taken in this prone, revealed that the proximal articular gripping position were important in surface of the lunate had healed, but confirming the diagnosis of “dynamic” the new hyaline cartilage had already ulnar impaction syndrome because the frayed and required debridement. A baseball player’s grip of the bat is large type I-B (dorsal ulnar) TFCC tear mimicked, and when ulnar deviation is was also found and repaired using an added during the baseball swing, the outside-in technique. Following a already decreased space between the gradual activity progression and return ulna and carpal bones becomes even to functional activities, the patient smaller as the structures in this space again complained of dorsal ulnar-sided are impinged. Conclusions: Because left wrist pain, despite having full of the variety of pathologies that can strength and full ROM. Differential occur at the wrist, differential Diagnosis: TFCC tear, lunotriquetral diagnosis of patients with idiopathic ligament sprain, extensor carpi ulnaris wrist pain can often be difficult. Even tendinopathy, chondromalacia of the in individuals who do not present with lunate or ulna, Kienböck’s disease, a positive ulnar variance on traditional ulnar impaction syndrome, dynamic radiography, a diagnosis of ulnar

Journal of Athletic Training S-139 Free Communications, Oral Presentations: Non-Mechanical Factors Associated with Injury Thursday, June 27, 2013, 3:15pm-4:30pm; Palm D: Moderator: Reed Ferber, PhD, ATC 13068SOIN 13027FOIN Epidemiology Of Basketball, calculated for each sport and across all Patients With Osteoarthritis Soccer And Volleyball Injuries sports. Injury rate was calculated for And A History Of Sport At The Middle School Level specific types of injuries within each Participation Consume More Barber Foss KD, Myer GD, Hewett sport. Results: A total of 134 injuries Medication And Supplement For TE: Cincinnati Children’s Hospital were recorded by the ATC over the Managing Joint Symptoms Than Medical Center, Cincinnati, OH three sport seasons. Basketball had the Patients With Osteoarthritis most reported injuries at 84 (52% And No History Of Sport Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: There are an estimated 30 risk), followed by Volleyball with 38 Participation: A Cross-sectional million school aged kids participating (47.5%) and then soccer with 12 Study in sports in the United States. This (46.1%). The overall rate of injury for Driban JB, Boehret SA, represents a greater than 20% increase basketball was 4.20 per 1000 AE for Balasubramanian E, Cattano NM, over the past decade. Of these 30 games and 2.24 per 1000 AE in Glutting J, Sitler MR: Tufts Medical million participants, 34% of middle practice. Soccer game rate was 9.05 Center, Boston, MA; Temple school aged participants become per 1000 AE and 5.27 per 1000 AE in University, Philadelphia, PA; injured and seek medical treatment at practice. The injury rate in volleyball Temple University Hospital, an annual cost of close to $2 billion. was higher for practice (5.55 per 1000 Philadelphia, PA; West Chester Middle School athletics show AE) than for games (0.75 per 1000 AE). University, West Chester, PA; increasing need for services provided The relative risk of injury was more University of Delaware, Newark, by a certified athletic trainer (ATC). than twice as high in soccer compared DE Objective: To describe the to basketball. Injuries to the knee were epidemiology of injuries documented the most common (99 injuries out of Context: Osteoarthritis is prevalent in the middle school setting over the 134 or 73.9%) of which PFD (31.3%), among athletes with a history of joint course of three sport seasons. Design: OSD (10.4%) and SLJ/patella trauma or participation in high-risk Cohort Study. Setting: Middle School tendonosis (9%) had the greatest sports. To provide better care for this and Controlled Laboratory. Patients or incidence. Ankle was the second most patient population we need to Other Participants: Female basketball, commonly injured body part understand how patients with and soccer and volleyball players were accounting for 16.4% of all injuries. without a history of sport participation recruited from a single county public Conclusions: Middle school aged (HxSP) manage joint symptoms. school district in Kentucky consisting athletes displayed comparable injury Objective: The purpose of these of five middle schools. A total of 268 patterns to those seen in their high analyses was to determine if patients subjects (162 basketball, 26 soccer and school counterparts. Future work is with and without a HxSP consume 80 volleyball) participated as entire warranted to determine the potential medications/supplements differently teams, resulting greater than 95% for improved outcomes in middle to manage joint symptoms. Design: recruitment and data monitoring. school populations with access to ATC Secondary analysis of a cross- Interventions: Athletes were monitored services. sectional study (Driban et al., BMC for sports related injury by an ATC Musculoskelet Disord. 2012). Setting: during each sports season. Injury was Urban hospital-based outpatient operationally defined as causing orthopedic practice. Patients: We cessation of participation in the recruited a convenience sample of 184 current game or practice and prevented patients with a primary complaint of return to that session or the day hip or knee osteoarthritis (22 patients following and any fracture, even if the were excluded or declined to athlete did not miss a session. Athlete participate). Hence, 162 patients were exposures were recorded on a weekly included. The sample included 70 basis. Exposure data was submitted by (43%) patients without a HxSP: 79% the coach into the SISS (Sports Injury female, 77% African descent, 58±10 Surveillance System). Injuries were years old, body mass index=34.7±7.2 recorded in SIMS (Sports Injury kg/m2, 36% less than a high school or Monitoring System). Main Outcome equivalent education, and 51% Measures: Athlete risk of injury was reported a diagnosis of arthritis at

S-140 Volume 48 • Number 3 (Supplement) May 2013 multiple joints. Additionally, 92 (57%) more efficacious treatments for Sleep Quantity, Sleep Quality patients had a HxSP: 58% female, patients with a HxSP we need to find and Daytime Sleepiness 70% African descent, 61±11 years old, new strategies to better educate and Assessment in Collegiate body mass index=35.7±8.2 kg/m2, communicate with HxSP patients Athletes 21% less than a high school or about safe medication use. Dettl MG, Ragan BG: Ohio equivalent education, and 63% University, Division of Athletic reported a diagnosis of arthritis at Training, Athens, OH multiple joints. Most HxSP patients competed at the recreational (35%) or Context: Sleep is an important high school (47%) level. component of health and can affect Interventions: One trained investigator normal psychological and Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 administered four interview-based physiological function. Poor sleep has questionnaires to obtain information been associated with suboptimal about the participant’s health history, athletic performance therefore it is sport participation, and pharma- important for athletic trainers to cological/supplemental use. The assess sleep in patients. There are 3 questionnaires were developed by the main characteristics associated with research team and reviewed by two sleep assessment: quality, quantity, and statisticians. Main Outcome daytime sleepiness. Currently, there is Measures: The questionnaires were an scant research in athletic training item-by-item design where each examining the relationship between question could be scored individually. these characteristics in collegiate We used Fisher Exact Tests and athletes. Objective: To examine the logistic regression models to relationship between the 3 determine if a HxSP was associated characteristics of sleep in female with patterns of medication/ collegiate athletes. Design: Cross- supplement use. Odds ratios (OR) and sectional. Setting: Clinical athletic 95% confidence intervals (CI) were training setting at a NCAA Division I calculated. Results: Patients with a institution. Participants: A total of 43 HxSP (49%) more often consumed >2 female student athletes (Age: mean ± medications/supplements for their SD: 19.57 yrs ± 0.86) volunteered for joint symptoms than patients without this study. Power analysis for a a HxSP (29%; OR=2.4, 95%CI=1.3 to correlation of 0.3 with a power 0 of 4.6). This was true even after adjusting 0.80 indicated a sample size of 42. for gender, education, ethnicity, or Intervention: Participants wore an reported diagnosis of arthritis at accelerometer to assess sleep quantity multiple joints. Both groups on their wrists while sleeping for 7 occasionally or never consumed their consecutive nights. At the end of the medication consistently (with data collection period, participants HxSP=44%, without HxSP =44%; completed computer adaptive p=1.00). Finally, patients with and PROMIS sleep-related impairment without a HxSP (15%, 18%; (SRI: daytime sleepiness) and sleep respectively) had a similar frequency disturbance (SD: sleep quality) of patients reporting their medication instruments. Validity of these sleep as ineffective or required a stronger measures has been well established in medication to manage joint symptoms. other disease populations. Main Conclusions: Similar to findings that Outcome Measures: The dependent current and retired football players variables were T scores from the SRI, may misuse analgesic medications we SD, and the 6 accelerometry variables. found that patients with a HxSP may Using the ActiLife5 software, the consume more medications to manage Sadeh algorithm was used because of their joint symptoms than patients the age of the population. The without a HxSP. To promote safer and algorithm produced the 7-day average

Journal of Athletic Training S-141 13310MOTE of the six key accelerometry sleep Relationship Between injury mood disturbance and perceived variables: latency (L), total sleep time Rehabilitation Related Mental stress. Results: Mean ± SD for the (TS), time awake (TA), number of Toughness, Mood, And Anxiety surveys are as follows: Profile of awakenings (A), average awakenings After Injury Mood States total mood disturbance (AA), and sleep efficiency (SE). Caswell A, Ragan BG, Snook EM: (27.27 ± 1 3.52), Perceived Stress Relationships between the 3 University of Massachusetts Scale (17.59 ± 7.13), and characteristics were examined using Amherst, Amherst, MA; Ohio MeBRecover (130.78 ± 13.08). Spearman Rho correlations. The University, Athens, OH; Datalys Mental toughness levels were PROMIS scores were expected to have Center for Sports Injury Research significantly correlated with total negative correlations with SE and TS and Prevention, Indianapolis, IN mood disturbance (r = -.47, p = .007) Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and to have positive correlations with and perceived stress (r = -.52, p = A, AA, TA, and L. Alpha was set at 0.05. Context: Many elite athletes .002), indicating that higher levels of Results: There were significant experience mood disturbances (e.g., mental toughness were associated with correlations between SRI and SD (r = depression) and stress after being less mood disturbance and stress after .42; P<0.05) and SD and TS (r = -0.31; injured during practice or competition. injury. Conclusions: This research P<0.05). There were no other These negative psychological provides evidence of relationship significant correlations. The sleep reactions to injury can reduce between mood disturbances, stress, quantity scores (mean ± SD) were: L adherence to rehabilitation protocols and mental toughness after injury. = 9.56 ± 9.24 min, TS = 391.67 ± 56.02 impacting recovery outcomes. Mental Mental toughness is a potentially min, TA = 95.34 ± 10.26 min, A = toughness has been shown to be modifiable variable. The results of this 19.48 ± 5.16 times, AA = 3.65 ± 1.31 associated with better adherence to research suggest that an intervention min per time, and SE = 85 ± 5.69 rehabilitation protocols, however the aimed at modifying mental toughness percent. SRI mean score (T score) was relationship between mental may have a positive impact on 56.1 ± 5.76 and SD was 51.88 ± 7.19. toughness and psychological variables psychological responses to injury and Conclusion: Our results indicate that after an injury has occurred has yet to potentially improve rehabilitation the three important characteristics of be examined. Objective: To determine adherence and outcomes. sleep in a collegiate population are the relationships among mental independent of each other and need to toughness, mood state, and anxiety in be assessed individually. Athletic injured collegiate athletes. Design: trainers should be aware that sleep Cross-sectional. Setting: NCAA quality, sleep quantity, and daytime Division I athletes at a public sleepiness should be assessed and university. Patients or Other PROMIS adaptive instruments and Participants: Thirty-four (n = 15 accelerometry together provide a females) collegiate athletes (20.0 ± clinically useful and easy way of 1.6 years of age) from 8 varsity sports measuring sleep. injured during practice or competition. Interventions: Injured athletes provided informed consent and then completed the study surveys on a laptop in the athletic training room. The surveys completed assessed mental toughness (Mental, Emotional, and Bodily Toughness Inventory for Rehabilitation [MeBRecover]), mood disturbance (Profile of Mood States), and perceived stress (Perceived Stress Scale). Main Outcome Measures: Pearson product-moment correlation coefficients (r) were calculated among the total scores from the surveys to determine if mental toughness was associated with post-

S-142 Volume 48 • Number 3 (Supplement) May 2013 13382FOIN Return-To-Play Probability intervals (1-2 day return, 3-6 days, 7- Estimates Are Affected By 9 days, 10-21 days, > 22-days, no Which Knee Ligament Is Injured return [censored]). Alpha levels were Medina McKeon JM, Adkins SG, set at p<.05. Results: A total of 1,332 Bush HM, Comstock RD: new, single-ligament knee sprains were University of Kentucky, Lexington, considered for analysis (ACL=340 KY, and Research Institute at [227 censored], PCL=35 [12 Nationwide Children’s Hospital, censored], MCL=799 [168 censored], Columbus, OH LCL=158 [31 censored]). There was a significant difference in median T- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Knee sprains are the second RTP amongst each ligament most common sports-related injury; (P<.0001). The median T-RTP for tissue damage alone is not a precise ACL=22 days (IQR=22,22); PCL=10 indicator of when an athlete will days (IQR=3,22); MCL=10 days return-to-play (RTP). Objective, (IQR=3,22); LCL=7 days (IQR= evidence-based estimates of RTP 3,22). Selected results are presented following a knee sprain are needed. to highlight characteristics of the KM Objective: To determine RTP curves generated. The T-RTP probability timelines amongst the 4 probability [exact 95% confidence major ligaments of the knee following intervals] of return by 7-9 days for an a sprain. Design: Observational, injury to the ACL=8.3% [5.8,11.8]; epidemiological. Setting: Secondary PCL=31.7% [18.9,49.9]; MCL= data analysis of High School RIO™ 39.3% [36.0,42.8]; LCL=51.9% database. Patients or Other [44.4,59.9]. The probability of return Participants: High school athletes by 10-21 days for an injury to the with knee sprains sustained during ACL=15.5% [12.1,19.1]; PCL= school-sanctioned athletic partici- 52.5% [37.0,69.7]; MCL =65.4% pation (mean±SD: age=16.0 ±1.2yrs, [62.1,68.7]; LCL=72.0% [64.9,78.9]. height =177.3±10.2cm; mass= 77.5 The lowest probability of return at ±18.7kg). Interventions: New knee every timepoint was due to ACL injury. sprains were classified by which Curves for the MCL and LCL indicated ligament was documented as injured: the highest probabilities of return at anterior cruciate (ACL), posterior all time points. Conclusions: RTP cruciate (PCL), medial collateral after a single ligament injury is (MCL), lateral collateral (LCL). Only affected by which ligament was single-ligament injuries were damaged. As expected, ACL injuries considered for analysis. A new injury had the highest proportion of censored was defined as an acute knee sprain cases, and the least likelihood to RTP with no prior history of that same at all time points following injury. The injury. Main Outcome Measures: likelihood of RTP following MCL or Kaplan-Meier(KM) estimators LCL injuries was far higher than that [censored data] were stratified by of the cruciate ligaments. RTP ligament damaged and used to probabilities can assist clinicians with statistically compare the probability of providing accurate prognoses for time until RTP (T-RTP) after new knee athletes, in particular when surgery is sprain for each ligament. Cases for not likely to be indicated. Further time- which the athlete did not RTP (medical to-event analysis of combination- disqualification or season ended ligament injuries is warranted. before the athlete was released) were considered censored. For the estimators, each knee sprain was analyzed based on RTP status (return, no return) at specified timeframe

Journal of Athletic Training S-143 Free Communications, Poster Presentations: Undergraduate Poster Award 13212UOPRFinalists 040UOMU

The Effects Of Ankle Kinesio anterior ankle. Main Outcome Comparison Of Gluteus Medius Taping On Muscle Activity Measures: Peak force (N) from Activation Between Weight During A Drop Landing landing was compared with a repeated- Bearing And Non-Weight Maneuver measures ANOVA with one within- Bearing Limbs During A Fayson SD, Needle AR, subject factor (Condition). Average Functional Assessment Of Kaminski TW: University of EMG (% ensemble peak) was Hip Abduction Strength Delaware, Newark, DE calculated 250ms prior to landing Baellow AL, Nguyen A, Boling (PRE), 0-250ms (POST-1) and 250- MC: High Point University, High 500ms (POST-2) after forceplate Point, NC, and University of North Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Kinesio tape (KT) has contact. EMG measures were Florida, Jacksonville, FL recently gained popularity in the compared with a 3-way ANOVA wih prevention and treatment of athletic three within-subject factors Context: Decreased function of the (Condition, Muscle, Time). Results: injuries, specifically in the lower gluteus medius (Gmed) leading to extremity. Previous research has No significant differences were dynamic lower extremity supported increases in ankle stiffness observed for peak force malalignments has been suggested to with use of KT; however, it is unclear (F2,40=1.349, BL=1809.5±824.6N, increase the risk of knee injuries. whether this is a result of increased KT-I=1758.0±784.5N , KT-24= However, the relationship between 1911.6±1060.0N , p=0.27). A muscle activation or the mechanical Gmed function and dynamic lower properties of the tape. Objective: To significant interaction effect for extremity motion remains unclear. examine the immediate and prolonged average EMG was observed between This may be attributed to the effects of KT application at the ankle condition, muscle, and time measurement methods of hip on lower-leg muscle activity during a (F8,160=4.19, p<0.001). Pairwise abduction function that are commonly drop landing. Design: Single group comparisons revealed TA activity at performed in side lying, non-weight pre-test, post-test. Setting: Climate- POST-1 decreased from BL bearing positions, which may not (62.2±14.1%) to KT-I (48.1±24.5%, controlled biomechanics laboratory. accurately reflect Gmed function during Patients or Other Participants: p=0.027), and trended toward a weight bearing, functional activities. decrease at KT-24 (47.7±26.2%, Twenty-two subjects (20.0±1.4yrs; Assessing Gmed function in a functional 72.0±9.8kg; 170.0±14.9cm) with no p=0.054). Furthermore, PL activity at position may require greater activation history of ankle pathology volunteered POST-2 decreased from BL to stabilize the pelvis in a single limb for this study. Interventions: Subjects (46.9±23.5%) to KT-24 (27.3±23.5%, stance. Objective: To examine the p=0.022). Conclusions: Our data were asked to jump from a 35cm box differences in Gmed activation between on to an in-ground forceplate and demonstrate a decrease in TA and PL the weight bearing (WB) and non- immediately jump to a height equal to muscle activity with KT application. weight bearing (NWB) limb during a 50 percent of their maximum vertical While this effect appears undesirable, functional assessment of hip abduction jump. Surface electromyography as no changes in peak force were strength. Design: Descriptive (EMG) was collected from the tibialis observed, these results could suggest laboratory study. Setting: Research anterior (TA), peroneus longus (PL) that individuals were able to maintain laboratory. Patients or Other and lateral gastrocnemius (LG) performance level with less muscle Participants: Twenty (10 males, 10 muscles and synchronized at 1000Hz activity. While previous research has females) healthy collegiate aged with forceplate data. Five trials were reported both muscle facilitation participants (24.9±3.9 yrs, 171.7±7.9 collected under each of 3 conditions: and inhibition following KT use, few cm, 71.6±14.9 kg) volunteered for this prior to ankle KT application (BL), have studied these variables with a study. Interventions: Gluteus medius immediately after tape application of measure of performance or joint surface electromyography signals (KT-I), and following 24-hours of use mechanics. To investigate whether this (sEMG) of the WB and NWB limb (KT-24). Kinesio tape application muscle inhibition is beneficial were measured as participants followed techniques reported in or detrimental, future studies might performed 3 standing hip abduction previous research, using an anterior test the effect of KT on muscle maximum voluntary isometric strip applied distal to proximal, a activation and performance during a contractions (MVIC) of the right and stirrup applied from medial to lateral, more complex landing task. left limbs (hip abducted 5°) on an and transverse strip applied over the isokinetic dynamometer. Excellent

Journal of Athletic Training S-145 13048UC day-to-day reliability of torque Metabolic Disorder In A physician further disqualified the production was previously Collegiate Football Player patient and instructed the athletic demonstrated for this standing Peters J, Rothbard M, Nelson training staff to monitor his condition. measure (ICC2,k=0.91, SEM=0.03 C: Southern Connecticut State Status-post 11 weeks, blood tests Nm·kg-1). Main Outcome Measures: University, New Haven, CT revealed that the patient’s CK levels The maximum root mean squared remained elevated (914U/L). The amplitudes (volts) of the WB and Background: A 17 year-old African- patient was diagnosed with non- NWB G across 3 trials were used med American male (179.8cm, 79.4kg) anesthesia malignant hyperthermia for analysis. Paired samples t-tests presented to the athletic trainer with because he continued to demonstrate determined the difference between thirst, fatigue, shortness of breath, hyper-CK-emia for which the etiology G activation of the WB and NWB Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 med dizziness, muscle pain, cramping, and remained unclear. The absence of a limbs. Results: The maximum root weakness shortly after completing muscle biopsy and subsequent caffeine mean square amplitudes during right sprints during an August halothane contracture test, which is hip abduction MVIC for the WB and intercollegiate football practice. On- only offered at five centers in the US, NWB G were 0.369±0.205 and med site evaluation by the athletic trainer created an inability to identify the 0.275±0.155 volts, respectively. The identified confusion, tachycardia, etiology of the case and prevented a maximum root mean square respiratory distress, significant loss of definitive diagnosis. The patient was amplitudes during left hip abduction extremity motion, and inability to self- cleared for unrestricted activity by the MVIC for the WB and NWB G were med ambulate. The patient’s medical history team physician and was instructed to 0.375±0.216 and 0.262±0.183 volts, was significant for a cramping and report any changes in health status to respectively. The maximum root mean vomiting episode associated with the athletic training staff. Uniqueness: square amplitudes of the WB G was med summer football camp at age 15, and Malignant hyperthermia is rare, significantly higher than the NWB G med sickle cell trait. Differential although its prevalence has not been during both right (paired difference = Diagnosis: Exertional heat stroke, established due to a lack of universal 0.090 volts, P<0.001) and left (paired rhabdomyolysis, sickle cell crisis, reporting. This case is unique because difference = 0.097 volts, P<0.001) McArdle disease, Tarui disease, and the presence of the hematological and hip abduction MVIC. Conclusions: malignant hyperthermia. Treatment: metabolic conditions that manifested, Activation of the G was greater on med After initial evaluation, an immediate in conjunction with the inability to the WB compared to the NWB limb attempt to orally rehydrate and rapidly obtain the necessary diagnostic when assessing hip abduction MVIC in cool the patient was performed by the testing, made the definitive diagnosis, a functional, WB position. In order for athletic training staff. EMS was management, and return to activity the NWB limb to produce an abduction activated and administered on-site IV clearance complex. Also, blood CK force, greater activation of the WB fluids and transported the patient to the levels normally range from 22 to 198 G may be necessary to meet the med emergency department. Upon arrival at U/L, depending on gender, activity increased demand to stabilize the the hospital, blood tests were ordered, level, and ethnicity. This patient’s CK pelvis and trunk. Assessing hip revealing changes in electrolyte levels levels were 23 times normal and he abduction MVIC in a more function- and blood chemistry. Creatine kinase continued to demonstrate hyper-CK- al position may be a more accurate (CK) levels were significantly elevated emia status-post 11 weeks, for which representation of G function when med (2540 U/L). At the hospital, the patient the etiology remained unclear. A lack examining the role of the hip was stabilized, prescribed Dantrium® of research exists about the safety of abductors in controlling lower for two weeks, instructed to follow up athletic participation and clinical extremity motion during dynamic with his health care provider, and interventions associated with activities and their contribution to the released. After following up with the malignant hyperthermia. Conclusion: increased risk of knee injuries. athletic trainer, the patient was referred Malignant hyperthermia is a rare, to the team physician who ordered life-threatening, inherited hyper- additional blood tests and restricted metabolism syndrome characterized the patient from athletic participation by muscle abnormality triggered by while awaiting results. Status-post two anesthesia, muscle relaxants, intense days, CK levels remained elevated exercise, and/or hyperthermia. In non- (1710 U/L) and the patient was anesthetic malignant hyperthermia subsequently referred to a neurologist, cases such as this, an abnormal nephrologist, and cardiologist. All ryanodine receptor in skeletal muscle examinations and additional diagnostic affects function when until exposed to testing was inconclusive. The team

S-146 Volume 48 • Number 3 (Supplement) May 2013 13361UOIN intense exercise or hyperthermia. A Determination Of Microbial over similar locations on the newer biochemical chain reaction begins that Populations In A Synthetic turf), as well as in areas of high traffic causes abnormal release of calcium Turf System such as the sidelines. This suggests from the sarcoplasmic reticulum. This Hintze D, Bass J, Oberg C: microbial populations can accumulate then results in excessive calcium in Weber State University, Ogden, in synthetic turf infill from year to skeletal muscles, leading to sustained UT year. When comparing the bacterial muscle contractions and an increase in load on different areas of the field, the muscular metabolism. ATP depletion Context: There is growing concern sideline has the highest counts with an is then followed by rhabdomyolyses, regarding the contribution of infilled average of 1.60E+08 CFUs per gram which causes the release of potassium turf fields on athlete infections. of rubber infill on the older turf. On Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and myoglobin into the blood stream. Abrasions that occur on these fields the new turf, the area with the highest Ultimately cardiac abnormalities and create a portal of entry for pathogens number of total microorganisms was renal dysfunction result. Such cardiac such as Staphylococcus aureus. the end of the field rather than the and renal complications include Objective: This study compared the sideline, with an average of 3.09E+05 metabolic and respiratory acidosis, occurrence of microbial populations CFUs per gram of infill. This is heat production, sympathetic nervous on two infilled turf fields (year old turf probably due to practices held on the system activation, hyperkalemia, and in stadium vs. 6 year old turf in practice stadium turf field rather than actual blood coagulation irregularity. field) in three locations on each field. game play. A high number of salt- It was hypothesized that the older turf tolerant, mannitol fermenting bacteria field will contain higher microbial (indicators of S. aureus) were also populations, therefore, presenting found, an average of 3.25E+02 CFUs greater risk. Design: Infill material per gram on the new turf and 2.73E+ from both fields was sampled weekly 03 CFUs per gram on the older turf. at each site for 5 months through the Escherichia coli was isolated using football season with microbial EMB agar on the newer turf, in an enumeration done on three selective area of high usage. Conclusions: media. Setting: Sites sampled include These results indicate that infill the sideline, the middle of the field, material can serve as a source for and the end of the field on both fields. the spread of pathogens among Interventions: Tryptic Soy Agar will athletes and that these organisms seem be used to determine total microbial to accumulate over time posing load, Mannitol Salt Agar for S. aureus, a greater risk if proper cleaning and Eosin Methylene Blue Agar to is not routinely performed. determine the number of coliforms such as Escherichia coli. Main Outcome Measures: A comparison was done between the two fields at each site to determine differences between microbial loads. Means at each site were determined and compared both for each sample time and over the test period. Results: Higher microbial populations were found on the older turf field (as much as a 1E+04 increase

Journal of Athletic Training S-147 13220UOBI

Velocity And Acceleration Of dimensional motion system with two, by the Eastern Athletic Trainers’ The Head During Emergency three-point segment marker sets (head Association and the Hamel Center Shoulder Pad Removal and torso) were used in capturing head for Undergraduate Research. Hall BT, Swartz EE, Al-Darraji SJ, and torso motion. Kintrak 6.0 and Eva- Bric JD, Decoster LC, Mihalik JP: RT 5.0 (Motion Analysis, Inc.) University of New Hampshire, software was used to digitize motion Durham, NC; New Hampshire trials and process the outcome Musculoskeletal Institute, variables. Main Outcome Measures: Manchester, NH; University of Dependent variables involved North Carolina, Chapel Hill, NC integrated velocity and integrated acceleration of the head in each of the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: As American football three planes (sagittal, frontal, equipment designs introduce new transverse). Trials for each pair were technology to improve safety, ensemble averaged. Due to our evidence-based techniques for their participant pairing, our analyses were emergent removal must coincide. based on a sample of n=20. Six paired Previous research in emergency samples t-tests compared means in removal of shoulder pads has each plane (Pd”0.05). Results: investigated the time for removal and Removing traditional shoulder pads the induced motion within the cervical resulted in significantly less spine. Velocities and accelerations of acceleration compared to removing TM the head and cervical spine during RipKord shoulder pads in the sagittal [(t = -4.404,P<.001) Trad these interventions are important 19 2 considerations that have not been =1964.53 ±639.01 m/s , Rip= 2 extensively studied. Objective: To 2915.47±780.02 m/s ], and frontal [(t = -2.620, P=.017) Trad= examine head velocity and 19 2 acceleration when removing two 842.32±336.22 m/s , Rip=1255.55 2 styles of football shoulder pads. We ±566.91 m/s ] planes. Removing hypothesized that a new quick release traditional shoulder pads also resulted style of shoulder pads would result in in significantly less velocity in all three planes [[(t = -4.194, P<.00) less acceleration and velocity at the 19 head during shoulder pad removal. Trad=94.63±23.44m/s, Rip= 136.07 ±38.49 m/s; (t = -3.822, P=.001) Design: Quasi-experimental. Setting: 19 Research laboratory. Patients or Trad=35.60 ±8.22 m/s, Rip= 49.30±15.01 m/s; (t = -2.632, Other Participants: Forty certified 19 athletic trainers (ATs) free of physical P=.016) Trad= 55.83±16.74 m/s, pathology preventing them from Rip=70.60±20.55 m/s]. Conclusions: completing the required tasks were Our hypotheses were rejected in that recruited (males=21; females=19; the data presented suggest that when age=33.7±11.2 yrs; mass=80.7±17.1 using the flat torso technique, a kg; height=173.1±9.2 cm; AT traditional style of shoulder pads will experience=10.6±10.4 yrs). Inter- result in lower velocity and ventions: The independent variable acceleration of the head compared to TM was the shoulder pad design the RipKord shoulder pads. This (Traditional or Riddell RipKordTM). data does not reflect the amount of After practicing and familiarizing motion experienced in the cervical themselves, paired participants spine at time of removal. Future conducted 8 successful, randomized research should investigate these trials where they removed traditional variables in different styles of (Trad) shoulder pads (using the flat shoulder pads using other removal torso technique) or RipKordTM (Rip) techniques (i.e., full body levitation, shoulder pads from a live model (4 torso lift). This study was funded trials of each). An eight-camera three-

S-148 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Poster Presentations: Master’s Poster Award Finalists 13417MOHE

Career And Family Aspirations Professionally, many FATs were Patient-Centered And Clinical Of Female Athletic Trainers unsure of their longevity within the Outcomes Associated With Employed In The NCAA Division collegiate setting or even the Grade II Lateral Ankle Sprains: I Setting profession itself, the major stimuli A Case Series Clines SH, Mazerolle SM, Ferraro included job demands and time. Only Mulligan RP, Mutchler J, Hoch EM, Barone CM, Goodman A: 3 FATs indicated a professional goal MC, Van Lunen BL: Old Dominion University of Connecticut, Storrs, that included persisting at the Division University, Norfolk, VA CT I setting regardless of their family or marital status. Six FATs plan to depart Background: The purpose of this case Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Evidence suggests that the profession entirely due to conflicts series is to describe the clinical and female athletic trainers (FAT) depart with motherhood and the role of the patient-centered outcomes of 5 the profession of athletic training after athletic trainer. The remaining 17 FATs collegiate athletes who presented to the age of 28. Factors influencing indicated a plan to make a setting their respective athletic training departure are theoretical, but include change to balance the roles of mother facilities with grade II lateral ankle burnout, job dissatisfaction, and and athletic trainer because the sprains. These patients (2 female, 3 motherhood. Professional demands, Division I setting was not conducive male; age=19.4±0.8years) were particularly at the collegiate setting, to parenting. All participants indicated participating in NCAA athletics have also been at the forefront of that no formal policies were in place (lacrosse, track, soccer and baseball) anecdotal discussion on departure to help FATs balance their roles as and sustained a lateral ankle sprain factors. Objective: Gain a better both a mother and collegiate athletic associated with an inversion understanding of the career and family trainer. Conclusions: Our results mechanism while running or landing. intentions of FATs employed in the substantiate previous research, which Four patients reported no previous collegiate setting. Design: Structured, indicates the Division I setting can be history of ankle sprain. All patients online asynchronous interviews via problematic for FATs and stimulates exhibited mild-to-moderate instability QuestionPro™ Setting: NCAA departure from the setting and even the with manual stress tests (anterior Division I Collegiate Setting. profession. Only a small few indicated drawer and talar tilt), point tenderness Patients or Other Participants: 26 an intention to remain in the collegiate over the lateral ankle ligaments, FATs (single=14; married=6; married setting long-term due to constraints limited ROM compared to the with children=6) employed in the related to the role of the athletic contralateral ankle, pain with weight- NCAA Division I setting volunteered. trainer in the collegiate setting and its bearing, and sudden onset of edema Average age of the participants was 34 impact on being a good mother. Those within 72 hours of injury. All patients ± 8. All were full-time BOC certified who intended to persist were reliant on were monitored over the course of with an average 11 ± 7 years of clinical personal and work support networks, treatment using objective clinical experience. All FATs were on 12 month common work life balance strategies. measures (OCM) including pain, the contracts, were responsible for Future research may investigate the global rating of change scale (GROC), medical coverage for an average of 2 role of mentorship on the retention of and active dorsiflexion range of ± 1 teams, and worked on average 59 FATs who are also mothers. motion (DROM) along with self- ± 18hours a week. Data Collection reported measures of health including and Analysis: All FATs responded to the Foot and Ankle Ability Measure a series of open-ended questions via (FAAM), the FAAM-Sport, the reflective journaling. Data was stored Cumberland Ankle Instability Tool on QuestionPro™ a secure data (CAIT), and the Tampa Scale of tracking website and the study was Kinesiophobia-11 (TSK-11). While piloted prior to data collection. Data the FAAM, FAAM-Sport, and CAIT are was analyzed borrowing from the patient reported outcomes (PRO) principles of general inductive focusing on regional measures of approach. Trustworthiness was health associated with the foot and established by peer review, member ankle, the TSK-11 describes the fear interpretive review, and multiple of movement. Treatment: Treatment analyst triangulation. Results: Our and rehabilitation protocols for each participants indicated a strong desire patient were dependent upon the to focus on family or to start a family discretion of their respective athletic as part of their personal aspirations. trainer. Patients completed PRO and

Journal of Athletic Training S-149 13F20MC

OCM one day post-injury (Day1), one 11=16.00±2.34) indicating minimal Multiple Joint Inflammation week post-injury (Week1), and at functional loss. Uniqueness: There is Within A Division IA Football return to play (RTP)(19.6±5.86days). a lack of evidence supporting the use Defensive Tackle Active DROM was measured in of PRO and OCM to track the progress Wall A, Uhl TL, Amponsah G: degrees with the patient in prone during rehabilitation of lateral ankle University of Kentucky. Lexington, position with the knee extended. Pain sprains. This case series demonstrates KY was measured in centimeters using a how patient-centered measures of visual analog scale (VAS) and changes function can be used to enhance patient Background: The individual is a 21 in self-reported injury status were evaluation and track rehabilitation year old African American division IA progress when combined with measured using the GROC. The FAAM football athlete. The athlete is a 330 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 contains 21 items related to activities traditional clinical indicators of pound defensive lineman with a history of daily living (highest score=100%), function. Conclusions: Following of arthritis within his right shoulder the FAAM-Sport contains 8 items lateral ankle sprain, patients and both knees. After playing in a game related to sport-specific activity demonstrated decreases in pain, the athlete presented with a fever of (highest score=100%), and the CAIT increases in DROM, and 100.9 degrees. He reported some contains nine items pertaining to improvements in perceived injury minor joint pain in his right wrist and instability during activity (highest status which corresponded with right great toe but the fever was his score=30). All items on the FAAM, improvements in self-reported main complaint. The athlete’s wrist FAAM-Sport, and CAIT are graded on measures of health assessed through and great toe were found to have full a Likert scale with higher scores PRO instruments. All patients range of motion and no pain limiting indicating greater self-reported demonstrated improvements in OCM motion. The athlete was treated for his function. The TSK-11 is an 11-item and PRO at RTP regardless of their fever with fluids, ibuprofen, and cold questionnaire graded on a 4-point rehabilitation plan. However, PRO relief medication. The following day Likert scale (total=44, lowest=11) instruments continued to identify the fever subsided but the pain in the with higher scores indicating greater improvements at RTP despite a plateau athlete’s great toe and wrist increased. fear of movement. Results: All in certain OCM. This demonstrates the The joints were re-evaluated and patients demonstrated improvements benefit of combining OCM and PRO immobilized due to limited motion in OCM as indicated by changes in for tracking the rehabilitation progress and pain. Athlete was referred to a DROM (Day1=6.6±8.47°; Week1= for patients with lateral ankle sprains. team physician for further evaluation. 10.6±5.32°), pain on the VAS Differential Diagnosis: Turf Toe, (Day1=5.28±2.41cm; Week1 =1.5± Tenosynovitis of the wrist, 1.19cm) and the GROC (Day1= - Inflammatory arthritis Treatment: 0.02±2.0; Week1=2.8±0.83). The The team physician ordered X-rays for improvements in OCM corresponded both joints which were negative for to improvements in overall health fracture in both joints. After one day status as indicated by changes in PRO of being immobilized in a walking measures for the FAAM (Day1= boot, a large amount of swelling and 55.50±20.00%; Week1 =79.00 pain developed in his left knee. The ±23.50%), the FAAM-Sport (Day1= athlete admitted himself to the 11.87±3.56%; Week1 =27.50 emergency room due to his increased ±6.38%), the CAIT (Day1= swelling and pain. The following day 8.20±7.43; Week1= 13.60± 7.43) and after being released from ER, the the TSK-11 (Day1=26.80±3.27; athlete had a MRI of his wrist and knee Week1=22.20±3.03). The GROC x-ray as ordered by the team physician. continued to improve at RTP MRI results of the wrist showed (4.5±0.55) while pain (0.06±0.09cm) tenosynovitis of the extensor and DROM (10.6±7.13°) did not digitorum tendon and the knee x-ray change. Upon RTP, all patients was negative for fracture. The team demonstrated high levels of function physician aspirated 120cc of murky on each PRO measure (FAAM yellowish fluid removed from his =98.50±2.05%; FAAM-Sport= 96.25 knee. After seeing the appearance of ±5.59%; CAIT=24.60±3.21; TSK- the aspirated fluid, the team orthopedists ordered laboratory tests

S-150 Volume 48 • Number 3 (Supplement) May 2013 13247MOBI to be conducted on the fluid. The medicine and allowed return to full The Landing Error Scoring results showed that the cell count with participation in sixteen days. System: Do Jump-Landing differential demonstrated elevated Patterns Differ Based On Sport? WBC count. Due to the elevated WBC, Kulow SM, Valovich McLeod TC, the team physician was worried about Lam KC: A.T. Still University, Mesa, the possibility of infection in the AZ athlete’s knee. The team physician ordered the athlete to be admitted to Context: The Landing Error Scoring the hospital for further evaluation and System (LESS) is a clinical screening he was given I.V. antibiotics for two tool used to assess jump-landing Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 days. Infectious disease doctors from patterns and identify individuals who the hospital ER diagnosed the athlete may be at-risk for an anterior cruciate with having either inflammatory ligament (ACL) injury. While previous arthritis or disseminated gonococcal investigations have identified sex and arthritis pending the athlete’s lab age differences in jump-landing results. The athlete was discharged patterns, it is unclear whether other from the hospital by the team physician group differences exist. Objective: with a prescription of Suprax to take To determine whether jump-landing twice a day for two weeks. Suprax is patterns, as assessed by the LESS, an antibiotic prescribed to treat differ based on sport. Design: Cross- bacterial infections.The athlete was sectional. Setting: Athletic training monitored closely by the athletic facilities. Patients or Other training staff over the next two weeks Participants: Two-hundred and fifteen to ensure the athlete was compliant intercollegiate athletes were grouped with taking his medication. Over the by high-risk (basketball, soccer, course of the two weeks the athlete’s volleyball) (male=37, female=62, symptoms subsided. The athlete was age=19.8±1.5 years, height= gradually returned to play and able to 173.3±10.0 cm, weight=68.7±10.2 kg) finish the remainder of the football and low-risk (baseball, softball, track season without a reoccurrence. and field, cross-country, wrestling) Uniqueness: This case was unique due (male=79, female=37, age=19.4±1.5 to the rapid onset of symptoms the years, height=176.0±10.3 cm, athlete experienced within a short time weight=72.6±12.3 kg) sports for ACL period. The staff believed that all of injury. Interventions: Independent the injuries were correlated to the variables included risk group and sex. inflammatory arthritis that attacked Participants were videotaped from the several joints in the athlete’s body. The frontal and sagittal views while athlete had typical presentation of performing three trials of a jump- inflammatory arthritis although this landing task. Videos were later scored condition is normally seen within an using the LESS, a reliable and valid 17- older age group of adults. The item binary scoring system that counts incidence rate of this kind of the number of errors (eg, knee valgus inflammatory arthritis is very rare in angle) an individual commits at initial athletic populations. Conclusions: ground contact (IGC) and maximum This case is important because athletic knee flexion (MKF) during the jump- trainers must be mindful of septic landing task. Each trial produces a trial and inflammatory arthritis in athletes score, and the mean of all trial scores with sudden onset of swelling and pain represents an overall score (OS), with within multiple joints. Given the higher scores indicating poorer jump- results of the laboratory tests, landing patterns. Errors for each the medical staff diagnosed this scoring item were summed across athlete with inflammatory arthritis trials for an item score (IS) and errors which was treated with appropriate for all frontal and sagittal items were

Journal of Athletic Training S-151 13203MOEX summed for a frontal total error (FTE) The Reliability Of Commonly Quest Temp 34 27.37ºC (0.17ºC) and and sagittal total error (STE) score, Used Wet Bulb Globe Extech Heat Stress Meter 26.90ºC respectively. Main Outcome Temperature Devices (0.30ºC), followed by the Reed Heat Measures: Dependent variables were Curry PR, Miles JD, Rosen AB, Index WBGT monitor 26.83ºC the OS, 17 ISs, FTE and STE. Ko JP, Cooper ER, Grundstein (0.37ºC) and Kyoto Electronics Generalized linear models with two AJ, Ferrara MS: University of WBGT 103 Heat Stress Checker factors (risk group, sex) were utilized Georgia, Athens, GA 26.45ºC (0.75ºC). The Kestrel 4400 for group comparisons. Group 28.23ºC (1.03ºC) and General Heat differences were further analyzed Context: Wet Bulb Globe Index Checker 25.83ºC (1.37ºC) were using pairwise comparisons the farthest from the ISORU. All units

Temperature (WBGT) is a composite Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (Bonferroni), p<0.05. Results: environmental measure used to demonstrated excellent correlation Significant interaction effects were estimate the effect of ambient (r>0.96) compared to the ISORU. The reported for three ISs (toe out at MKF temperature, humidity and radiation. Quest Temp 34 and Extech Heat Stress [p=0.048], knee valgus at MKF WBGT measures are used in a variety Meter units performed the best with [p=0.017], overall frontal plane of settings including the workplace, the lowest MAE (RMSE) values of º º º º displacement [p=0.021]) and for FTE military and athletics. The Georgia 0.19 C (0.27 C) and 0.46 C (0.56 C) (p=0.011), with high-risk females High School Association has adopted respectively, followed by the Reed generally committing more errors specific rules for practice based on the Heat Index WBGT meter and Kyoto than other groups. Significant main WBGT reading. Objective: To assess Electronics WBGT103 units with º º º effects of risk group were reported for the reliability of commonly used values of 0.81 C (0.93 C) and 0.64 C º OS (p=0.009; high-risk=5.51±0.39, WBGT devices on different surfaces. (0.85 C). The Kestrel 4400 and low-risk=4.97±0.24), three ISs (foot Design: Observational field study. General Heat Index Checker units had asymmetry at IGC [p=0.024; high- Setting: Artificial field turf and grass the largest MAE and RMSE values of º º º º risk=0.71±0.10, low-risk=0.39 practice fields in Athens, Ga. 1.05 C (1.02 C) and 1.37 C (1.42 C), ±0.94], limited hip flexion at MFK Equipment: The Extech Heat Stress respectively. Conclusions: All six [p=0.030; high-risk=0.94±0.11, low- Meter, General Heat Index Checker, units tested performed well compared risk=0.59±0.11], overall sagittal joint Kestrel 4400 Heat Stress Tracker, to the ISORU. Overall the Quest Temp displacement [p=0.001; high- Kyoto Electronics WBGT 103 Heat 34 performed best with the lowest risk=2.93±0.18, low-risk=2.11 Stress Checker, Quest Temp 34 and MAE and RMSE of the units assessed. ±0.17]) and STE (p=0.033; high- Reed Heat Index WBGT meter were However, all six units had excellent risk=7.72±0.49, low-risk=6.26± assessed. The reference unit was correlations (r>0.96) and were within º 0.47), with the high-risk group designed to meet specifications for a 1.42 C of the ISORU. We conclude the committing more errors than the low- WBGT monitor determined by ISO units are each reliable devices risk group. Significant main effects standard 7243 (ISORU). Inter- for monitoring WBGT on both of sex were reported for knee valgus ventions: WBGT devices were artificial and grass surfaces. Athletic at IGC (p<0.001; females=1.25±0.12; simultaneously tested against the trainers should evaluate each unit to males=0.57±0.11). Conclusions: ISORU for two sessions. The first determine the best unit based on their Our findings suggest that high-risk session was on field turf and the individual psychometric properties. sport athletes, particularly females, second session was on grass. Main tend to demonstrate poorer jump- Outcome Measures: Data were landing patterns than low-risk sport recorded for two, 2-hour afternoon athletes. This is surprising given that sessions, at 2 minute intervals. Data high-risk sport athletes are likely more were then averaged over 14 minute familiar with the movement pattern of periods for analysis. Mean absolute a jumping-landing task than their low- error (MAE), root mean square error risk counterparts. Future studies (RMSE), and Pearson’s correlation should determine if these differences coefficient (r) were used to quantify are clinically significant (eg, increases instrument performance relative to the risk for lower extremity injury). reference unit. Results: The overall mean and standard deviation for the ISORU was 27.20ºC and 2.07ºC. The mean and (average mean difference from the ISORU) was lowest in the

S-152 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Poster Presentations: Doctoral Poster Award Finalists 13064DOSP 13416DOMU

The Validity Of Head Impact We used frequency analyses to Kinesiophobia And Fear- Indicators To Positively Predict compute the sensitivity, specificity, Avoidance Beliefs Are Greater Concussion and PV+. Main Outcome Measures: In Those With Chronic Ankle Lynall RC, Mihalik JP, Guskiewicz Frequencies of dichotomized injury Instability KM, Marshall SW: University of diagnosis, RLHA and HIC. Results: Houston MN, Van Lunen BL, North Carolina, Chapel Hill, NC Based on our independent head impact Hoch MC: Old Dominion biomechanical data, head impact University, Norfolk, VA Context: Commercially available indicators employing a 50 g impact helmet- and chinstrap-based head threshold would be 95.8% (95%CI: Context: Individuals with chronic Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 impact indicators purportedly measure 79.8–99.3) sensitive based on 24 ankle instability (CAI) have exhibited resultant linear head acceleration injuries and 90.4% (95%CI: 90.3– decreased health-related quality of life (RLHA), measured in gravities (g), or 90.5) specific, but possess 0.1% PV+ based on regional and global measures the Head Injury Criterion (HIC), and based on 27,148 impacts >50 g. At a of health. Despite these findings, the alert coaches and athletes when head 75 g threshold, we observed 75.0% extent to which these individuals impacts exceeding predetermined sensitivity (95%CI: 55.1–88.0) and display deviations in mental aspects of tolerance thresholds are sustained 97.0% specificity (95%CI: 96.9– function such as kinesiophobia and during sports participation. These 97.0), but only 0.2% PV+. Employing fear-avoidance belief is unknown. thresholds vary among currently a 100 g threshold, we observed 45.8% Objective: To determine if measures available head impact indicators and sensitivity (95%CI: 27.9–64.9) and of kinesiophobia and fear-avoidance are widely unsupported by the research 99.0% specificity (95%CI: 99.0– belief differ between individuals with literature. Objective: To determine 99.1), with a 0.4% PV+. Lastly, head and without CAI and correlate with the sensitivity, specificity, and positive impact indicators would be 20.8% injury characteristics that quantify the predictive value (PV+) of head impact (95%CI: 9.2–40.5) sensitive and magnitude of CAI. Design: Case- indicators. We hypothesized variable 99.3% (95%CI: 99.3–99.4) specific, control. Setting: Laboratory. Patients sensitivity, high specificity, and poor with a 0.3% PV+ if a HIC of 240 were or Other Participants: Sixteen PV+ of head impact indicators. to be employed as an impact indicator participants with CAI (3 males, 13 Design: Prospective cohort. Setting: threshold. Conclusions: While females, age=21.9±2.6 years, Field setting. Patients or Other specificity appears high using these height=170.8±9.8cm, Participants: Convenience sample of indicator thresholds, clinicians should mass=70.1±13.3kg) were gender and 184 male (age=19.2±1.4yrs) football consider the very low PV+ and variable age matched to sixteen healthy players representing all playing sensitivities associated with utilizing participants with no history of ankle positions recruited from one Division theoretical impact thresholds for sprain (3 males, 13 females, I program. Interventions: Head removal from play. Our findings age=22.6±1.7 years, height= 166.4± impact biomechanics for 283,348 suggest that conducting an 8.9cm, mass= 63.8±12.1kg). impacts were collected using Head examination based on head impact Participants were included in the CAI Impact Telemetry System indicators alone would result in group if they reported at least one instrumentation during practices and an extremely high number of ankle sprain, two episodes of “giving competitions over an 8-year period unnecessary athlete evaluations. We way” in the past three months, and (preseason, fall, and spring seasons). only studied the thresholds employed answered “yes” to five or more During this time, a team of physicians, by commercially available head impact questions on the Ankle Instability athletic trainers, and clinical indicators as a means of exploring Instrument. Interventions: Partici- researchers made concussion whether the concept has any clinical pants reported to the laboratory for a diagnoses based on a comprehensive utility for athletic trainers. Future single testing session. Participants in multi-faceted concussion management studies investigating head impact both groups completed the Tampa program (n=24). We dichotomized indicators’ actual measurement validity Scale of Kinesiophobia-11 (TSK-11) each impact based on concussion should be pursued. Study funded in part and Fear-Avoidance Beliefs diagnosis (yes=24/no=283,324). We by the Centers for Disease Control Questionnaire (FABQ). The TSK-11 also dichotomized RLHA and HIC and Prevention and the National contains 11 items with 4-point likert based on whether thresholds employed Operating Committee on Standards scales. The FABQ contains a total of by commercially available head impact for Athletic Equipment. 11 items with 6-point likert scales. indicators were exceeded: RLHA of 50 Individuals in the CAI group also g, 75 g, or 100 g; and HIC value of 240. reported the number of previous ankle

Journal of Athletic Training S-153 13037DOMU sprains (PAS), the number of episodes Increase In Humeral respectively. Main Outcome Measure: of “giving way” in the past 3 months Retrotorsion Accounts For Age- A 3-trial mean was calculated for IRROM (EGW), and completed the 8-item Related Increase In and humeral torsion measures. Foot and Ankle Ability Measure-Sport Glenohumeral Internal Rotation Corrected-IRROM was calculated as the (FAAM-Sport). Main Outcome Deficit In Youth/Adolescent amount of available IRROM once Measures: TSK-11 scores range from Baseball Players humeral torsion was accounted for. 11-44 with higher scores indicating a Hibberd EE, Oyama S, Myers JB: GIRD and corrected-GIRD side-to-side greater level of kinesiophobia. FABQ University of North Carolina at differences were calculated as the scores range from 0-66 with higher Chapel Hill, Chapel Hill, NC, and angular difference in IRROM and scores indicating increased fear- University of Texas San Antonio, corrected-IRROM. Three separate one- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 avoidance belief. Dependent variables San Antonio, TX way ANOVAs were used to compare included the TSK-11 and FABQ scores GIRD, humeral retrotorsion, and and the independent variable was group Context: Glenohumeral internal corrected-GIRD between age groups. (CAI, healthy). Independent samples t- rotation deficit (GIRD) of the throwing Results: There were significant group tests were used to examine group limb relative to the non-throwing limb difference in GIRD (F3,284=8.957, differences in TSK-11 and FABQ has been linked to shoulder and elbow p<0.001) and humeral torsion side-to- scores. Pearson-product moment injury in baseball players. While it has side difference (F3,284=9.688, p<0.001), correlations (r) were calculated to been demonstrated that GIRD but not in Corrected-GIRD determine if TSK-11 and FABQ scores increases during adolescence, it (F3,284=1.136, p=0.335). GIRD was were related to PAS, EGW, or FAAM- remains unclear whether this change greater in varsity participants compared Sport scores (%) in the CAI group. is due to increases in humeral to youth (mean difference (md)=5.05°, Alpha level was set a priori at p<0.05 retrotorsion (osseous) or soft tissue p=0.002) and JH (md=4.95°, p=0.002) for all analyses. Results: Significant tightness of the throwing limb. participants, and in JV participants group differences were identified for Measuring humeral retrotorsion along compared to JH (md=5.36°, p=0.002) the TSK-11 (CAI=18.1±4.0, with shoulder internal rotation range and youth (md=5.47°, p=0.002) Control=13.5±3.0, p=0.004) and of motion (IRROM) allows us to participants. Humeral torsion was greater FABQ (CAI=17.9±9.7, Control= differentiate osseous vs. soft tissue in varsity participants compared to youth 1.5±2.6, p<0.001). Within the CAI contribution to GIRD in baseball players (md=8.79°, p<0.001) and JH group, TSK-11 scores were of different ages, as well as compare (md=5.52°, p=0.014) and JV compared significantly correlated to PAS GIRD between age groups once it has to youth participants (md=7.88°, (4.5±3.8; r=0.52, p=0.04), but not been corrected for humeral retrotorsion. p=0.001). Conclusions: As EGW (7.2±7.4; r=-0.49, p=0.054) Objective: The purpose of this study was demonstrated previously, GIRD or FAAM-Sport scores (76.2±18.1%; to evaluate the influence of age group increased with age in youth/ r=-0.13, p=0.62). The FABQ was not on GIRD, humeral retrotorsion, and adolescent baseball players. We also significantly correlated to PAS corrected-GIRD in baseball players. observed that humeral retrotorsion (r=0.01, p=0.98), EGW (r=0.08, Design: Cross-Sectional. Setting: increased with age, while the torsion p=0.77) or FAAM-Sport scores (r= Field Laboratory. Patients or Other corrected GIRD remained -0.18, p=0.51). Conclusions: Participants: Four groups of baseball unchanged. This result indicates that Individuals with CAI experience players (n=287) participated: 1) youth the age-related increase in GIRD is greater kinesiophobia and fear- (6-10 year olds) (n=52, age= 8.3±1.3yrs, primarily attributed to increase in avoidance beliefs compared to height=133.7±11.1cm, humeral retrotorsion, and not soft healthy controls. Also, individuals with mass=33.6±8.6kg), 2) junior high (11- tissue tightness. Our study suggests CAI with a greater number of sprains 13 year olds (JH)) (n=52, age that the most significant alterations report increased levels of =11.9±0.9yrs, height=149.9±17.8cm, in torsional side-to-side differences kinesiophobia. These findings suggest mass=47.2±9.7kg), 3) junior varsity occur between youth and JV that measures of kinesiophobia and (14-15 year olds (JV)) (n=70, participants (6-16), suggesting that fear-avoidance belief should be age=14.6±0.5yrs, height =176.3 this period of physical maturation examined during the rehabilitation ±5.7cm, mass=69.6±12.9kg), and 4) should be further investigated in process of individuals with CAI. varsity (16-18 year olds) (n=113, relation to the development of risk age=16.9±0.8yrs, height =180.3± factors for shoulder and elbow injury. 6.6cm, mass=78.0±11.4kg). Inter- Acknowledgements: Funding provided ventions: IRROM and humeral torsion by NIH-NIAMS:R03AR055262. were measured bilaterally using a digital inclinometer and diagnostic ultrasound,

S-154 Volume 48 • Number 3 (Supplement) May 2013 13201DOTE 13066DONE

Effect Of Strength-Training subjects were post-tested at the end Shoulder Flexion Torque Is Protocols On Strength And of six weeks in the same manner as Augmented By A Volitional Dynamic Balance In Participants the pre-test. Main Outcome Abdominal Contraction With FAI Measures: Dorsiflexion, plantar- Cacolice PA, Carcia CR, Hall EA, Docherty CL, Simon JE, flexion, inversion, and eversion Scibek JS: Duquesne Kingma J, Klossner JC: Indiana isometric strength (kg) and Y-balance University, Pittsburgh, PA University, Bloomington, IN test (composite score of three directions standardized to limb length Context: Increased activation of the Context: While lateral ankle sprains in cm). Maximum values were used abdominal musculature increases for statistical analysis. Separate are common in sport and can often lead active stiffness of the trunk and Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 to functional ankle instability (FAI), RMANOVA was completed for each enhances core stability. A strong and strength-training rehabilitation dependent variable and Bonferroni stable core is associated with protocols may improve the deficits of post hoc test was conducted on any decreased injury and improvements in FAI. Purpose: To determine the significant findings. Alpha level was performance. Further, a stable core effects of strength-training protocols set a p<0.05. Results: Both the RBP provides a solid base thereby on strength and dynamic balance in and PNF groups significantly theoretically enhancing extremity participants with FAI. Design: A improved between pretest and posttest function. Contraction of the abdominal randomized controlled clinical trial. in isometric strength. In the RBP musculature during functional Setting: University Athletic Training group, dorsiflexion improved by 23% activities however generally occurs (F =3.43, p=0.043) and plantar- Research Laboratory. Patients and 2,36 automatically at a subconscious level. flexion improved by 15% (F = 3.48, Other Participants: Thirty-nine 2,36 It is unclear if an individual is able to participants (17 males, 22 females, p=0.041) over the training period. produce a greater amount of extremity 19.72±1.96 years, 173.54±9.21 cm, For inversion strength, the RBP group torque while performing a 70.68±12.89 kg) with FAI volunteered improved by 29% and the PNF group superimposed volitional contraction to participate in the study. The Ankle improved by 28% following training of the abdominals. Objective: To (F =6.14, p=0.005). Similarly for Instability Instrument determined the 2,36 determine if shoulder torque values presence of FAI and subjects were eversion strength, the RBP group were different when subjects excluded if they had a history of lower improved by 28% and the PNF group performed a maximal voluntary improved by 31% (F =7.44, extremity fracture/surgery or a balance 2,36 isometric contraction (MVIC) of the disorder. Interventions: Participants p=0.002). There were no significant shoulder flexors with and without a were pre-tested for strength and strength improvements in the CON volitional isometric contraction of the dynamic balance. Strength was group between the pretest and posttest abdominals. We hypothesized assessed isometrically using a handheld (p>.05). There were no significant participants would be able to generate dynamometer (Lafayette Manual differences in Y-balance test a greater amount of isometric shoulder Muscle Tester, Lafayette Instruments performance (p=0.08) in any group. flexion torque (ISFT) when the Co) in four directions: dorsiflexion, Conclusion: Both rehabilitation abdominals were consciously plantarflexion, inversion, and eversion. protocols were effective at activated. Design: Quasi- Three trials of each direction were improving isometric ankle strength experimental repeated measures. performed. Dynamic balance was following the six weeks. Neither Setting: Research laboratory. assessed using the Y-balance test kit rehabilitation protocol created an Patients or Other Participants: A (Functional Movement Systems, Inc). improvement in dynamic balance. convenience sample of 30 healthy, Participants completed three reach recreationally active college aged trials in each direction: anterior, students (age=21.9±1.2years; weight posterolateral and posteromedial. =75.2±16.3kg; height= 174.7±9.4cm) Participants were then randomly participated. Interventions: Partici- assigned to either the resistance band pants completed a 5-minute warm up protocol (RBP), Proprioceptive on an upper body ergometer (Monark; Neuromuscular Facilitation strength Vansbro, Sweden) at a self-selected protocol (PNF), or control group pace. Next, using a standardized and (CON). Participants in the RBP and previously reported protocol, surface PNF groups completed their respective EMG (sEMG) was captured from the protocols 3x/week for 6 weeks. right and left rectus abdominis (RA) Participants in the CON group did not using a telemetry system (Noraxon; attend rehabilitation sessions. All

Journal of Athletic Training S-155 Scottsdale, AZ) that was interfaced with a commercially available software acquisition system (Run Technologies; Laguna Hills, CA) and personal computer (Dell; Austin, TX). Collection of RA sEMG was essential to determine if RA percent activation was different between test conditions. Subjects then completed three repetitions of an isometric abdominal

crunch to establish an MVIC of the RA Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 for normalization. Then in a counterbalanced order using their dominant upper extremity, subjects completed three trials of maximal isometric shoulder flexion at 90 degrees using an isokinetic dynamometer (Biodex; Shirley, NY) with and without a volitional contraction of the abdominals. Main Outcome Measures: Dependent variables included RA percent activation and ISFT. We used paired t- tests to determine if RA percent activation and ISFT values differed between conditions (contracted; relaxed). Results: Percent activation of the RA was greater when subjects volitionally contracted their abdominals (15.8±12.7%) compared to the relaxed condition (6.3±4.8%) (Pd”0.001). ISFT was greater when the abdominals were actively contracted (44.6±18.9N*m) compared to ISFT when the abdominals were recruited subconsciously (30.7±15.7N*m) (Pd”0.001). Conclusions: Subjects are able to volitionally recruit greater amounts of RA sEMG compared to the percent activation that automatically occurs while performing an upper extremity task. ISFT values at 90 degrees of flexion are greater when a subject volitionally superimposes a contraction of the abdominals when compared to ISFT when the abdominals are solely recruited in a subconscious fashion.

S-156 Volume 48 • Number 3 (Supplement) May 2013 13267FOBIFree Communications, Poster Presentations: Lower Extremity13092DOEX Neuromechanics

Double Legged Squat calculated using the electromagnetic Interactive Effects Of Body Mechanics Influence Medial tracking system and was defined as Position And Resistance On Knee Displacement displacement of the knee center in the Muscle Activation And Bell DR, Pennuto AP, Stiffler MR, frontal plane (cm). Peak values were Cardiorespiratory Response Smith MD, Olson ME: University of obtained for each trial and the average During Spinning® Wisconsin-Madison. Madison, WI was used in the analyses. Separate Rendos NK, Musto A, Signorile J: forward stepwise regressions were University of Miami, Coral Gables, Context: Dynamic knee valgus or performed for each gender to FL medial knee displacement (MKD) is a determine the influence of lower theorized risk factor for chronic and extremity kinematics on MKD. All Context: Spinning® is used during Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 acute knee injuries. MKD is the medial statistical analyses were performed in rehabilitation to maintain collapse of the knee and is a SPSS with significance set a priori at cardiorespiratory fitness and muscle combination of tibial and femoral P < 0.05. Results: In females, peak hip function. Intensity is the major factor motions. However, it is unclear what adduction angle (5.1±4.4°) and peak affecting these variables and is specific kinematic components knee valgus angle (-8.4±9.1°) controlled by body position (POS) and specifically contribute to MKD during explained 29% of the variance in MKD perceived resistance level (RES). the double legged squat (DLS). This (1.1±1.1 cm, R2=0.29, P<0.001). In Objective: To examine the effect of information could be valuable to males, 22% of the variance in MDK 3 POS and 4 RES on muscle activity clinicians as they design intervention was explained by peak hip flexion angle of the vastus lateralis (VL) and strategies to improve performance and (-115.2±11.1°) during the DSL cardiorespiratory response during decrease injury risk. Objective: The (1.0±1.0 cm, R2=0.22, P=0.03). Spinning®. Design: Within-subjects purpose of this investigation was to Conclusions: Kinematics contribut- repeated measures design. Setting: examine how kinematics of the lower ing to MKD differed by gender. MKD Laboratory of Neuromuscular extremity influence MKD during the appears to be related to frontal plane Research and Active Aging Patients DLS. Design: Cross-sectional. hip control in females; however, or Other Participants: Eleven Setting: Laboratory. Patients or sagittal plane hip control influences healthy, recreational athletes with at Other Participants: Eighty three MKD in males. Clinicians should least 6 months Spinning® experience volunteers with no history of lower consider these relationships when (height=1.68±.09 m, mass=65.8±11.3 extremity injury (171.3±9.2cm, designing interventions to reduce kg, age=24.4±6.3 years). Inter- 69.2±12.2kg, 20.3±1.5yrs, 21 Males, MKD. Other factors not assessed in ventions: Following and 8h fast, 62 Females) completed this study. this study most likely account for electromyographical normalized root Interventions: All individuals some of the unexplained variance in mean square (nRMS) of the right VL completed five trials of a DLS from a the position of MKD including range and breath-by-breath data were standardized start position: feet should of motion restrictions or static recorded during 12 (3POS x 4RES) width apart, toes straight ahead, with postural alignment. Funding: Virginia three-minute randomly assigned the hands over the head. Subjects were Horne Henry Fund and the Wisconsin Spinning® conditions on four testing instructed to squat like they were Athletic Trainers’ Association. days. POS included seated, running, sitting in a chair to a deep but and standing climb (SC), and RES used comfortable depth and in a controlled 4 ranges of the 15-point Borg manner. The dominant limb was used Perceived Exertion Scale (RPE 6-9, for testing which was defined as the 10-13, 14-6, 17-20). RMS was limb used to kick a ball maximal normalized for each testing session distances. Main Outcome using maximal voluntary isometric leg Measures: Peak kinematics extensions (hip and knee at 90° of associated with ACL loading of the hip flexion). Main Outcome Measures: (flexion, adduction, and internal Dependent variables included nRMS,

rotation), knee (flexion, valgus, and heart rate (HR), VO2 relative to body

internal rotation), and trunk flexion weight (VO2rel), and respiratory were used as predictor variables while exchange ratio (RER) during each MKD during the DLS was used as a condition. A 3(POS) x 4(RES) within- criterion variable. MKD was

Journal of Athletic Training S-157 13261FODI subjects ANOVA with Bonferroni post- A Comparison Of Body Fat, athlete participation. Body fat hoc analysis was performed for each Lean Muscle Mass And Max percentages calculated using variable. Results: A significant POS Vertical Jump Height In Lohman’s validated method included a x RES interaction was observed for Olympic Level Athletes body fat caliper three trial three site nRMS (p=.034). For the seated Moore MT, Daniels EJ, Dixon pinch (abdominal, subscapular and position, RPE 10-13 (0.26±0.08), 14- JB: Northern Michigan University, triceps) and was compared to DEXA 16 (0.39±0.15), and 17-20 Marquette, MI, and Marquette measures. All body fats were measured (0.51±0.14) were significantly greater General – A Duke Life Point on the right side and by the same than RPE 6-9 (0.09±0.08) and RPE Hospital, Marquette, MI examiner. Vertical jump scores were

17-20 was significantly greater than recorded for the best of three max Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 RPE 10-13. For running and SC, RPE Context: Anecdotal evidence among attempts using the Vertec following 17-20 (0.50±0.15 and 0.49±0.13) was coaches suggests a relationship validated standardized warm-up significantly greater than RPE 6-9 between body composition and procedures. Main Outcome (0.23± 0.08 and 0.20±0.07) and 10- performance despite little research Measures: The dependent variables 13 (0.25±0.06 and 0.27±0.08). examining this connection. Athletic were body fat percentages via caliper Additionally for SC, RPE 14-16 performance is often contextually and DEXA, body mass index (BMI) and (0.37±0.15) was greater than RPE 6- linked to body fat and lean muscle maximum vertical jump. Analyses 9. When the post-hoc analysis was mass scores, particularly when scores included a paired t-test and Pearson performed across RPE levels, the only may be subjective and associated with correlations with a priori alpha level significant difference detected was visual appeal. Body fat is often set at P=.05. Results: A paired t-test between the running and seated measured using skin fold calipers, and showed no significant difference conditions at RPE 6-9. A significant is prevalent in sports that are between DEXA (mean 20.64+10.74) main effect was observed for POS and considered aesthetic or have weight and caliper (mean 20.03+7.96) testing RES for VO2rel (p<.02). VO2rel was categories. The reliability of body (P=.559). Pearson Correlations greater for the running (28.9±2.2 mass index (BMI) in elite athletes is revealed lean muscle mass was -1 -1 ml•kg •min ) and standing climb low due to athletes’ higher percentages strongly correlated with DEXA (mean -1 -1 positions (26.8±1.7 ml•kg •min ) of lean muscle mass. However, Dual- 60.87+14.75) and caliper calculations than for the seated POS(23.5± Energy X-ray absorptiometry (DEXA) (mean 60.87+14.75). BMI (26.52 -1 -1 2.0 ml•kg •min ) and greater for RPE has been shown to provide an accurate +4.03) was low to moderately 14-16 and 17-20 (31.2±2.4 and assessment of body composition. correlated with DEXA percent body fat -1 -1 34.9±2.6 ml•kg •min ) than RPE 6-9 Objective: The objectives were two (P=.089, r=.347). DEXA percent body and 10-13 (16.5±1.8 and 22.9± fold 1) Determine if a three trial, three fat was moderately inversely -1 -1 1.9 ml•kg •min ) and RPE 10-13 was site pinch caliper test and DEXA yield correlated with jump height (P=.004, significantly greater than 6-9 (p<.01). similar results. 2) Determine if lean r=-.565) and moderately correlated RER was affected by RES only muscle mass and percent body fat is with lean muscle mass (P=.013, (p<.001), while a significant correlated with max vertical jump r=.501). Conclusions: Body fat POSxRES interaction was observed height (measure of power output). calipers are an accurate substitute for for HR (p=.024) where HR Design: Cross-sectional Setting: DEXA measures, while BMI was not patterns did not match VO2rel patterns. Outpatient Orthopedic Clinic. significantly correlated with DEXA in Conclusions: VL activity patterns Patients or Other Participants: 25 this population. Individuals who had consistently increased with Olympic level athletes (ages 18-27) lower body fat scores, and more lean RES regardless of POS. The SC volunteered that participated in muscle mass were more likely to score and running POS can be expected Olympic weight lifting (men and higher on the max vertical jump. to produce higher cardiorespiratory women), Greco-Roman (men) or responses than seated across freestyle wrestling (women), short RES levels. HR appears to be track speed skating (men and women). ineffective as a monitoring method Males (N=12) mean height was for cardiovascular effort. 164.17cm+5.08 and weight was 69.1kg+15.9. Females (N=13) mean height 172.76cm+9.53, and weight was 82.83kg+17.57. Interventions: The independent variable was level of

S-158 Volume 48 • Number 3 (Supplement) May 2013 13241DOBI 13146MONE

Lower Extremity Functional with left SLHOP (.322, p=.04), lunge Effect Of Diminished Plantar Contributions To Dynamic dorsiflexion (.565, p<.001) and Cutaneous Sensation And Foot Postural Control kneeling dorsiflexion (.647, p<.001). Type On Static Postural Control Grooms D, Beisner A, Bowman J, Right SLAR was correlated with right Kang TK, Lee SC, Lee HD, Lee Borchers J, Miller M, Schroeder single leg hop distance (.426, p<.006), SY: Yonsei University, Department M, Schussler E, Onate J: The lunge dorsiflexion (.655, p<.001) and of Physical Education, Seoul, Ohio State University, Columbus, kneeling dorsiflexion (.717, p<.001). Korea OH Trunk endurance and hip strength were not correlated with SLAR Context: Plantar cutaneous sensation

Context: A lack of standardized performance. The best regression and different foot types may influence Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 clinical tools exists for model to predict SLAR performance the regulation of postural control. musculoskeletal injury risk and included kneeling dorsiflexion and However, it is unclear whether functional performance assessment. SLHOP as significant predictors different foot types are associated with The single leg anterior reach (SLAR) (Right: r² .50, p<.001, Left: r² .55, variances in postural control before component of the star excursion p<.001). The regression model and after removal of plantar cutaneous balance test is a commonly utilized indicated that the variance of SLAR sensation. Objective: To determine if clinical option to assess dynamic performance is explained heavily by different structural foot types postural control and ankle sprain injury kneeling dorsiflexion (Right: r² .42, influence postural control after risk. However, the contributions of p<.001, Left: r² .51, p<.001). The diminished plantar cutaneous ankle joint range of motion and single inclusion of the additional lunge sensation. Design: Case controlled leg dynamic function to SLAR postural dorsiflexion measure did not add to the study. Setting: Laboratory. Patients or control is unknown. Objective: To model as the correlation between Other Participants: A total of 39 determine the relationship between these two measures was very high healthy, young adults (age: 24.67±2.39 various aspects of functional (Right: .903, p<.001, Left: .889, years; height: 173.17±8.57 cm; performance and dynamic postural p<.001). Trunk endurance and hip weight: 69.05±13.78 kg) were control and the best predictors of strength were not significant recruited. There were 18 pronated, 35 dynamic postural control. Design: predictors in the model. Conclusions: neutral, and 25 supinated feet. Descriptive laboratory study Setting: The results of this study show that Interventions: We classified foot type Biomechanics research laboratory SLAR performance is highly related to as pronated (e”10mm), neutral (5- Participants: 41 male NCAA kneeling weight bearing dorsiflexion 9mm), or supinated (d”4mm) by Division I lacrosse athletes (19.6±1.17 and lunge dorsiflexion range of motion navicular drop test measures. Subjects years, 1.83±0.08 m, and 84.7±8.6 kg) and moderately related to SLHOP placed the plantar surface of both feet Interventions: A comprehensive performance. This indicates that the in an ice bath for 10 minutes. Before functional performance assessment SLAR clinical assessment of postural and after ice-immersion, subjects was completed prior to the regular control is moderately dependent performed three trials of a 10 seconds season consisting of left and right on closed chain dorsiflexion range single-leg stance balance test with SLAR for dynamic balance, single leg of motion. Clinicians assessing their eyes closed while standing on top hop (SLHOP) for single leg power and dynamic balance should consider of an Acusway forceplate (AMTI INC, landing control, two measurements of dorsiflexion range of motion as a Watertown, MA). Main Outcome dorsiflexion range of motion (lunge possible limiting factor. Other measures: Center of pressure x range and kneeling), trunk endurance(back variables such as postural control and (RangeX); y range(RangeY); x extension and side bridges for time) eccentric muscle strength may also velocity(VelocityX); y velocity and hip strength (isometric flexion, play a role in SLAR performance that (VelocityY); x standard deviation extension, abduction, adduction). is not captured with dorsiflexion (SDx); y standard deviation(SDy); x Main Outcome Measures: Pearson motion or hop performance. time to boundary (TTBx); y time to correlations were performed to assess boundary(TTBy); x mean time to the relationship between SLAR and boundary(mean TTBx); y mean time to SLHOP, dorsiflexion, trunk endurance boundary(mean TTBy); x standard and hip strength with an alpha level set deviation time to boundary(SD TTBx); at .05. A regression model was and y standard deviation time to completed to determine the best boundary(SD TTBy) were measured to predictors of SLAR performance. quantify postural control. Group (foot Results: Left SLAR was correlated type) by time (plantar sensation) mixed

Journal of Athletic Training S-159 13076MONE model two-way repeated measures of Postural Control Differences sec) is defined as the ratio of the ANOVA was used to analyze Between Adolescent And distance traveled by the center of differences between foot types and Collegiate Male Athletes Using gravity to the time of the trial. A higher plantar cutaneous sensation. Results: The Stability Examination Test score indicates poorer balance. A 2 A significant main effect for time was Rice T, Mayfield RM, Lam KC, (group) by 6 (condition) repeated found in SDy (F1,75=9.57; P=.00). Post Valovich McLeod TC: Athletic measures analysis of variance was used hoc analysis showed that diminished Training Program, A.T. Still to evaluate differences in SV. An plantar cutaneous sensation resulted in University, Mesa, AZ independent t-test assessed increased standard deviation (SD) of differences in the composite SV center of pressure (CoP) in A-P Context: Postural control is an variable. Results: The interaction for direction (pre: 1.13±.28; post: essential component of athletic SV was significant (P=.028) and there Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 1.22±.29; P=.00). A significant main participation and has roles in both were significant main effects for group effect for time was found in RangeY musculoskeletal rehabilitation and (P=.001) and condition (P<.001). The (F1,75=9.07; P=.00). Also diminished concussion evaluation. The Stability composite SV was significantly higher plantar cutaneous sensation resulted in Examination Test (SET) aims to (P=.023) in the adolescents increased range of CoP in the A-P objectively analyze an athlete’s (3.29±1.21 deg/sec) compared to the direction (pre: 5.53±1.34; post: balance and postural control through college athletes (2.79±0.60 deg/sec). 5.97±1.44; P=.00). A significant main measurement of sway velocity (SV) on Post-hoc analysis of the interaction effect for time was found in VelX a portable force platform. To date the revealed that the adolescents had (F1,75=4.00; P=.05). Diminished SET has been primarily used in significantly higher SV for the single- plantar cutaneous sensation also collegiate athletes, however the firm (3.22±1.78 vs. 2.16±.90 deg/sec) resulted in decreased velocity of CoP development of postural control and single-foam (5.25±1.99 vs. in M-L direction (pre: 5.11±1.18; progresses into adolescence, due to 4.44±1.25 deg/sec) conditions, with post: 4.96±1.22; P=.05). Interestingly, continued neural development, no significant differences among the the main effect for foot type strength gains, and muscle activation. other conditions. The significant main and interaction did not reveal Objective: To determine whether effect for condition revealed significant differences and all time to postural control differences exist differences between all 6 conditions boundary variables did not have between adolescent and collegiate with DFi (0.75±0.22 deg/sec) < TFi significant differences. Conclusions: populations using the SET protocol. (1.78±0.97 deg/sec) < SFi (2.367± After plantar cutaneous de- Design: Cross-sectional. Setting: 1.17 deg/sec) < DFo (2.84±0.88 deg/ sensitization, there was a deficit in A- High school and collegiate athletic sec) < SFo (4.85±1.47 deg/sec) < TFo P directional postural control and training facilities and a research (5.19±2.26 deg/sec). Conclusions: improvement in M-L directional laboratory. Patients or Other Our results indicate that the adolescent postural control. This indicates that Participants: Convenience sample of population had an overall higher mechanoreceptors located in the deep 35 adolescent (age=11.1±2.1 years, composite SV, indicating decreased plantar surface of the foot play an height=149.7±15.7cm) and 133 postural control. The differences were important role to control posture. collegiate (age=19.4±1.3 years, more profound on the conditions that height=181.3±9.0cm) male athletes. required a single-limb stance, perhaps Interventions: The independent resulting from a lack of lower limb variable was group; adolescent (9-15 strength, in addition to postural years) vs. college (18-22 years). All instability. Future studies should participants completed the SET, which evaluate whether these differences involved 6 20-second balance tests exist in females and at what age do with eyes closed, under the following adolescents resemble adults with this conditions: double-leg firm (DFi), measure of postural control. single-leg firm (SFi), tandem firm, (TFi), double-leg foam (DFo), single- leg foam (SFo), and tandem foam (TFo). Main Outcome Measures: The dependent variable was sway velocity (SV) for each of the 6 SET conditions. A composite SET SV variable was also analyzed. SV (deg/

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Normally-Occurring Ankle lift while the knee was able to touch Effect Of Body Composition On Range Of Motion And Dynamic the wall. Each participant performed Changes In Biomechanics And Postural Control Asymmetries 4 practice trials of the ANTSEBT and Performance During An In Healthy Collegiate Cross- 1 for the WBLT for each limb. Exercise Challenge Country Runners ANTSEBT reach distance and WBLT Tritsch AJ, Montgomery MM, McNulty MB, McKeon PO: distance were recorded in cm. Main Cone JC, Schmitz RJ, Shultz University of Kentucky, Outcome Measures: The mean of SJ: University of North Carolina Lexington, KY the 3 trials for each variable was at Greensboro, Greensboro, NC, calculated for each limb. Limits of and California State University, Context: Cross-country running agreement analysis (LoA) assessed the Northridge, Northridge, CA requires participants to constantly level of asymmetry between limbs for Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 adapt to changing surfaces over the the ANTSEBT and DFROM. Pearson course of training and racing. Lower correlation determined the Context: During intermittent exercise extremity injuries are widespread in relationship between asymmetries on decrease in neuromuscular control is this sport. Side-to-side asymmetries these two measures. Alpha level was thought to contribute to an increased in ankle dorsiflexion (DFROM) and set a priori at p<0.05. Results: For risk of injury as exercise progresses. the anterior reach distance of the Star DFROM (right: 11.4±3.0 cm, left: As individuals with less lean body mass Excursion Balance Test (ANTSEBT) 11.7±4.0 cm), the LoA indicated there per total body mass (LBM:TBM) have been identified as risk factors for was an average mean difference of require greater muscle activation to lower extremity injury in other sports, 0.3±2.2cm between limbs. The 95% control the same body weight but no evidence exists about the confidence limits around the mean compared to those with higher normally occurring asymmetries in difference revealed DFROM LBM:TBM, it has been hypothesized these measures for collegiate cross- asymmetries up to 4.3 cm bilaterally. that greater lean mass may provide country runners. By examining the For the ANTSEBT (right: 68.2±7.0cm, protection to the joint during dynamic normally occurring DFROM and left: 68.2±7.4 cm) there was an average tasks. However, whether greater ANTSEBT asymmetries, we can build mean difference of 0.0±5.3 cm LBM:TBM protects against the a better understanding of their utility between limbs with the 95% fatigue-induced biomechanical as screening tools in this population. confidence limits of ANTSEBT changes has not been directly Objective: To determine the normally asymmetries up to 10.4cm bilaterally. examined. Objective: To compare occurring DFROM and ANTSEBT There was a significant relationship individuals stratified into above asymmetries in healthy collegiate between the asymmetry of WBLT average and below average LBM:TBM cross-country runners. Design: and ANTSEBT (r=0.51, r2=0.26, on performance and landing Cross-sectional design. Setting: p=0.01). Conclusion: There are biomechanics during an intermittent Athletic Training Room. Parti- normally occurring asymmetries exercise protocol (IEP). Design: cipants: 25 healthy Division I in DFROM and ANTSEBT in Descriptive cohort. Setting: collegiate cross-country runners (11 collegiate cross-country runners. Research laboratory. Participants: Females, 14 Males, Age: 19.9±1.5 yrs, Differences beyond 4.3 cm of Fifty-nine (29F, 30M;20.4±2.2yrs, Height: 1.7±0.4m, Mass: 64.1± DFROM or 10.4 cm on the ANTSEBT 173.3± 9.0cm, 68.7±10.5kg) healthy, 13.0kg) who were free from any lower may be indicative of pathological active participants. Interventions: extremity injury for at least 6 weeks asymmetries in this population. Males and females were equally participated. Interventions: All stratified into above and below average testing procedures were performed on LBM:TBM and participated in an both limbs of each participant. individualized 90 minute IEP that Participants performed 3 trials of included 7 varying running intensities. maximum reach in the ANTSEBT on Performance measures and each limb. The weight-bearing lunge biomechanical data were assessed test was used to measure DFROM. during a 45cm drop jump (DJ) landing Subjects performed 3 trials of the protocol performed before exercise WBLT in which they kept their test heel (Pre) and immediately after two 45- firmly planted on the floor while they minute bouts of running (Post45 and flexed their knee to the wall. Post90). Main Outcome Measures: Maximum dorsiflexion was defined as Performance was monitored via a the distance from the great toe to the rating of perceived exertion (RPE) wall based on the furthest distance the scale, counter-movement jump height foot was able to be placed without heel- in meters (CMJ), and sprint speed in Journal of Athletic Training S-161 13272FOBI m/s (SS). To assess biomechanical Changes In Time-To-peak (initial contact:toe-off) was measured changes, kinetic and kinematic data Kinetics After Neuromuscular in milliseconds (ms). Time-to-peak were collected and used to calculate Fatigue (TTP) kinetics [vertical ground hip, knee, and ankle energy absorption McGrath ML, Stergiou N, reaction force (VGRF), posterior (JxBW(N)-1xHt(m)-1) from foot Blackburn JT, Lewek MD, Giuliani ground reaction force (PGRF), knee contact until peak knee flexion. C, Padua DA: University of North extension moment (KEM), knee valgus Separate 2 (group) x 3 (time) repeated Carolina, Chapel Hill, NC, and moment (KVM), and anterior tibial measures ANOVA’s examined University of Nebraska at Omaha, shear force (ATSF)] were calculated differences in CMJ, RPE, SS, and Omaha, NE pre- and post-fatigue from initial energy absorption. Results: RPE contact to the peak value during the increased [Pre (10.09± 2.11)Post45(4.68±0.42)>Post90 at the end of halves or games. Comparisons were made between (4.57± 0.44); P<0.001] at each time Researchers have found altered lower groups and fatigue using mixed-model point regardless of group. Energy extremity kinetics post-fatigue that are ANOVA’s with Bonferroni post-hoc absorption at the knee decreased for prospectively linked to greater risk of tests (a<0.05). Results: A significant both groups at the Post45 and Post90 ACL injury. However, no studies have fatigue x group interaction was observed for TTP VGRF (F =7.242, compared to Pre [Pre(-0.090 examined how the rate of loading, 1,53 ±0.020)>Post45(-0.085± 0.022), measured via time-to-peak forces or P=0.01). The NFB group decreased Post90(-0.086± 0.022); P=0.018]. moments, may be impacted by fatigue TTP VGRF post-fatigue (pre-fatigue: While those with greater LBM:TBM or the presence of interventions like 52±21ms, post-fatigue: 41±15ms), reported less exertion (12.3 vs. 13.6; verbal feedback. Objective: To whereas the FB group had no change P=0.004), jumped higher (0.38 vs. quantify the effects of fatigue and (pre-fatigue: 43±14ms, post-fatigue: 0.31 m; P=0.003), and sprinted faster verbal feedback on the rate of knee 41±11ms) (t=4.193, P<0.001). (4.80 vs. 4.57 m/s; P=0.024) there joint loading during an unanticipated Significant fatigue main effects were were no group differences by time (P- sidestep cut. Design: Cross-sectional. found for TTP ATSF (pre-fatigue: value range: 0.51–0.93). Hip, knee, or Setting: Research laboratory. 136±180ms, post-fatigue: 76±137ms, F =8.859, P=0.004) and total stance ankle energy absorption did not differ Patients or Other Participants: 1,53 by group (P-value range: 0.14-0.75) or Fifty-nine club-sport athletes (31M, time (pre-fatigue: 995±281ms, post- fatigue: 1106±324ms, F =12.139, group by time (P-value range: 0.46– 28F; 19.8±1.6yrs, 176.7±9.2cm, 1,53 0.77). There was no main effect or 71.2±10.0kg) were randomly assigned P<0.001). Conclusions: In general, interaction for CMJ (P>0.05). to either receive verbal feedback (FB) fatigue appears to increase the rate of Conclusions: Regardless of or no feedback (NFB) post-fatigue. loading on the knee joint via shorter LBM:TBM, RPE increased, SS Interventions: The unanticipated TTP VGRF and ATSF, despite a longer decreased, CMJ did not change, and sidestep cutting task involved a jump stance phase. However, feedback was energy absorption at the knee over a hurdle, triggering a randomized effective at preserving TTP VGRF. decreased after 45 minutes of directional cue. The participant landed Prior research using identical methods exercise, where it remained after 90 with the dominant foot on a force found fatigue increased the magnitude minutes. While those having greater platform and cut 60° in the indicated of ATSF and VGRF, which combined LBM:TBM reported lower RPE, and direction. Participants then performed with lower TTP VGRF and ATSF would were able to jump higher and sprint an intense, intermittent fatigue likely increase the strain on the ACL. faster throughout the IEP, LBM:TBM protocol involving multi-directional Therefore, feedback may be one had no effect on the degradation of sprints and broad jumps. Testing method to protect the ACL from injury lower extremity energy absorption procedures were repeated post- under fatigued conditions. with fatiguing exercise. Therefore, fatigue, but the FB group received while overall performance may be instructions to “land softly, keep your dependent on body composition, body knee over your toes, and make the composition was not a factor in one’s movement ‘smooth’”. The NFB group ability to maintain their performance received no instruction. Main or lower extremity biomechanics as Outcome Measures: A 7-camera fatigue ensued. Acknowledgements: motion capture system and force Supported by NFL Charities platform collected kinematics and kinetics. The length of the stance phase

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Hip Abduction Torque Between between limbs, and normalized to body Effects Of Hip Abductor Fatigue Non-Specific Low Back Pain mass. A 2 x 2 ANOVA with repeated On Kinematics Of The Foot And Healthy Individuals With measures compared the average during Walking Gait Repeated Exercise normalized hip abduction torque at the Coldiron GR, Tufaro VJ, Bamberg Sutherlin MA, Hart JM: University beginning of the first fatigue trial and SJM, Switzler CL, Hicks-Little CA: of Virginia, Charlottesville, VA the end of the last fatigue trial between University of Utah, Salt Lake City, groups. Results: There was no UT Context: Low back pain (LBP) is a difference between groups prevalent condition that can lead to (F(1,23)=0.207, p=0.653) at the onset Context: Multiple studies have found muscle weakness and adaptations. (NSLBP=1.52±0.42 Nm/kg, Healthy that control at the hip is essential for People with LBP have weaker core =1.62±0.30 Nm/kg) or following the proper function throughout the distal Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 musculature potentially leading to repeated fatiguing exercise (NSLBP lower extremity. Research has shown instability. Weakness or poor =1.10±0.42 Nm/kg, Healthy= that hip function can affect function at endurance in the gluteus medius may 1.13±0.30 Nm/kg) for normalized hip the knee and ankle; but it is only be an easily treatable deficiency in abduction torque. There was a assumed that there could be similar patients with LBP. Objective: To significant main effect of time within effects into the foot. Paucity in the compare isometric hip abduction groups (F(1,22)=71.120, p<0.001) literature currently exists regarding torque of the gluteus medius muscle following fatigue (Prefatigue the effects hip fatigue or weakness has in healthy individuals to those with = 1.57±0.36 Nm/kg, Postfatigue on foot mechanics during gait. NSLBP following a repeated = 1.12±0.36 Nm/kg), but no group Objective: The purpose of this study isometric side-lying hip abduction by time interaction (F(1,22)=0.535, was to determine if there is a direct task. Design: Descriptive laboratory p=0.472). Conclusions Averaged relationship between hip abductor study Setting: Laboratory Patients or normalized hip abduction torque fatigue and amount of subtalar Other Participants: 24 subjects, 12 decreases following fatigue, however pronation or supination during walking with a history of NSLBP (5M/7F, no differences were observed between gait. Our hypothesis was that hip age=24±4, body mass index= groups. An isometric side-lying abductor fatigue will directly affect 25.19±3.44, Oswestry low back pain hip abduction task is sensitive kinematics of the foot during walking scale=8.67±5.61, pain=1.06±0.88, to changes in torque following gait on both the fatigued and non- Fear and Avoidance Belief prolonged exercise, however fatigued legs. Design: A repeated questionnaire=18.00±8.07) and 12 we are unable to discriminate measures design. Setting: Sports healthy controls (3M/9F, age 22±3, between those with NSLBP likely to Medicine Research Laboratory. body mass index=21.28±2.40, experience reoccurrences and those Patients: Seventeen healthy Oswestry low back pain scale= who do not have NSLBP. volunteers (10 men and 7 women) age: 0.67±1.23, pain=0±0, Fear and 22.17 ± 2.45 years, height: 174.0 ± 9.0 Avoidance Belief questionnaire 0±0). cm, weight: 170.59 ± 32.08 lbs were Interventions:Participants recruited to participate in the study. All completed a total of five repeated participants were right foot dominant. isometric side-lying hip abduction Interventions: Participants trials of 30 seconds durations with 30 completed five walking trials both pre seconds rest between trials. Subjects and post completion of a hip abductor were side-lying with the testing leg fatigue intervention on the dominant secured to an isokinetic dynamometer, leg. Subjects wore a customized foot and the back stabilized with foam rolls pressure system and 3D lower during testing. Testing of the opposite extremity reflective markers during limb was conducted 20 minutes after the walking trials. The hip abductor completion of the first leg to reduce fatigue protocol involved completing the effects of fatigue. Main Outcome a side lying hip abduction movement Measures: Mean hip abduction to a pre-determined height with a 5lb torques of the dominant and non- weight attached to the lower leg of the dominant limb were recorded at 2 dominant leg of all participants. Hip second intervals during the second to abduction movement was continued fourth seconds and the twenty-six to until failure. At that time, participants twenty-eighth seconds during each immediately performed the post trial. Torque values were averaged

Journal of Athletic Training S-163 13F07FOBI fatigue walking trial measures. Main The Effect Of Equalizing Task Normalized EA (J*N-1*m-1) for the Outcome Measures: Mean joint Demands According To Sex hip, knee, and ankle were calculated position during gait, maximal subtalar Differences In Lower Extremity from the kinematic and kinetic data pronation and maximal subtalar Lean Mass During Landing during the initial deceleration phase supination in degrees; and mean center Montgomery MM, Shultz SJ, of the DJ landing and expressed of pressure in millimeters during Schmitz RJ: California State relative to total EA (%). Separate walking gait. A repeated measures University, Northridge, Northridge, ANOVAs compared males and females ANOVA was utilized with alpha set a CA, and The University of North on joint EA before and after equalizing priori at d•0.05. Results: Significant Carolina at Greensboro, task demands. Results: LELM differences were found for mean joint Greensboro, NC (Mean±SD) for females compared position (P=.048) and maximal to males: 23.6±2.9 vs. 29.1±2.3%. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 supination (P=.019) between the Context: Females possess less relative During the HeightSTD condition fatigued and non-fatigued legs. lower extremity lean mass (LELM) (0.45±0.0m), males absorbed a greater Specifically, participants spent a and strength than males. Less LELM proportion of total EA than females longer time in a pronated position in in females has been suggested as a about the hip: 18.1±8.4% vs. the fatigued leg versus a supinated factor influencing sex differences in 22.4±9.6% (p=0.05), with no position in the non-fatigued leg. lower extremity (LE) landing differences at the knee: 60.5± Further, the non-fatigued leg presented biomechanics, particularly greater 10.8% vs. 56.0±10.6% (p=0.08) or with a maximal supination angle of relative energy absorption (EA) about ankle: 21.3±9.3% vs. 21.6±7.0%

12.6° compared to 4.9° for the the knee, which may lend towards their (p=0.88). During the HeightEQU fatigued leg. However, no statistically greater risk of ACL injury. However, condition (0.57±0.07m), males significant differences were found for sex comparisons in biomechanics may continued to absorb a greater maximal pronation (P=.074) or mean be biased as the majority of studies proportion of energy about the hip: center of pressure (P=.186). utilize experimental procedures in 18.1±8.4% vs. 23.1±9.5% (p=0.02), Conclusions: Our results revealed which males and females perform with no differences observed at that there is a relationship between hip equivalent tasks (i.e. same drop the knee: 60.5±10.8% vs. abductor fatigue and foot kinematics. height), thus requiring females to 56.0±10.6% (p=0.08) or ankle: The significant differences found in perform a task which is relatively more 21.3±9.3% vs. 20.8±7.0% (p=0.81). our results suggest that compensatory difficult. Objective: To determine the Conclusions: Equalizing task actions occur between limbs which effect of equalizing task demands on difficulty according to sex may potentially place athletes at a relative LE joint energetics during a differences in LELM had no effect greater risk for lower extremity injury drop jump (DJ) according to on the relative joint contributions if hip abductor weakness or fatigue is differences in LELM between males to EA, which suggests that it is not present. Further research is needed and females. We expected sex just task demand driving the sex to explore the effect hip abductor differences in EA to decrease when differences in biomechanics. strengthening programs have on foot task demands were equalized. These results may also point mechanics and the prevention of Design: Descriptive Cohort. Setting: towards an inadequacy in the lower extremity injury. Controlled Laboratory. Patients or current methods for equalizing Other Participants: 35 female (1.67 task demands according to LELM; ±0.1m, 65.3±6.6kg, 21.6±3.6yrs) and there may be other factors that 35 male (1.78±0.1m, 74.7±8.9kg, more accurately characterize 20.9±2.9yrs) athletes. Interventions: relative task demands when Participants were enrolled in male- comparing males and females. female pairs, matched by similar body Future work should examine a more mass index. LELM was measured via functional factor, such as strength, dual-energy x-ray absorptiometry. LE for equalizing task demands with biomechanics were assessed during a the larger goal of making unbiased DJ from a standardized height sex comparisons in future investigations. Supported by NATA (HeightSTD) and after equalizing the task demands based on the difference Foundation.

in LELM within each pair (HeightEQU). Main Outcome Measures: LELM was normalized to body mass (%).

S-164 Volume 48 • Number 3 (Supplement) May 2013 13408MOBI

Pubertal Maturation Effects On Data were collected using eight high- Lower Extremity Kinetics And speed Vicon motion analysis cameras Kinematics Of Adolescent Male and two Bertec force plates. Kinetic Athletes During A Stop-Jump and kinematic data were measured Task and analyzed during the unanticipated Turn KK, Greska EK, McCarty stop-jump only. Main Outcome CW, Waters B, Van Lunen BL: Measures: The independent variable Old Dominion University, Norfolk, was maturation stage(3), and the VA; University of West Florida, dependent variables were knee flexion Pensacola, FL; A.T. Still University, (KF), knee abduction (KA), hip flexion

Mesa, AZ (HF), hip abduction (HA), knee flexion Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 moment (KFM), knee abduction Context: There has been extensive moment (KAM), hip flexion moment research on the incidence of anterior (HFM), and hip abduction moment cruciate ligament (ACL) injuries in the (HAM). All dependent variables were high school and collegiate population. measured at initial contact (IC), peak However, ACL injuries have become knee flexion (PKF), peak vertical increasingly common in the ground reaction force (PVGRF), and adolescent population, and there has peak posterior ground reaction force been limited research investigating the (PPGRF). A one-way MANOVA was cause. It has been suggested that performed for each dependent variable changes experienced during pubertal across all time instances, with a maturation may affect lower extremity Bonferroni adjustment set at Pd”.01. kinetics and kinematics during athletic Results: For HA, PRE subjects maneuvers. Objective: To determine demonstrated significantly greater if pubertal maturation has an effect on angles than PUB subjects (IC: PRE lower extremity biomechanics of -8.64±5.06, PUB -1.00±4.33, P=.002; healthy adolescent male athletes PPGRF: PRE -8.34±5.20, PUB during a stop-jump task. Design: Non- -0.40±4.80, P=.001; PVGRF: randomized cross-sectional study. PRE -8.30±5.82, PUB -0.01±5.11, Setting: Biomechanics laboratory. P=.002; PKF: PRE -7.00±6.75, PUB Patients or Other Participants: 0.74±5.30, P=.01). No significant Thirty-three healthy male adolescent differences (P>.01) were noted athletes between the ages of 9 and 14 between maturation stages for (11.52±1.54 years, 1.53±0.14m, all kinetic measures, KF, KA, 44.22±11.37kg) volunteered to and HF across all time instances. participate. Participants were placed Conclusions: As a decrease in into three maturational categories HA has been noted as a possible ACL [pre-pubescent (PRE), early- injury risk factor, the differences pubescent (PUB), post-pubescent demonstrated between pre-pubescent (POST)] based on the Pubertal and post-pubescent males Maturation Observational Scale that during the stop-jump may be a was completed by the participants’ contributing factor to the rise in injury parent or legal guardian prior to occurrence across maturation. Hip participation. All participants were free strengthening and other aspects of ACL of lower extremity injury during the prevention programs may decrease the time of the study. Intervention: risk of a non-contact ACL tear. More Participants lower extremities were research is needed to further marked with 42 reflective markers investigate the effects of maturation prior to performing 5 trials each of an stage on lower extremity anticipated side-step cut and running biomechanics in adolescent athletes. stop-jump, followed by 5 trials each of an unanticipated side-step cut and an unanticipated stop-jump.

Journal of Athletic Training S-165 13F18DOBI 13253DONE

Hip Abductor Induced Fatigue at 30° knee flexion (F1,27=6.39; The Relationship Between And Lower Extremity Joint P=0.00). Post hoc analysis showed that Musculoskeletal Strength, Angles During Unilateral Drop fatigue protocol resulted in decreased Physiological Characteristics Landings In Males And Females hip abduction angle at 30° of knee And Knee Kinesthesia Following Kim CY, Lee SC, Lee HD, Lee SY: flexion (Pre: -8.06°±3.52°; Post: Fatiguing Exercise Yonsei University, Department of -6.19°±4.19°). A significant main Allison KF, Sell TC, Abt JP, Beals Physical Education, Seoul, Korea effect for fatigue was also found in K, Nagle EF, Lovalekar MT, knee varus/valgus angles at 30° of knee Lephart SM: Neuromuscular flexion (F =30.83; P=0.00). Post Context: Fatigue of abductor muscles 1,27 Research Laboratory, Department of the hip may cause increased frontal hoc analysis showed that fatigue of Sports Medicine and Nutrition, plane knee motion leading to increased protocol increased knee valgus angles School of Health and Rehabilitation Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 risk of knee valgus collapse. However, at 30° of knee flexion (Pre: - Sciences, University of Pittsburgh, comparing landing mechanisms 0.09°±4.23°; Post: -2.32°±4.58°). Pittsburgh, PA between males and females before and Other kinematic variables did not show after lower extremity fatigue has not significant main and interaction effect. Context: Fatiguing exercise may yet been investigated. Objective: The Conclusions: Fatigue-induced result in impaired functional joint objective of this study was to assess changes in the lower extremity stability and increased risk of gender differences in unilateral kinematics during unilateral landing musculoskeletal injury. While there landing before and after hip abductor may lead to lower extremity motions are several musculoskeletal and muscle fatigue. Design: Case that are characteristic of ACL physiological characteristics related controlled study. Setting: Laboratory mechanisms of injury. However, there to fatigue onset, their relationship with Patients or Other Participants: were no differences between gender proprioceptive changes following Fifteen healthy male (age: 29.6±2.07 which indicated that only fatigue do fatigue has not been examined. yrs; weight: 75.4±5.12 kg; height: play an important role in controlling Objective: To establish the 177.6±5.70 cm) and female (age: knee motion regardless of sex. relationship between musculoskeletal 22.6±3.29 yrs; weight: 57.9±5.68 kg; Therefore, it may be necessary to and physiological characteristics and height: 163.4±4.64 cm) subjects were enhance hip abductor muscle strength changes in knee proprioception recruited for this study. Intervention: and resistance to fatigue in an effort following fatigue. Design: Cross- A continuous side lying hip abduction to ensure safe maneuvering such as in sectional, correlational study design. exercise was performed to induce sudden changes or unilateral landing Setting: Research laboratory. fatigue until subjects were unable to which are common during sport events. Participants: Twenty healthy, touch target angle which was 35°. In physically active females participated order to confirm muscle fatigue, the (age: 28.7±5.6 years, height: gluteus medius muscle median 165.6±4.3 cm, weight: 61.8±8.0 kg, frequency (MDF) was collected during BF: 23.3±5.4%). Subjects were free exercise using a Delsys wireless EMG from lower extremity injury within the system (Delsys Inc, Boston, MA). past year, surgery within the past 5 Main Outcome Measures: years, and had no history of Independent variables of this study ligamentous injury to the knee. were gender and fatigue status. Interventions: During Visit 1, Landing data were collected using a subjects underwent threshold to detect Vicon motion analysis system (Vicon passive motion familiarization Inc, LA, CA) during landing at 200 Hz. (TTDPM, passive mode, 0.25°/s, 3 Since ACL injuries occur near 30° of repetitions each for knee extension/ knee flexion, all 3-D joint kinematics flexion). In addition, isokinetic knee at the hip, knee, and ankle were flexion/extension strength testing analyzed in this specific angle. A (60°/s, 5 repetitions each) and peak gender by time mixed model two-way oxygen uptake (VO2peak)/lactate repeated measures of ANOVA were threshold (LT) assessments were performed to analyze mean performed (treadmill protocol). differences. Alpha level was set a During Visit 2, subjects completed priori at .05 for all analysis. Results: TTDPM testing and isometric knee A significant main effect for fatigue flexion/extension strength testing (5- was found in hip adduction/abduction

S-166 Volume 48 • Number 3 (Supplement) May 2013 13320MOBI s, 3 repetitions each) immediately Future studies should consider There Is A Relationship Between before and after a fatiguing exercise different subject populations, other Knee And Hip Kinematics And protocol designed to elicit upper/ musculoskeletal strength character- The Reduction Of Vertical lower body, core, and general fatigue. istics, and different modalities of Ground Reaction Forces In Strength and TTDPM testing were proprioception to determine the Youth Soccer Athletes performed on the dominant limb, most important contributions to Stephenson LJ, DiStefano LJ, defined as the limb used to maximally proprioceptive changes following Padua DA: University of North kick a ball. Wilcoxon signed rank tests fatigue. Supported by Freddie H. Fu, Carolina, Chapel Hill, NC; Stony determined TTDPM and isometric MD Graduate Research Award. Brook University, Stony Brook, knee strength changes from pre- to NY; University of Connecticut, post- fatigue. Spearman’s rho Storrs, CT Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 correlation coefficients determined the relationship between isokinetic Context: It has been shown in adult strength and physiological variables populations that vertical ground with pre- to post-fatigue changes in reaction forces (VGRF) are absorbed TTDPM and with pre-fatigue and post- primarily through altering knee fatigue TTDPM in extension and kinematics and secondarily through flexion (˜=0.05). Main Outcome changes in ankle angles in females and Measures: Strength was reported as hip angles in males. As youth athletes average peak torque normalized to demonstrate different landing body weight, VO peak as highest 15- 2 biomechanics than that of adults it is s averaged O uptake normalized to 2 prudent to assess their energy body weight, and LT as %VO peak. 2 absorption strategies so that anterior Mean absolute error from pre- to cruciate ligament (ACL) injury post-fatigue was calculated for prevention programs can address these TTDPM. Results: No significant changes in lower extremity kinematics differences were demonstrated in to decrease forces at the knee. TTDPM from pre- to post-fatigue Objective: To identify relationships despite a significant decrease in between decreased VGRF and knee isometric knee flexion strength and hip kinematic variables during a (P<0.01) and flexion/extension ratio jump-landing task and determine how (P<0.05). No significant correla- VGRF is being absorbed in youth tions were observed between soccer athletes. Design: Cross- strength or physiological variables sectional. Setting: Research and changes in TTDPM from pre- to laboratory. Participants: Twenty-nine post-fatigue. Isokinetic flexion/ healthy soccer athletes (females: extension ratio was significantly n=12, age=10±1 years, height negatively correlated with pre- =141.68±4.51cm, mass= 33.28±4.40 fatigue TTDPM into extension (r=- kg; males: n=17, age=10±1 years, 0.231, P<0.05) and VO peak was 2 height=141.59±6.06cm, significantly negatively correlated mass=32.59±3,73kg) volunteered to with pre-fatigue (r=-0.500, P<0.01) participate. Interventions: Two sets and post-fatigue (r=-0.520, P<0.05) of three jump-landing trials were TTDPM into extension. Con- performed during a single testing clusions: No significant session. Participants were provided relationships were demonstrated with instructions regarding proper between musculoskeletal and landing technique prior to each trial of physiological characteristics and the second set of landings. The task changes in TTDPM following required participants to jump forward fatigue, which may be related to the from a 30cm high box placed a high fitness level of these subjects. distance of half their height away from However, higher strength ratio and a force plate, land with their dominant VO peak were associated with better 2 foot on the force plate, and proprioception pre- and post-fatigue. immediately jump for maximal vertical

Journal of Athletic Training S-167 13444FOGA height. An optical three-dimensional Frontal Plane Knee Laxity Is linear regressions examined the extent motion analysis system and a force Predictive Of Measures to which absolute (varus) and relative plate measured lower extremity Associated With Medial Knee (varus/valgus) knee laxity predicted the kinematics and kinetics. Main Loading During Gait peak biomechanical measures, after Outcome Measures: Dependent Schmitz RJ, Shultz SJ, Wang accounting for TFA and sex. Results: variables included sagittal and frontal HM, Copple TJ, Rhea CK: The After accounting for TFA (11.8±3.1°) plane knee and hip angles at initial University of North Carolina at and sex, lesser absolute (3.5±1.2°) and contact and peak values over the stance Greensboro, Greensboro, NC relative (0.77±.25) varus laxity phase and peak VGRF which was predicted greater peak knee adduction normalized to body weight. Bivariate angle (5.1±3.4°) (R2"=17.5%,

Context: Knee osteoarthritis (OA) Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 correlations were analyzed assessing onset and progression is related to gait P”=0.014) and greater peak knee the relationship between VGRF and all biomechanics characteristic of medial external adduction moment (0.039 kinematic variables and were knee loading. While frontal plane knee ±0.010 Nm*bw-1*ht-1 x10-2) (R2"= additionally analyzed by sex (d”.05). joint laxity has been associated with 13.3%, P”=0.032). Laxity measures Results: Analysis of all participants OA progression, it is unknown if were not significantly predictive of revealed significant moderate positive frontal plane knee joint laxity is related peak hip adduction angle (5.8±4.2°) correlations between VGRF and hip to gait biomechanics commonly (R2"=12.8%, P”=0.072) or peak flexion at intial contact (HFIC) associated with medial joint loading external hip adduction moment -1 -1 -2 (r(27)=.404, p<.05) and between VGRF and OA initiation. Objective: (0.0570±0.011 Nm*bw *ht x10 ) 2 and peak hip flexion (HFP) (r(27)=.442, Determine if frontal plane knee laxity (R "=13.7%, P”=0.070). Con- p<.05). When analyzed by sex no is related to frontal plane gait clusions: After accounting for bony significant correlations were found mechanics commonly associated with alignment and sex, lesser absolute and between VGRF and the kinematic OA onset and progression after relative varus laxity predict knee variables for males, and females accounting for pertinent anatomy. biomechanics commonly associated demonstrated a moderately strong Design: Cross-sectional. Setting: with greater medial knee loading in significant negative correlation Controlled Laboratory. Participants: healthy individuals. Mechanical between VGRF and peak knee flexion Forty healthy participants (20 females; restraints to frontal plane knee motion (r(10)=-0.578, p<.05). Correlations 1.64±0.04m, 65.1±11.1kg, 21.7± have the potential to affect chronic between VGRF and knee flexion at 3.1yrs; 20 males: 1.79±0.09m, 83.2 knee loading patterns that may initial contact (r(10)=.-0.573, p=.051) ±17.2kg, 25.1±3.6yrs) with no current predispose one to knee OA. Future and peak knee valgus (r(10)=.-0.206, orthopedic injury or history of surgery work needs to further understand the p=.052) were approaching in left limb. Interventions: On a predictive role of knee joint laxity in significance. Conclusion: In order single day participants underwent OA onset and progression. to decrease VGRF youth soccer goniometric assessment of lower limb athletes alter hip flexion. This alignment, frontal plane knee laxity landing strategy is in contrast testing using the Vermont Knee Laxity to their adult counterparts who favor Device, and 10 trials of over ground changes in knee kinematics as walking at a self-selected pace. All a strategy in decreasing VGRF. The testing was performed on the left limb. females in this study demonstrated Main Outcome Measures: landing in a more erect posture with Tibiofemoral angle (TFA) represented increased hip extension followed the angle formed in the frontal plane by increases in peak knee flexion by the anatomical axes of the femur to absorb VGRF; this is concurrent and tibia. Varus and valgus knee laxity with the literature on landing were determined at ±10Nm using the strategies in adult females. Vermont Knee Laxity Device. Lower By understanding these force extremity joint biomechanics during absorption strategies we can the stance phase of gait were construct a more comprehensive normalized to 100 points and ACL injury prevention program ensemble averaged over the 10 trials. for these young athletes. Peak hip and knee adduction angles and peak external hip and knee adduction moments were extracted from the first 50% of stance phase. Separate

S-168 Volume 48 • Number 3 (Supplement) May 2013 13301MOBI 13232UOBI

Hip Abductor And External force>10N) and maximum knee Hip External Rotation Strength Rotator Strength Is Not Related flexion. The average value for MKD Impacts Frontal Plane Hip To Medial Knee Displacement In and strength were used for analyses. Motion During Unanticipated Post-Pubescent Females Separate Pearson correlation Landing Activities In Collegiate Barry MA, Martinez JC, Trojian coefficients were calculated Female Soccer Players TH, Joseph MF, Denegar CR, to evaluate the relationship between Meinerz CM, Kipp K, Wood CM, DiStefano LJ: University of hip abductor strength and hip Geiser CF: Marquette University, Connecticut, Storrs, CT external rotator strength with MKD. Milwaukee, WI A linear regression was performed to evaluate if hip abduction and/or

Context: Anterior cruciate ligament Context: A number of lower extremity Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (ACL) injuries are frequently seen hip external rotator strength injuries have been linked to hip muscle during cutting and single leg landing significantly predicted MKD. weakness in both cross-sectional movements. Excessive medial knee Results: Neither hip abduction (r= studies and theoretical papers. displacement (MKD) is theorized to -0.24, p=0.26) nor hip external However, studies on the link between be a risk factor for ACL injuries. rotation (r=-0.007, p=0.97) strength hip muscle strength measures and Post-pubescent females demon- were significantly correlated kinematic variables have been strate greater MKD and have a higher with MKD or significantly predicted inconclusive or inconsistent. 2 risk of ACL injury compared to their MKD (R =0.11, p=0.28) in post- Objective: To examine the association male counterparts. There is pubescent females. Conclusions: between hip strength measures and conflicting evidence regarding the These results suggest that increasing landing kinematics during athletic-like role of hip strength in controlling hip strength alone may be tasks. Design: Cross-sectional MKD specifically in a high-risk insufficient to control MKD and correlation. Setting: Biomechanics population. Objective: To evaluate prevent ACL and other lower laboratory Participants: Twenty- the relationship between hip abductor extremity injuries in this high risk three healthy collegiate female soccer and hip external rotator strength population. Strength training of the players (Age: 19.6+1.3 yrs, Height: with medial knee displacement hip musculature may still need to 1.69+0.06 m, Mass: 63.3+6.6 kg) (MKD) in post-pubescent high be addressed in prevention Interventions: A Lafayette manual school female athletes. Design: and rehabilitation programs, but muscle testing system™ was used Cross-sectional. Setting: Research should also be combined with with a standardized protocol to Laboratory. Patients or Other teaching proper neuromuscular measure hip abduction and external Participants: Twenty-five post- control through balance, plyometrics, rotation strengths. Participants pubescent high school female and sport-specific exercises. performed three tasks while three- athletes (age= 16 ±1 years, mass= dimensional kinematic data of the 58.6±7.4 kg, height= 166±8 cm) lower extremity were collected. For volunteered to participate in this each task, participants had to stride study. Interventions: Maximal forward off of a platform, and land on isometric hip abduction and external a force plate with a single leg. rotation strength were measured Platform height and stride distance during two trials using a hand-held were normalized to the participant’s dynamometer. MKD was assessed vertical jump height and stride length, during three trials of a standardized respectively. While in the air, jump-landing task using three- participants were given one of three dimensional motion analysis. The visual signals on a video screen, which jump-landing task required would indicate one of three actions participants to jump forward from after landing; continue running forward a 30-cm high box a distance of (RUN), stop and balance on the landing half their height jump for maximum leg (STOP), or cut to the side away vertical height immediately upon from the landing leg (CUT). Visual 3D landing. Main Outcome Measures: was used to process kinematic data MKD was calculated as the during the landing phase, which was displacement of the knee joint identified using vertical ground center between initial ground reaction force and corresponded to contact (ground reaction approximately the first 30% of total

Journal of Athletic Training S-169 13294FONE ground contact time. Hip excursion Understanding The Role Of Hip step-wise linear regressions was calculated as the difference Muscle Activation In Controlling determined the extent to which hip between maximum and touchdown Lower Extremity Motion During muscle activation and hip torque angle. Hip strength measures were Functional Tasks predicted hip kinematics during a drop- normalized to body mass and segment Nguyen A, Baellow AL, Boling landing and SLH. Main Outcome lengths. Both normalized hip strength MC: High Point University, High Measures: Hip torque was measured measures were simultaneously entered Point, NC, and University of in Newton-meters and normalized to into three regression models with hip North Florida, Jacksonville, FL body mass (Nm•kg-1). Frontal and excursions as the outcome variables. transverse plane hip angles (°) at IC, Main Outcome Measures: Hip peak angle during the landing (IC to Context: Weakness of the hip Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 excursion (degrees) in each cardinal musculature has been suggested to maximum knee flexion), and joint plane. Results: Hip External Rotation contribute to an increased risk of knee excursion (peak minus IC angle) were strength was significantly associated injuries due to decreased control of the extracted. The average root mean with hip excursion during landing in the hip. However, the relationship between square (RMS) amplitude of the Gmed

Frontal plane during all three tasks hip strength and dynamic hip motion and Gmax during the drop-landing and 2 (Stop R Adj=0.243, B=0.768, remains unclear, as many studies have SLH were normalized to the peak RMS t(20)=3.025, p=0.006; Cut not accounted for activation of the hip value during MVIC for each muscle 2 R Adj=0.476, B=0.889, t(20)=4.021, musculature during dynamic activities. (%MVIC). Results: In females, less 2 p=0.001; Run R Adj=0.0.283, B=0.808, Objective: To determine the role of Gmed pre-activation (0.32±0.15% t(20)=3.267, p=0.004), but not in the hip torque and muscle activation in MVIC) predicted less hip internal sagittal or transverse planes. Hip predicting hip kinematics during a rotation at IC (0.53±6.07°) during a Abduction strength was not associated drop-landing and single leg hop (SLH). drop-landing (R2=0.145, P=0.017) significantly with any hip excursion Design: Descriptive laboratory study. and less peak hip internal rotation (- measures. Conclusions: Regression Setting: Research laboratory. 4.42±7.79°) during a SLH (R2=0.115, coefficients demonstrate a positive Patients or Other Participants: P=0.038). In males, less Gmed post- association between hip External Seventy-eight (39 males, 39 females) activation (0.932±0.658%MVIC) Rotation isometric strength and hip healthy participants (22.1±3.5 yrs, predicted less peak hip internal excursion in the frontal plane during 169.9±10.2 cm, 71.2±15.8 kg) rotation (-10.79±7.45°) during a drop- unanticipated landing tasks. In the volunteered for this study. landing (R2=0.210, P=0.005) while frontal plane, the stronger the hip Interventions: All measures were less hip extension torque (3.52±0.80 external rotators were isometrically, performed on the dominant stance Nm•kg-1) predicted greater hip internal the greater frontal plane hip excursion limb. Hip abduction (standing, hip rotation excursion (-3.13±3.18°) they demonstrated during abducted 5°) and extension (supine, hip during a SLH (R2=0.248, P=0.016). unanticipated tasks. The association flexed 90°) torques were measured Hip muscle activation and torques were was greatest for the cutting task, which during maximal isometric voluntary not significant predictors of other hip is a frontal plane activity when contractions (MVIC) using an kinematics (P>0.05). Conclusions: compared to the more sagittal plane isokinetic dynamometer. Three- While hip torque was associated with tasks of stopping and running. dimensional hip kinematics, gluteus hip internal rotation excursion in males, activation of the G was a medius (Gmed) muscle activation and med consistent predictor of hip kinematics gluteus maximus (Gmax) muscle activation were assessed during during dynamic tasks. Future studies bilateral drop-landings (height=45cm) should account for hip muscle activation and SLH trials (hop distance=40% of when investigating neuromuscular height, minimal vertical height=5”). control of lower extremity motion and The highest peak torque over 3 trials risk factors for knee injuries. for each strength measure, and the average hip angle at initial contact (IC), peak angle, total excursion, and

average Gmed and Gmax pre-activation (250ms prior to IC) and post- activation (IC to maximum knee flexion) over 5 drop-landing and SLH trials were used for analyses. Separate

S-170 Volume 48 • Number 3 (Supplement) May 2013 13294FONE 13215MONE

Understanding The Role Of Hip step-wise linear regressions Knee Joint Stiffness Differs Muscle Activation In Controlling determined the extent to which hip Among Athletes With Varying Lower Extremity Motion During muscle activation and hip torque Conditioning Histories Functional Tasks predicted hip kinematics during a drop- Oates DC, Needle AR, Kaminski Nguyen A, Baellow AL, Boling landing and SLH. Main Outcome TW, Swanik CB: University of MC: High Point University, High Measures: Hip torque was measured Delaware, Newark, DE. and Point, NC, and University of in Newton-meters and normalized to Campbell University, Buies North Florida, Jacksonville, FL body mass (Nm•kg-1). Frontal and Creek, NC transverse plane hip angles (°) at IC, peak angle during the landing (IC to Context: Weakness of the hip Context: Maintaining functional joint Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 musculature has been suggested to maximum knee flexion), and joint performance and stability is dependent contribute to an increased risk of knee excursion (peak minus IC angle) were on the ability to optimally regulate injuries due to decreased control of the extracted. The average root mean stiffness while preparing and reacting square (RMS) amplitude of the G hip. However, the relationship between med to the onset of loads. However, and G during the drop-landing and hip strength and dynamic hip motion max previous research is unclear with remains unclear, as many studies have SLH were normalized to the peak RMS respect to the types of training or not accounted for activation of the hip value during MVIC for each muscle conditioning histories that may musculature during dynamic activities. (%MVIC). Results: In females, less promote different optimal joint G pre-activation (0.32± 0.15% Objective: To determine the role of med stiffness levels. Training with low hip torque and muscle activation in MVIC) predicted less hip internal repetitions and high weight (power), as predicting hip kinematics during a rotation at IC (0.53±6.07°) during a well as training with high repetitions 2 drop-landing and single leg hop (SLH). drop-landing (R =0.145, P=0.017) and low weight (endurance) are both Design: Descriptive laboratory study. and less peak hip internal rotation related to several neurophysiological 2 Setting: Research laboratory. (-4.42±7.79°) during a SLH (R adaptations; however, it is unclear how =0.115, P=0.038). In males, less G Patients or Other Participants: med these conditioning histories affect Seventy-eight (39 males, 39 females) post-activation (0.932± 0.658% joint stiffness. Objective: To assess healthy participants (22.1±3.5 yrs, MVIC) predicted less peak hip internal the effect of conditioning history on 169.9±10.2 cm, 71.2±15.8 kg) rotation (-10.79±7.45°) during a drop- knee joint stiffness under various 2 volunteered for this study. landing (R =0.210, P=0.005) while reactive conditions. Design: Post-test Interventions: All measures were less hip extension torque (3.52±0.80 only. Setting: Biomechanics -1 performed on the dominant stance Nm•kg ) predicted greater hip internal laboratory. Patients or Other limb. Hip abduction (standing, hip rotation excursion (-3.13±3.18°) Participants: Forty-two male 2 abducted 5°) and extension (supine, hip during a SLH (R =0.248, P=0.016). collegiate athletes (20.1±1.3yrs, flexed 90°) torques were measured Hip muscle activation and torques were 73.0±12.0kg, 176.4±6.2cm) with no during maximal isometric voluntary not significant predictors of other hip history of knee injury volunteered for contractions (MVIC) using an kinematics (P>0.05). Conclusions: this study. Subjects included endurance isokinetic dynamometer. Three- While hip torque was associated with athletes (END, 15 cross-country dimensional hip kinematics, gluteus hip internal rotation excursion in runners), power-trained athletes males, activation of the G was med (PWR, 12 sprinters), and 15 medius (Gmed) muscle activation and a consistent predictor of hip recreational athletes (CON). gluteus maximus (Gmax) muscle activation were assessed during kinematics during dynamic tasks. Interventions: Subjects were tested bilateral drop-landings (height=45cm) Future studies should account for on a customized stiffness assessment and SLH trials (hop distance=40% of hip muscle activation when device that generated a rapid 40° height, minimal vertical height=5”). investigating neuromuscular control flexion perturbation to the knee (30° The highest peak torque over 3 trials of lower extremity motion and risk to 70° flexion arc). Perturbations were for each strength measure, and the factors for knee injuries. randomly applied in 5 different average hip angle at initial contact (IC), conditions: passively (no muscle peak angle, total excursion, and contraction, PS), actively contracted (85% effort, AS), relaxed with average Gmed and Gmax pre-activation (250ms prior to IC) and post- subjects reactively stiffening the joint activation (IC to maximum knee (PRS), pre-contracted (85% effort) flexion) over 5 drop-landing and SLH with subjects reactively stiffening the trials were used for analyses. Separate joint (ARS), and pre-contracted (85% effort) with subjects asked to

Journal of Athletic Training S-171 13260DONE reactively deactivate and relax (DS). Force Sense Does Not Differ CON) and muscle (hamstrings and Main Outcome Measures: Between Power And Endurance quadriceps). Dependent variables Normalized knee joint stiffness Trained Collegiate Athletes included relative error (RE, %), (˜torque/˜position, Nm/°/kg) was An YW, Oates DC, Needle AR, coefficient of variation over the calculated at the short-range (0-4°), Kaminski TW, Swanik CB: 500ms match (CV, %), and time-to- and for the total perturbation (0-40°). University of Delaware, Newark, matched torque (sec). Separate Differences were assessed using a 3- DE, and Campbell University, repeated-measures analysis of way analysis of variance to compare Buies Creek, NC variance was used to determine across groups (3-levels), conditions differences between muscles (2 (5-levels), and stiffness ranges (2- levels) and groups (3 levels). Results: Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 levels). Results: A significant 3-way Context: Recent studies have linked The main effect for conditioning interaction effect was observed deficits in the early detection of joint history (group) was not significant for (F8,156=2.52,p=0.013). Pairwise loading to recurrent episodes of RE (F2,39=0.220, p=0.803), CV comparisons revealed short-range instability. Force sense (FS) is a (F2,39=1.068, p=0.353), or time-to- stiffness was greater in END perception influenced by adaptations matched torque (F2,39=0.674, (0.0569±0.0028 Nm/°/kg) than CON to Golgi Tendon Organs (GTO) and p=0.515). Mean ± SDs of RE for the (0.0474±0.0028 Nm/°/kg, p=0.021) muscle spindles, which play an hamstrings were END= 26.37± under the passive condition. Total important role in regulating joint 18.17%, PWR= 33.44± 18.33%, stiffness was higher in PWR (0.0020 stiffness and responding to injurious CON= 33.74±20.53%, and the Nm/°/kg ±0.003) than END loads. Enhancing force sense through quadriceps were END=37.62 (0.0009±0.0002 Nm/°/kg, p=0.016) specific types of conditioning ±30.29%, PWR=33.08±16.97%, in the passive condition. Additionally, programs may be desirable during CON=25.2±18.34%. Mean ± SDs of for ARS, END (0.0507±0.004 Nm/°/ prevention and rehabilitation, but it is time-to-matched torque for the kg) had higher total stiffness than CON unclear whether power or endurance hamstrings were END=2.72±1.21 sec, (0.0289±0.004 Nm/°/kg, p=0.001) or training would convey any advantages. PWR=2.45± .88 sec, CON=2.4±1.02 PWR (0.0372±0.005 Nm/°/kg, Objective: To determine if sec, and for the quadriceps were p=0.044) groups. Conclusions: Our conditioning history influences FS END=3.14±1.18 sec, PWR= results indicate conditioning history perception. Design: Case-control 2.99±1.22 sec, CON=2.54±1.29 sec, changes stiffness regulation strategies study. Setting: Biomechanics respectively. The main effect for in response to knee perturbations. laboratory. Patients or Other muscle was not significant for RE Higher joint stiffness was observed in Participants: Forty-two male athletes (F1,39=0.030, p=0.864) or CV power-trained athletes under the (20.1±1.3yrs, 73.0±12.0kg, 176.4± (F1,39=0.162, p=0.690). Mean ± SDs passive condition, indicating a 6.2cm) with no history of knee injury of RE for the hamstrings and potential alteration in the fusimotor volunteered for this study. Subjects quadriceps were 31.18±2.96% and reflexes while at rest. Furthermore, included endurance athletes (END, 15 31.97±3.58%, respectively. However, our results found that endurance- cross-country runners), power-trained the main effect for muscle for time- trained athletes had higher knee joint athletes (PWR, 12 sprinters), and 15 to-matched torque was significant stiffness during the reactive trials with recreational athletes (CON). (F1,39=11.12, p=0.002). Time-to- a larger range of motion. As this Interventions: Subjects were tested matched torque for the hamstrings perturbation condition is more for quadriceps and hamstrings FS at (2.52±0.17 sec) was faster than representative of a functional task, it 30% of their maximum voluntary quadriceps (2.89±0.19 sec). suggests that training with low-load isometric contraction on a custom- Conclusions: Our findings revealed and high repetitions may be more built assessment device. Subjects were that conditioning history does not beneficial for achieving greater joint allowed practice with visual feedback affect FS and that the time-to-matched stiffness when necessary. of force prior to the first trial but no torque was faster for the hamstrings feedback was provided between trials. compared to the quadriceps Subjects were instructed to exert their in healthy subjects. FS does not target torque and depress a hand-held appear sensitive to differences in switch. A period of 500ms from physical conditioning among healthy depression of the switch was used to subjects; therefore future studies may determine matched force. Order of explore whether FS deficits existing testing was randomized. Main in injured populations may benefit Outcome Measures: The independent from conditioning programs. variables were group (END, PWR, S-172 Volume 48 • Number 3 (Supplement) May 2013 13319DOMU 13193MOPR

Hip Abductor Peak Torque As A Measures: Hip abduction peak Lower Extremity Muscle Activity Predictor Of Rapid Force torque (Nm), rate of torque While Wear A Functional Knee Production And Strength development (Nms-1) from 0-50 and Brace Endurance 0-200 milliseconds and strength Melinchak M, Donovan L, Hertel Kollock RO, Van Lunen B, Ringleb endurance were calculated as a J, Hart JM: University of Virginia, SI, Oñate JA: Auburn University, percent fatigue using a fatigue index Charlottesville, VA Auburn, AL; Old Dominion (FI): FI = [1 – (area under the torque- University, Norfolk, VA; The Ohio time curve 0-30 seconds /maximum Context: The use of functional knee State University, Columbus, OH force 0-5 seconds x 30)] x 100. To braces among athletes to prevent address the research question of the injury is common. However, the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Lower extremity muscular present study the investigators used application of knee braces can alter the strength deficits may increase an three simple linear regression electromyographic amplitude and athlete’s susceptibility to injury. Many analyses. Results: The M+SD for timing characteristics of thigh have proposed the inclusion of peak torque and strength endurance musculature. There is little research maximum strength evaluations into was 112.60±31.66 Nm and that evaluates the effects of a pre-participation screening exams. 29.99±7.34 percent, respectively. functional knee brace on trunk, hip and However, strength consists of three The M+SD for rate of torque crural musculature. Objective: To parameters (maximum strength, rapid development at 0-50 and 0-200 compare lower extremity force production and strength milliseconds was 1838.73±588.84 electromyographic muscle activity endurance) and there is minimal Nm”s-1 and 455.78±144.60 Nm”s- during a drop landing task with and evidence indicating maximum strength 1, respectively. Peak torque was without functional knee braces. as a predictor of these other qualities. a significant predictor of rate of Design: Randomized, controlled Objective: To determine the extent to torque development from 0-50 cross over design. Setting: which maximum strength predicts milliseconds [F(1, 31) = 433.19, Laboratory. Patients or Other other qualities of strength. Design: p < .001, R2 adjusted = .93] and Participants: Twenty-four young Within-subjects correlational study. from 0-200 milliseconds, [F(1, 31) healthy adults (height= 172±9cm, Setting: Research Laboratory. = 233.09, p < .001, R2 adjusted = mass= 69.65±1.4kg, age= 21.63± Patients and Other Participants: .88]. Peak torque was not a 4.4yrs sex=M:8 F:16). Inter- Thirty-three recreationally active significant predictor of strength ventions: Each participant performed females (20.94±2.86 yrs, endurance, [F(1, 31) = 2.50, p = 10 drop landing tasks in both the 168.75±7.58 cm, 67.75±13.72 kg). .117, R2 adjusted = .05]. braced and non-braced conditions, in Interventions: The investigators Conclusions: Although, isometric random order. The brace was placed collected isometric maximum abductor peak torque is a predictor on the dominant leg (leg used when strength (i.e. peak torque) and rate of rate of torque development from kicking). The drop landing task of torque development data 0-50 and 0-200 milliseconds these consisted of jumping off a 30.5cm box simultaneously from the hip results suggest peak torque does not landing on both feet and immediately abductors in a standing position predict an individual’s ability to performing a maximum vertical jump. using a load cell and data acquisition sustain (i.e. endurance) force Main Outcome Measures: Surface system at 1 kHz. To calculate the rate isometrically at the abductors. EMG was collected from the lumbar of torque development from 0-50 paraspinals, gluteus medius, vastus and 0-200 milliseconds, the lateralis, biceps femoris, medial investigators used the initial 200 gastrocnemius, peroneus brevis, and millisecond after the contraction. tibialis anterior. Normalized surface Isometric rate of torque EMG mean amplitude (50ms development test consisted of three immediately prior to contact (pre- 5-second trials with a 60-second rest contact 1), 50ms immediately between trials. Following a 10- following initial contact (post-contact minute rest, the participant 1), 50 ms prior to vertical jump (toe- underwent isometric strength off), 50ms immediately prior to the endurance testing, which consisted second initial contact (pre-contact 2) of two 30-second isometric and 50ms following the second contact contractions separated by a two- (post-contact 2)), time to activation minute rest. Main Outcome relative to first contact, and percent

Journal of Athletic Training S-173 13218MONE activation across total foot contact Knee Stiffness Regulation After perturbation on 3 randomly selected time. Muscle activation threshold was The Startle Response And trials. Main Outcome Measures: reached if the amplitude exceeded 10 Hormonal Changes Normalized knee stiffness (˜torque/ standard-deviations above that of quiet DeAngelis AI, Needle AR, Royer ˜position, Nm/°/kg) was calculated at standing. Percent of activation was T, Knight CA, Kaminski TW, the short-range (0-4°) and for the total calculated as the total time across the Swanik CB: University of perturbation (0-40°). The average of stride cycle that the amplitude Delaware, Newark, DE, and the control (CON) and startle trial (ST) exceeded activation threshold. Non- Delaware State University, were used for analysis. Repeated- normally distributed data were Dover, DE measures analyses of variance compared between bracing conditions comparing gender (M, FF, FO) and Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 using Wilcoxon signed-ranked test for Context: Growing evidence suggests startle condition (CON, ST) were used each dependent variables. Alpha level the nervous system has a significant for analysis at both short-range and was d”0.05. Results: The pre-contact role in the high rate of non-contact total range. Results: The startle 1 amplitude of the tibialis anterior was anterior cruciate ligament injuries. significantly increased short-range significantly lower in the brace Females are the most susceptible, but stiffness (F=4.24, p=0.04), and condition when compared to the non- evidence for a hormonal role is decreased total (F=11.25, p<0.001) braced condition (31.36±29.57 vs. conflicting. The startle reflex is stiffness. Pairwise comparisons 32.56±34.95, p=0.007). The medial universal across animals and stiffens revealed that at short-range, ST gastrocnemius was activated limb muscles after sudden, displayed a significantly greater significantly earlier relative to initial unanticipated events. No studies have stiffness of 0.047±0.002Nm/°/kg, contact in the braced condition when investigated how hormonal changes (p=0.003) compared to the CON compared to the non-braced condition during the menstrual cycle may (0.043±0.003Nm/°/kg). However, for (-0.109±0.102 vs. -0.073±0.13ms, interact within the nervous system to total stiffness, the startle response p=0.05). The medial gastrocnemius alter the startle response and knee caused significantly less total stiffness and gluteus medius were activated for stiffness regulation among males and (0.028±0.002Nm/°/kg) than the CON a significantly longer percentage females. Objective: To assess if (0.037±0.002Nm/°/kg, p=0.004) across total foot contact time in the reactive knee joint stiffening strategies condition. No significant gender or braced condition when compared to are affected differently in males and menstrual cycle phase differences the non-braced condition (MG: females during an acoustic startle. were observed for stiffness values. 57.3±24.8 vs. 52.7±23.6%, p=0.03; Design: Post-test only with repeated Conclusions: This is the first study GM: 48.0±32.4 vs. 40.8±30.2, measures. Setting: University to indicate that the startle response can p=0.03). Conclusions: A functional laboratory Patients or Other significantly disrupt the normal knee knee brace alters the activation of Participants: 16 males (21.3±2.0 yrs, stiffness regulation strategies that are the tibialis anterior and the timing 82.8±15.8 kg, 179.5±6.9 cm) and 16 required to maintain joint stability, and characteristics of the medial females (20.9±2.0 yrs, 61.8±7.6 kg, this effect may occur equally in males gastrocnemius and gluteus medius in 164.4±6.8 cm) with no previous knee and females. Gender and menstrual healthy young adults. It is not clear injury participated in this study. All cycle phase do not appear to affect whether these changes would females were tested at 2 points in the knee stiffness or negatively interact influence performance or injury risk. menstrual cycle to form 3 groups: with the startle response. Further Males (M), Female-Follicular (FF), studies should explore the potential and Female-Ovulation (FO). role of startle responses in accidents Interventions: Subjects were seated and unintentional non-contact injuries. on a custom stiffness device that generated a rapid 40° flexion perturbation to the knee (30° to 70° flexion arc). Subjects remained relaxed prior to the perturbation, and were instructed to react with maximal extension force as quickly as possible when the perturbation was sensed. A total of 6 trials were performed, with an acoustic startle (50ms, 1000Hz, 100dB) applied 100ms prior to the

S-174 Volume 48 • Number 3 (Supplement) May 2013 13452DONE 13078DOBI

Muscle Activity Of The Vastus threshold was defined as the force at Sex, Hormones, And Use Medialis And Vastus Medialis which 4 consecutive discharges Of Contraceptives On Oblique Are Differentially occurred. The initial firing rate was Neuromuscular Function Modulated By The Menstrual the average of these intervals, Russ AC, Yingling VR, Stearne Cycle converted to hertz. ANCOVA DJ, Anastasio SM, Tierney RT, Tenan MS, Lam A, Hackney AC, analysis was performed with VM/ Moffit DM: Biokinetics Research Griffin L: University of Texas at VMO comparisons at each menstrual Laboratory, Temple University, Austin, Austin, TX, and University phase and males to determine if Philadelphia, PA; West Chester of North Carolina at Chapel Hill, initial firing rate was different after University, West Chester, PA; controlling for recruitment Chapel Hill, NC Idaho State University, Pocatello, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 threshold. A Wilcoxon rank-sum test ID was used to determine if the VM and Context: Patellofemoral pain VMO had different recruitment Context: Fluctuating hormones of the incidence is more than twice as high threshold distributions. Main menstrual cycle may influence the rate in females than in males. This may be Outcome Measures: The dependent of non-contact anterior cruciate due to differences in the activation of variables were initial firing rate, ligament (ACL) injuries, with the muscles that stabilize the patella. which is continuous, and recruitment increased risk prior to ovulation when In vitro and in vivo evidence suggest threshold, which is a bounded estrogen levels peak. Females have that sex hormones can modulate motor measure with a right-skewed shown increased strength and altered neuron activity. Objective: To distribution. Results: Similar VM neuromuscular activation prior to examine the differences in motor unit and VMO recruitment threshold ovulation. These findings have not been (MU) recruitment patterns of the distributions were observed in the replicated in females using oral vastus medialis (VM) and the vastus early follicular phase (p=0.728; contraceptives, which prevent the medialis oblique (VMO) muscles VMO median=8.7%; VM median menstrual cycle. Objective: To across the menstrual cycle and in =8.7%) and there were no determine the effect of sex, hormones, males. We hypothesized that MU differences observed in the other and contraceptive use on knee recruitment would be delayed and phases or males (p>0.05). The initial neuromuscular function at three points initial firing rate would be lower in the firing rate was significantly lower in coinciding with the menstrual cycle. VMO compared to the VM in the the VMO than in the VM at the Design: Decroptive cohort. ovulatory and luteal phases of the ovulatory (p=0.007; VMO= 8.0±0.4 Settings: Controlled laboratory. menstrual cycle due to elevated sex Hz; VM= 9.1±0.4 Hz) and mid luteal Participants: Thirty healthy hormones. Design: The data is (p=0.007; VMO= 7.9±0.4 Hz; VM= physically active college-age students considered cross-sectional since 9.1±0.4 Hz) phases. No differences volunteered (10 males [M], different MUs were presumably between the muscles occurred at the height=182.40 ± 8.47cm, mass=76.41 sampled on each testing date. other phases or in males (p>0.05). ± 11.33kg; 10 female OC [FOC], Setting: Controlled laboratory. Conclusions: The initial MU firing height=169.33 ± 7.47cm, mass=71.34 Patients or Other Participants: 11 rate of the VMO is lower than in ± 17.83 kg; 10 female non-OC males (24.6±5.1 yr) and 7 the VM at the ovulatory and mid [FNOC], height= 72.80 ± 5.12cm, eumenorrheic females (24.9±4.3 yr) luteal phases. The lower activation of mass=68.78 ± 10.57cm). Inter- participated. From these participants, the VMO compared to VM due ventions: Participants completed 510 MUs were analyzed. to hormonal oscillations may three testing sessions (1/follicular, 2/ Interventions: Using basal body increase lateral glide of the patella ovulatory, 3/luteal). FOC testing temperature mapping, 5 menstrual and predispose females to a higher sessions were scheduled based on phases were determined for data incidence of patellofemoral contraceptive pill day, FNOC were collection. Males attended only one pain compared to males. scheduled around self-report and a session. All sessions consisted of an positive ovulation test. A standardized isometric ramp knee extension up to testing protocol was followed. 30% maximal force. Before the Participants completed 3 drop jumps contraction, intramuscular off a 46-cm box, landing on a force electrodes were inserted into the plate. Data from area VMO and VM. Individual MUs were electromyography (EMG [% identified based upon shape and maximum voluntary isometric discharge timing. MU recruitment contraction]) of the rectus femoris

Journal of Athletic Training S-175 (RF) and biceps femoris (BF) were collected 250ms pre- and post-land. Force plate data were used to calculate vertical leg stiffness (VLS) during the eccentric phase of landing and normalized with a liner regression- based correlation using body weight. Main Outcome Measures: Neuromuscular activation (RF, BF) by

group (M, FOC, FNOC), testing Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 session (1/follicular, 2/ovulatory, 3/ luteal), and time period (pre, post); and VLS by group (M, FOC, FNOC) and testing session (1/follicular, 2/ ovulatory, 3/luteal). A multiple analysis of variance was used to analyze EMG data, while an analysis of variance was used to analyze VLS (pd”.05). Results: Post-land, EMG area of RF (pre=19.71 ± 1.46%, post=46.23 ± 25.36%) and BF (pre=9.40 ± 6.18%, post = 19.69 ± 14.71%) were significantly greater than pre-land across groups and testing sessions (F=3.71, p<.001). No other significant interactions or main effects for EMG data were observed. A significant difference existed between groups with respect to VLS (F=4.66, p=.012). Males (88.15 ± 51.86kN/m) and FOC (81.09 ± 55.53kN/m) had significantly greater VLS than FNOC (52.66 ± 26.53). Conclusion: Neuromuscular activation was not affected by sex, hormones, or contraceptive use. Lower extremity stiffness was affected by sex and contraceptive use. Males and FOC experienced greater levels of stiffness than the FNOC group. Higher levels of stiffness are theorized to be more protective of the ACL. There was no evidence that variation within the menstrual cycle affected neuromuscular function. Future research should explore the relationship between neuromuscular activation, stiffness, and hormones in relation to ACL injury. A smaller time frame is needed to examine EMG activation as it relates to stiffness.

S-176 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Poster Presentations: Psychometrics 13F12DOIN 13350MOMU

Development Of A Patient-AT background information and a concept Reliability Of Bony Anatomic Trust Instrument Using A Focus of trust to help facilitate discussion of Landmark Assessment In The Group ideas. We were able to provide relative Lumbopelvic Region David SD, Price EA, Ragan BG: item difficulty of initial trust items that Schultz SM, Jacobs MM, Gorgos Division of Athletic Training, Ohio were calibrated using Rasch Rating KS, Wasylyk NT, Van Lunen BL: University, Athens, OH Scale Model, which places items and Old Dominion University, Norfolk, people on a common metric. VA Context: Patient care has had a Trustworthiness of the data was paradigm shift from the disease- ensured using an external auditor, Context: The ability to palpate bony Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 centric to the patient-centered focus, member checks, and methods landmarks within the lumbopelvic making the patient the centered of the triangulation. Results: The focus region is considered to be a basic skill health care plan. This change group revealed seven themes: fidelity needed for application of treatment emphasizes that patients and caregivers (decision making with the patient’s techniques and assessment of patient communicate effectively so patients best interest in mind), education, progress. Assessment of athletic can actively participate in their competence, confidentiality, trainers(ATCs) accuracy of this healthcare decision process. Patient reliability, time/availability, and measurement has not been examined. trust is an important factor in this communication. Each theme was Objective: To examine intra- and communication. It has been linked to further classified into one of two inter-tester reliability of four ATCs increased adherence and ultimately categories: personal attributes or for identification of the L4 spinous better treatment outcomes. Despite personalization. Personal attributes process and the right and left posterior the positive benefits the definition and were personal characteristics of the superior iliac spine(PSIS) compared to factors of trust have varied across athletic trainer while personalization expert raters. Design: Cross- healthcare settings with little attention was making the treatment approach sectional reliability. Setting: to the application in athletic training. individualized with the patient at the Laboratory Participants: Sixteen The long-term purpose of this multi- center of the health care. Personal physically active adults (age= phased project is to develop an attributes were: time/availability, 22.56+2.67yrs, ht= 172.0+ 9.38cm, instrument to quantify trust in AT communication, confidence, and mass= 67.39+ 9.73kg, BMI= 22.8+ through a mixed methods approach and knowledge while personalization 1.97) volunteered to participate. Four psychometric testing standards. themes were: fidelity, education, and novice ATCs (certified<1yr) served as Objective: The purpose of this study confidentiality. Conclusion: the testers of interest. Intervention: (phase 1) was to understand key Results from the two main The subjects were placed in a prone components of trust in the athletic categories provide a framework for position and two expert ATCs training (AT) setting through qualitative trust in the AT setting. The (certified>12yrs) agreed upon each inquiry. Design: A qualitative focus themes from this qualitative study bony landmark and transferred the group was completed using grounded provide a blueprint for item expert markings to contact paper. The theory techniques. Setting: A quiet development to ensure each theme contact paper and skin of the classroom. Participants: A typical, is adequately represented. This participant were aligned via permanent stratified purposeful sample of six will ultimately lead to the markings, which were also used to college-aged Division I student- development of a psychometrically align the tester contact paper when athletes (5 females; 1 male; 20±1.6 sound AT trust instrument. transferring markings. Each tester yrs) from a variety of sports (field palpated the landmarks twice within the hockey, wrestling, and volleyball) same test session by utilizing invisible participated in a focus group. Data pens and ultraviolet light. Testers Collection and Analysis: Focus rotated between subjects after one group questions were targeted to marking trial. Testers transferred their better understand the definition and own markings and removed the factors of trust related to AT. We used markings with alcohol wipes, prior to initial data collected in the AT setting testing the next subject. Expert marks from a modified psychotherapy trust were transposed over the tester marks scale to provide participants with via transparency on which the contact

Journal of Athletic Training S-177 13353DOBI paper was attached. Main Outcome agreement. Competency in palpation Reliability And Validity Of A Measurements: The independent skills throughout professional Standing Hip Isometric variables were tester(T1,T2,T3,T4) education should be confirmed Endurance Test For Generating and time(Trial 1,Trial 2) and the in order to ensure proper treatment Muscle Fatigue dependent variables included distance application and pathology assessment Mutchler J, Weinhandl J, Hoch from the expert marking in within clinical practice. MC, Van Lunen BL: Old Dominion millimeters(mm) for L4 and PSIS University, Norfolk, VA palpations, and agreement as to whether marks landed within or Context: Muscle fatigue is a common outside of a designated area for the L4 consideration when evaluating and Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 spinous process. The predetermined rehabilitating athletic injuries. Current area included a rectangular box assessments of hip muscle fatigue are transposed over the expert markings as performed in seated and/or lying determined by previous research. positions. Research has not Intraclass correlation coefficients determined if a prolonged isometric

(ICC2,1) and standard error of test in a standing position is a reliable measurement(SEM) were calculated and valid technique for generating to determine the intra- and inter-tester muscular fatigue of the hip. Objective: reliability for all objective To determine the reliability and assessments. Percent agreement was validity of a standing hip isometric also calculated for each tester endurance test to generate muscle (between expert and novice) for L4 fatigue. Design: Cross-sectional markings. Results: Intra-tester design. Setting: Laboratory. Patients

ICC2,1’s for L4 ranged from ICC2,1=- or Other Participants: Twenty

0.14(SEM=2.49mm) to ICC2,1=0.83 healthy recreationally active

(SEM=4.62mm). Inter-tester ICC2,1’s individuals(10 male, 10 female; for L4 were ICC2,1=0.16 (SEM age=25.2±3.3years; height= 175.1 =7.02mm) for Trial 1 and ±11.6cm;mass=70.6±15.4kg)

ICC2,1=0.26(SEM=6.1mm) for Trial 2. participated. Participants were Percent agreement between expert excluded if they scored above 9.33 on and testers ranged from 13-56% for the Disablement in the Physically

L4. Intra-tester ICC2,1’s for right PSIS Active Scale, had a lower extremity ranged from ICC2,1=-0.15(SEM= injury within 4 months, or did not

4.03mm) to ICC2,1=0.77 (SEM= partake in physical activity for at least 3.21mm) and left PSIS ranged from 30 minutes, 3 times per week.

ICC2,1=-0.17(SEM=6.44mm) to Intervention: Participants completed

ICC2,1=0.74(SEM=3.81mm). Inter- two sessions of testing within the same tester ICC2,1’s for right PSIS were day. The second session began

ICC2,1=0.17(SEM=4.36mm) for Trial approximately 30 minutes after the

1 and ICC2,1=-0.001(SEM=4.86) for firstsession. Electromyographic

Trial 2. Inter-tester ICC2,1’s for left (EMG) surface electrodes were placed

PSIS were ICC2,1=0.15 (SEM= on the rectus femoris(RF), biceps

4.76mm) for Trial 1 and ICC2,1=- femoris(BF), gluteus maximus 0.05(SEM=5.57mm) for Trial 2. (GMax), gluteus medius (GMed) and Conclusion: Our results indicate adductor longus(ADD) of the poor to moderate intra-tester dominant limb. Endurance testing was reliability for palpation of bony conducted through a single 60-second landmarks in the lumbopelvic region hip flexion, extension, adduction, and for newly credentialed ATCs, as well abduction Maximum Voluntary as poor inter-tester reliability and Isometric Contraction on an isokinetic dynamometer in a standing position.

S-178 Volume 48 • Number 3 (Supplement) May 2013 13282MOMU

Two minutes of rest was provided Conclusion: The MF associated Reliable Change Index Of between trials and the order of hip with the 0-15s and 46-60s time Scapular Upward Rotation action was counterbalanced. Main intervals of the 60-second standing Ingram RL, Munkasy BA, Tucker Outcome Measures: Median hip isometric endurance test WS, Buckley TA: Georgia frequency(MF), interpreted as the displayed suitable intra-session Southern University, Statesboro, rate of conduction of muscle fibers, reliability for all hip actions. The GA, and University of Central was used to quantify fatigue. MF was decrease in MF over time indicates Arkansas, Conway, AR examined from the EMG signal of the this protocol generates fatigue for primary muscle of each hip action all hip actions, except abduction. Context: Recently, the importance of (Flexion=RF, Extension=BF and Therefore, the endurance test used in scapular upward rotation in relation to Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 GMax, Adduction=ADD, Abduction this study is a reliable and valid technique chronic shoulder pathology has been =GMed) for the first and last 15s of to generate muscular fatigue for hip highlighted. However, a reliable each trial through power spectral flexion, extension, and adduction. change index (RCI) of scapular upward analysis (Hz). Intra-session rotation has not been established to reliability was assessed for each help identify true difference as action using intraclass correlation opposed to the result of random coefficients (ICC[3,1]). Face variation in measurements. The validity of the endurance test was establishment of RCIs will assist with examined through paired t-tests for the interpretation of both statistically each action between the two time and clinically significant changes in intervals(0-15s,46-60s) of the data scapular upward rotation collected in the second session. measurements. Jacobson proposed Decreases in MF represented fatigue that change should reflect more than of fast twitch muscle fibers, leaving fluctuations of a potentially imprecise slow twitch fibers to sustain activity. measuring instrument. Objective: To Descriptive statistics were determine the RCI for scapular upward calculated as mean±standard error. rotation at four commonly assessed Alpha level was set at pd”0.05. shoulder angles. Design: Prospective Results: The ICC[3,1] values for test-retest. Setting: Biomechanics intra-session reliability were good- research laboratory. Patients or to-excellent for both time Other Participants: Twenty-six intervals(0-15s,46-60s) of each males with no history of shoulder action (Flexion=0.95,0.84; Ex- injury participated in this study: (age: tension =0.92,0.95; Ex-tension BF GMax 22.2±2.6 years, height: 1.77+0.07 m, = 0.64,0.84; Adduction =0.79,0.90; weight:76.9+10.9 kg). Interventions: Abduction= 0.91,0.62). Significant Static scapular upward rotation was decreases in MF were detected over measured on the throwing dominant time for Flexion(0-15sec= 83.66 arm with a digital protractor while ±1.72Hz;46-60s=74.22 ±3.74Hz; subjects were at rest and at 60ˆ, 90 p<0.001), Extension (0-15s= BF and 120 of humeral elevation in the 83.75±3.74Hz;46-60s= scapular plane on two consecutive 74.37±3.82Hz;p <0.001), days. The root of the scapular spine and Extension (0-15s= 57.72 ±4.10 GMax the posterolateral acromion were Hz;46-60s= 48.29± 2.26Hz; palpated and used as landmarks for the p=0.001), and Adduction(0-15s= measurements. Three trials were 61.03 ±1.40 Hz;46-60s= 49.97± performed at each position with a 30 1.95Hz; p<0.001). Although MF second rest period between each trial. decreased during Abduction, Order of position was randomized statistical significance was not during each of the two days. The three reached(0-15s =75.36 ±3.90Hz;46- upward rotation measurements at each 60s= 69.59 ±3.03Hz; p=0.132). position were averaged for each day. Main Outcome Measures: The RCI

Journal of Athletic Training S-179 13131FOMU was calculated according to the A Modified Digital Inclinometer calculate position, orientation and Jacobson method of quantifying Is A Valid Instrument For displacement of the scapula. Scapular clinically significant change by Measuring Scapular Anterior- AP tilt was measured using a modified dividing the change in measurements Posterior Tilt In Shoulder digital inclinometer that has been between test days on the outcome Injured Subjects validated (r = 0.63 - 0.86) and in which measure by the standard error of Scibek JS, Gatti JM, Carcia CR, intra-rater (ICC(3,2)= 0.86 – 0.99) and difference score. Intraclass Vomer R: Duquesne University, inter-rater reliability (ICC(2,2)= 0.83 - correlation coefficients (ICC) were Pittsburgh, PA 0.92) have been previously established needed to complete the RCI for healthy shoulders. All data calculation. An RCI was calculated for collection involved the injured Context: Using electromagnetic Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 the four positions of humeral elevation tracking systems, investigators have shoulder. Subjects performed three (rest, 60°, 90°, and 120°). Results: been able to quantify tri-planar trials of 0o, 30o, 45o, 60o, 90o, and 120o The mean scapular upward rotation at scapular kinematics in healthy and of humeral elevation in the scapular rest was 0.04 + 2.46° with an ICC of shoulder injured subjects. Modified plane in a randomized fashion. Main 0.97 and an RCI of 3.84°. At 60°, the digital inclinometers have been Outcome Measures: The dependent mean was 7.72 + 4.42° with an ICC of validated for the assessment of variable was scapular AP tilt. 0.89 and an RCI of 0.92°. At 90°, the scapular upward rotation. While Criterion-related validity of the mean was 18.57 + 4.69° with an ICC evidence suggests that scapular inclinometer was assessed via Pearson of 0.92 and an RCI of 6.31°. At 120°, anterior-posterior (AP) tilt is also an Product Moment correlations. SPSS the mean was 31.84 + 5.17° with an important factor to consider when version 17.0 was used for the ICC of 0.95 and an RCI of 3.77°. treating shoulder injured patients, no statistical analyses. An a = 0.05 was Conclusions: The results of this clinical instruments have been set a priori. Results: Correlation study provide clinicians with validated for this purpose. Objective: analyses revealed significant moderate baseline values for normal scapular The purpose of this study was to test to good correlations (r = 0.68 - 0.76, upward rotation, reliability of the hypothesis that measurements of p < 0.001) for clinically relevant the measurements and RCIs to scapular AP tilt obtained using a combinations of humeral elevation. identify clinically significant modified digital inclinometer would The coefficients of determination changes. These measurements may produce valid results when compared revealed that 45-58% of the error provide clinicians with reference to measures acquired using an variance could be accounted for by values to identify potentially electromagnetic tracking system in common factors involving the two pathological shoulder movements in shoulder injured subjects. Design: devices. Conclusions: The results of order to distinguish true differences Quasi-experimental, correlational this study indicate that the modified from slight variation normally design. Setting: Controlled digital inclinometer is a valid method associated with a repeated laboratory environment. Patients or for assessing scapular AP tilt in measurement. Future research Other Participants: Nineteen shoulder injured patients. Use of should compare these results to volunteers (20.42 + 1.92 years; 1.77 the modified digital inclinometer will patients with scapular dysfunction + 0.09 meters; 85.13 + 23.11 kg; 10 enhance our ability to affordably and intervention protocols used to males, 9 females), with either a current monitor in-vivo scapular AP tilt in the treat scapular dyskinesis. or a history of shoulder injury (43.89 clinical environment. Further + 31.18 months, ranging from 1 to 96 modifications to the inclinometer may months). All subjects underwent an be warranted to address the error evaluation to confirm shoulder injury between the devices. This study was status. Intervention: Shoulder fully funded by the Eastern Athletic kinematic data were collected using Trainers’ Association, Inc. the MotionStar electromagnetic tracking system (Ascension Technology, Burlington, VT), and Motion Monitor software (Innovative Sports Training, Chicago, IL). Anatomic and reference coordinate systems approved by the International Society of Biomechanics were used to

S-180 Volume 48 • Number 3 (Supplement) May 2013 13098DOMU 13226MOGA

Mechanical Laxity Testing In LR+ and LR- were calculated for both Identifying Clinically Important Those With Chronic Ankle ML and TT in those diagnosed with CAI Observed Gait Abnormalities Instability: An Evidence Based and non-CAI participants via the Samson CO, Kuntzelman KS, Approach aforementioned criteria. Results: Ragan BG: Ohio University, Rosen AB, Ko JP, Brown CN: Non-CAI participants (N=37) had Division of Athletic Training, University of Georgia, Athens, GA CAIT scores of 29.6±0.7, while CAI Athens, OH participants (N=37) had 19.9±5.2. For Context: Chronic ankle instability ML, non-CAI participants had Context: Gait assessment is an (CAI) commonly develops following 16.47°±10.37° and CAI participants important component of many had 22.94°±11.16° inversion. For ML lateral ankle sprain. There is limited evaluations. There are multiple Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 consensus concerning the role sensitivity=0.33 (95%CI: 0.20, 0.50), methods available for clinicians to use mechanical laxity plays in those with specificity=0.86 (95%CI: 0.72, 0.94), for gait assessment. The most common CAI. Additionally, it has not been LR+=2.45 (95%CI: 0.97, 6.30) and method relies on observation of established if clinical orthopedic tests LR-=0.77 (95%CI: 0.59, 1.00). For patients while walking or running are comparable to instrumented TT, sensitivity=0.50 (95%CI: 0.34, rather than the more expensive use of arthrometry. Objective: To determine 0.66), specificity=0.81 (95%CI: force plates and 3D cameras. Because if instrumented and manual talar tilt 0.66, 0.90), LR+=2.64 (95%CI: methods and philosophical approaches tests have diagnostic utility in CAI 1.26, 5.55) and LR-=0.62 (95%CI: to assessment vary greatly, there is a populations. Design: Cross-sectional. 0.43, 0.89). Conclusions: The results need for standardized gait assessment. Setting: Biomechanics Research indicate mechanical laxity testing has Objective: To identify observed gait Laboratory. Patients or Other some diagnostic value for evaluating abnormalities perceived as clinically Participants: Seventy-four CAI. The high specificity revealed a important and the corresponding recreationally active participants with positive laxity test suggests a high assessment parameters commonly varying degrees of ankle function (41 degree of likelihood that one has CAI. used by clinicians for each. Design: females, 33 males, mean age±standard The results also indicate clinicians can Survey. Setting: An online survey was deviation 21.0±2.4years, height effectively identify participants’ laxity administered through Patient Reported 169.57±9.97cm, mass 69.86± through manual testing. This finding is Outcomes Measurement Information 13.60kg). Interventions: In a single important in clinical settings due to System (PROMIS). Participants: test session participants completed the limited access to instrumented Fourteen licensed and currently Cumberland Ankle Instability Tool arthrometers. Currently, the “gold practicing athletic trainers (mean±SD: (CAIT) and an ankle injury history standard” for evaluating CAI is limited age = 26 ± 9.1 yrs; 6 male, 8 female; questionnaire. Mechanical laxity to self-report questionnaires and past experience = 4 ± 12.2 yrs) volunteered testing consisted of instrumented medical history. Objective measures of to serve as content experts (CE). For arthrometer inversion talar tilt tests CAI may be necessary for researchers tool development, 10-15 CE are (ML) and manual medial talar tilt stress to increase homogeneity among group typically needed. Interventions: The tests for laxity (TT). Sensitivity, membership. The few false positives in Gait Abnormalities: Clinical specificity, positive likelihood ratio both mechanical laxity tests imply Importance Survey (GACIS) was (LR+) and negative likelihood ratio clinical usefulness and it is suggested developed based on 60 gait (LR-) were calculated to assess the CAI be evaluated through a wide range abnormalities identified in the ability of both laxity tests to correctly of quantitative and qualitative tools. literature. Twenty of the 60 diagnose CAI. Main Outcome abnormalities were eliminated Measures: A CAI group was identified primarily due to repetitive definitions as those with history of lateral ankle using varied nomenclature and a few sprain, e”2 reported episodes of ankle were considered unfeasible. The instability in the last 12 months, and a remaining 40 abnormalities were CAIT score d”26. The non-CAI group identified for GACIS and pilot tested was those with a CAIT score e”28 and for readability. Prior to the completion no history of instability in the past 12 of GACIS, definitions of each phase months Based on previous literature, were provided. CE were asked to rate hypermobility was denoted with ML of the clinical importance of each gait >29.4°. For TT, a scale of 1-5 was abnormality on a scale of 1 to 5 (least used; scores of 4 and 5 were labeled to most clinical importance). hypermobile. Sensitivity, specificity,

Journal of Athletic Training S-181 13070FOBI

Subsequently, CE identified the plane Reliability Of Injury Risk of interest, such as ACL injury, may of view (anterior, posterior, or lateral) Prediction Algorithm Across particularly benefit from this and gait velocity (walking, jogging, or Three Different Institutions: approach. The biomechanical variables running) used to observe each Implications For Multi-Center that contribute to a predictive abnormality. Main Outcome Biomechanical And nomogram for knee injury have been Measures: The variables evaluated in Epidemiological Research validated and established as reliable at the survey include clinical importance, Myer GD, Wordeman SC, a single center. However, the utility and plane of view, and gait velocity for each Sugimoto D, Bates NA, Roewer translatability of these tests across of the 40 abnormalities. A mean of 3.5 BD, Medina McKeon JM, multiple institutions has not been or greater was used to determine Dicesare CA, Di Stasi SL, Barber assessed. Objective: To assess the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 abnormalities with perceived clinical Foss KD, Thomas SM, Hewett TE: within- and between-center reliability importance. A consensus of at least 75 Cincinnati Children’s Hospital of an affordable, clinically-based risk percent among CE was used to Medical Center, Sports Medicine factors that utilize two-dimensional determine the consistency of the plane Biodynamics Center and Human (2D), camcorder-based methods to of view and gait velocity observation Performance Laboratory, screen young athletes for high risk of parameters. Results: Twenty-two of Cincinnati, OH; Division of Athletic knee injury at three institutions. We the 40 gait abnormalities were Training, College of Health hypothesized that the 2D screening considered to be clinically important. Sciences, University of Kentucky, methods would provide good-to- CE varied in their opinions of which Lexington, KY; Departments of excellent reliability within and plane of view should be observed for Athletic Training, Sports between institutions for frontal and 18/22 clinically important Orthopaedics, and Pediatric sagittal plane biomechanics and abnormalities, agreeing on only 4/22 Science Rocky Mountain variables that contribute to nomogram- abnormalities. CE agreed that 11/22 University of Health Professions, predicted high knee abduction loads. abnormalities should be observed Prove, UT; Departments of Design: Multi-center laboratory while the patient is walking; opinions Pediatrics and Orthopaedic reliability study. Setting: School and varied for the type of velocity that Surgery, College of Medicine, Controlled laboratory. Patients or should be used to observe the University of Cincinnati, Other Participants: Nineteen (19) remaining 11/22 abnormalities. Cincinnati, OH; Department of female, varsity and junior varsity level Conclusions: CE agreed upon 22 gait Biomedical Engineering, College high school volleyball players abnormalities that are clinically of Engineering and Applied participated in this study (Mean age ± important when conducting gait Sciences, University of Cincinnati, SD, 15.27 ± 1.0 years; height, 1.69 ± assessment, but had varied opinions of Cincinnati, OH; Sports Medicine, 0.42 m; mass, 61.08 ± 7.9 kg).. which plane of view and gait velocity The Sports Health & Performance Interventions: 2D motion capture were optimal to observe these Institute, Departments of techniques were used to collect abnormalities. This lack of consensus Physiology & Cell Biology, kinematics of the lower extremity creates a challenge for testing the Orthopaedic Surgery Family during a drop vertical jump task. The inter-rater and intra-rater reliability of Medicine and Biomedical subjects were tested as a group at each clinicians in the assessment of gait Engineering, The Ohio State testing center on separate dates within abnormalities for the development of University, Columbus, OH; Athletic a three week period. Main Outcome a gait assessment screening tool. Training Division, School of Allied Measures: Within-center and Medical Professions, The Ohio between-center reliability were State University, Columbus, OH assessed with intra-class and inter- class correlation coefficients (ICCs). Context: Multi-center collaborations Results: Within-center reliability of for prospective, longitudinal the variables that comprise the clinical investigations provide an appealing nomogram was consistently classified alternative to single-center studies. A as excellent, but between-center multi-center approach has the capacity reliability was classified as fair-to- to generate large sample sizes and thus good. The within-center ICCs for all generate more generalizable and nomogram variables combined was statistically powerful results. Studies 0.98 (ICC range 0.95-0.99), while that investigate difficult or rare combined between-center ICC was phenomena as their primary outcome 0.63 (ICC range 0.51-0.78). The

S-182 Volume 48 • Number 3 (Supplement) May 2013 13162MOMU average typical error for frontal plane Reliability And Validity Of Hand- Additionally, at the first session, knee excursion was 2.3 cm for within- Held Dynamometry Assessment HABD strength was also measured center comparisons and 2.5 cm for Of Hip Abduction Strength In using the ID, utilizing the same between-center comparisons, with no Healthy, Young Adults protocol as the HHD for trials and rest. discernible side-to-side differences. Boland SA, Quinlevan ME, Dodge Main Outcome Measures: Raw The average typical error for knee EB, Gribble PA: University of force values were converted to torque flexion range of motion was 5.9° for Toledo, Toledo, OH values using the appropriate moment within-center comparisons and 6.7° arms and reported in Nm. ICC2,2 for between-center comparisons. Context: Hip musculature weakness, models were calculated for interrater Conclusions: The risk screening and intersession reliability for each specifically of the hip abductors Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 protocols were reliable within centers (HABD), has been associated with condition. Pearson Correlation and repeatable between centers. numerous musculoskeletal coefficients were calculated for Additional efforts to increase pathologies. Screening of hip strength validity between each HHD condition between-center investigator training during pre-participation examination and the ID measure. Results: There and further standardize methodologies may be important in the prevention of was strong interrater reliability for the may reduce between-center error SW (ICC =0.989; 95%CI:0.965- lower extremity injury. Hand-held 2,2 during biomechanical assessments, 0.996), SWO (ICC =0.929; dynamometers (HHD) are a 2,2 and further enhance reliability. The 95%CI:0.778-0.977), SLW (ICC convenient and relatively inexpensive 2,2 current results demonstrate the clinical tool that can estimate muscle =.986; 95%CI:0.956-0.995), SLWO feasibility of multi-site biomechanical conditions (ICC =0.963; 95%CI: strength. In addition, a strap to stabilize 2,2 studies and establish a framework for the HHD and address bias associated 0.884-0.988). Additionally, there was the further dissemination of injury risk with tester strength has been utilized strong intersession reliability for the screening algorithms for young SW (ICC =0.958; 95%CI:0.870- in recent investigations. Limited data 2,2 athletes. Specifically, the proposed 0.987), SWO (ICC =0.964; exists on the accuracy of HHD 2,2 multi-center studies may allow for 95%CI:0.889-0.989), SLW (ICC = assessment compared to the gold 2,2 validation and optimization of readily standard of isokinetic dynamometry 0.983; 95%CI:0.948-0.995), and accessible and inexpensive 2D SLWO conditions (ICC =0.967; (ID). Objective: To determine the 2,2 camcorder based screening tools to intersession and interrater reliability, 95%CI:0.896-0.989).There were identify young and underserved female as well as the validity of the HHD in strong, positive correlations between athletes at high risk for knee injury. measuring HA strength in sidelying the HHD and SW (r=0.921,p<.01), (SL) and supine (S) positions, both SWO (r=0.917,p<.01), SLW with (SLW, SW) and without a stability (r=0.882,p<.01), and SLWO strap (SLWO, SWO). Design: conditions (r=0.852,p<.01). Controlled laboratory. Setting: Conclusion: The HHD had strong Research laboratory. Participants: interrater and intersession reliability Fourteen healthy, young adults (4M, for HABD strength assessment in two 19.25±2.5yrs; 178.44±6cm, 70.31± testing positions, both with and without 7.64kg; 10F, 23.6±2.01yrs; a strap. Additionally, there was a strong 166.88±5.62cm, 65.14±11.05kg). correlation between the ID and HHD Intervention: Participants for HABD strength. The HHD appears volunteered and reported for two to be a valid and reliable tool for sessions one week apart. At each clinicians in assessing HABD strength. session, two raters, both certified athletic trainers, performed assessments in SL and S positions. During the no strap condition the raters performed a manual muscle test holding the HHD. During the strap condition, the volunteer pushed against the HHD secured with a strap. Four, 5-second trials were performed during each condition, with appropriate rest between trials, conditions, and raters.

Journal of Athletic Training S-183 13269FOMU 13266DOBI

Reliability And Validity Of M- Three trials were assessed for each sEMG Onset Method Selection Mode Ultrasound Measurements location of each reliability measure in Affects Reliability Estimates And Of Quadriceps Femoris knee extension and each correlation of Statistical Outcomes Contractile Time time to peak torque at 60° knee Lippa NM, Krzeminski DE, Piland Boucher T, La Bounty PM, Rigby flexion. Intraclass correlation SG, Rawlins JW, Gould TE: The R, Arnold E: Baylor University, coefficients (ICC) were used to University of Southern Mississippi, Waco, TX; Texas A&M University, measure reliability and Pearson Hattiesburg, MS College Station, TX; Baylor correlation coefficients ( = 0.01) were University, Waco, TX used to analyze time to peak torque Context: Methods to determine relationships. Results: The measure- surface electromyography (sEMG) Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Recruitment and timing of ment method had excellent intra-rater onset criterion scores are susceptible the quadriceps femoris (QF) muscle reliability for the VMO (ICC2,12 rater to measurement error which can affect is often impaired with knee 1=0.95, 95% CI=0.90-0.98; rater statistical outcomes. Limited peer- dysfunction. Real time ultrasound 2=0.91, 95% CI=0.84-0.96), RF-VI reviewed data examines the imaging (RTUS) is a non-invasive (ICC2,12 rater 1=0.97, 95% CI=0.95- dependence of outcomes and rehabilitative technology to assess 0.99; rater 2=0.91, 95% CI=0.83- subsequent inferences on onset skeletal muscle and its contractile 0.96), and VL (ICC2,12 rater 1=0.96, method selection. Objective: To performance. Objective: To 95% CI=0.93-0.98; rater 2=0.94, 95% quantify reliability estimates of, and determine the reliability and validity CI=0.89-0.97); excellent inter-rater determine how statistical outcomes of RTUS M-mode temporal reliability for the VMO (ICC3,6 session and inferences are affected by, three measurements of QF contractile time 1=0.95, 95% CI=0.91-0.98; session literature-based methods for (CT). Design: Reliability and 2=0.92, 95% CI=0.86-0.96), RF-VI determining sEMG pre-activation concurrent validity design. Setting: (ICC3,6 session 1=0.94, 95% CI=0.89- onset. Design: Repeated measures. Outcome measures were assessed in 0.97; session 2=0.96, 95% CI=0.93- Setting: Research laboratory. a university research laboratory. 0.98), and VL (ICC3,6 session 1=0.95, Patients or Other Participants: A Participants: Twenty healthy 95% CI=0.90-0.98; session 2=0.96, convenience sample of active females participants (Eleven female, nine male, 95% CI=0.93-0.98); and excellent (n=10, 24±2.3 yrs, mass 65±10 kg, age=22.6±4.5, height =168.5±7.5 cm, test-retest reliability for the VMO height 165±6.3 cm) without pregnancy mass=70±7 kg) were assessed for (ICC2,24=0.96, 95% CI=0.93-0.98), or illness affecting balance reliability. Nineteen healthy RF-VI (ICC2,24=0.97, 95% CI=0.95- volunteered to participate. participants (fifteen female, four male, 0.99), and VL (ICC2,24=0.97, 95% Interventions: Participants stepped age=20.9±1.5, height=170.8±7.8 cm, CI=0.95-0.99). Mean reliability CT of down from a standardized height (7.5”) mass= 71.5±11.7 kg) were assessed the VMO=70 ms, RF-VI=68 ms, and onto impact-resistant polyurethane for concurrent validity. Interventions: VL=72 ms. A strong correlation foams of pre-determined thicknesses RTUS M-mode intra-rater, inter-rater, between VMO RTUS CT and time to (independent variable; 0”, ¼”, ½”, 1”, and test-retest reliability of isometric peak torque was significant 2”). sEMG data were collected (1kHz, QF CT by two different investigators (r(43)=0.62, P<0.001). A strong BIOPAC Systems) in tibialis anterior was compared during two testing correlation between RF-VI RTUS CT (TA), lateral gastrocnemius (LG), and sessions 4-7 days apart. RTUS M- and time to peak torque was significant vastus medialis (VM) muscles. Each mode concurrent validity of isometric (r(38)=0.61, P<0.001). A medium of the five conditions was repeated 10 QF CT was correlated to isometric correlation between VL RTUS CT and times, ensemble averaged, and root- time to peak torque on an time to peak torque was significant mean squared. Pre-activation onset electromechanical dynamometer in (r(53)=0.42, P=0.001). Mean validity was determined by the following another session. Main Outcome RTUS CT of the VMO=92 ms, RF- methods: (1) regression line (RL), (2) Measures: M-mode RTUS was used VI=92 ms, and VL=93 ms. Mean visual inspection (V), and (3) three to measure longitudinal muscle validity time to peak torque of the standard deviation threshold method thickness of the distal vastus medialis VMO=290 ms, RF-VI=300 ms, and (TH). Main Outcome Measures: oblique (VMO), rectus femoris/vastus VL=310 ms. Conclusions: This Calculated reliability estimates for intermedius together (RF-VI), and study describes a new reliable and valid sEMG onset time included coefficient vastus lateralis (VL). CT was the time alternative measurement method of QF of variation (CV), intraclass interval from muscle thickness at rest timing with M-mode RTUS. correlation coefficient (ICC(2,1) and to the muscle thickness in a maximal (2,k)), as well as standard error of voluntary isometric contraction. measurement (SEM) (ICC and SEM

S-184 Volume 48 • Number 3 (Supplement) May 2013 13195DOMU for 0” only). The continuous dependent Assessment Of Quadriceps (MVIC/SIB)*100. Mean MVIC and outcomes, sEMG pre-activation Activation Via Burst SIB torque were normalized to body duration (ms) and mean amplitude Superimposition In A Closed mass. The intra-class correlation Chain Position: A Novel (mV), were determined for each coefficient (ICC2,k) and Bland-Altman method-muscle combination. Six (3 Approach plot were used to assess inter-session muscles x 2 outcomes) separate Norte GE, Kuenze C, Roberts D, reliability and agreement among multivariate one-way repeated Hart JM: University of Virginia, quadriceps CAR in a CKC position measure analyses of variance were Charlottesville, VA between sessions. Two separate paired performed. Alpha was set at p<.05. samples t-tests were used to evaluate

Results: In terms of reliability, CV Context: Central activation ratio differences between sessions for CAR Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 ranged from CVRL=18-69% (CAR) is used to estimate volitional and MVIC torque. Results: Inter-

(35±11%), CVV=24-37% (29±4%), quadriceps activation during a maximal session reliability was moderate for and CVTh=18-47% (27±11%), non- voluntary isometric contraction quadriceps CAR (ICC2,k) = 0.68, (F21,22 uniformly across muscles or (MVIC). CAR values are typically = 3.12, P = 0.005). CAR did not thicknesses. ICC(2,1) values ranged calculated from force data during an significantly differ between sessions from RRL =.130-.547(.378±.2), RV open-kinetic-chain knee extension (Session 1: 81.4 ± 11.5%, Session 2:

=.531-.688(.594±.1), and RTH=.471- task. Variability in CAR values exists 84.2 ± 8.5%; t21,.975 = -1.13, P = 0.27). .995(.804±.3). ICC(2,k) comparing based on the technique used for Bland-Altman plots revealed a mean the three onset methods yielded performing MVIC. Assessing CAR difference between sessions of

RTA=.077, RLG=.754 and RVM=.766. quadriceps activation in a closed- -2.5 ± 10.3% (LOA -23.1 to 18.1%).

SEM values ranged from SEMRL=84- kinetic-chain (CKC) position is a novel Knee extension MVIC torque was

99 ms (89±10 ms), SEMV=51-72 ms approach. Objective: The primary significantly greater on Session 2

(61±10 ms), and SEMTh=7-66 ms objective was to determine the test- (Session 1: 1.28 ± 0.40 Nm/kg;

(30±30 ms). As for statistical retest reliability of the quadriceps Session 2: 1.48 ± 0.44 Nm/kg; t21 = - outcomes, RL produced a statistically CAR in a closed-kinetic-chain 2.21, P = 0.038). Conclusions: CAR significant decreasing trend in LG mean position. Design: Crossover, calculated via burst superimposition is amplitude with increasing thickness controlled laboratory study. Setting: moderately reliable in a closed- (p=.017). V indicated a decreasing trend Research laboratory. Patients or kinetic-chain position with technique- in LG mean amplitude (p=.022), as well Other Participants: 25 healthy based instruction. Observed as a within effect (p=.042) and an participants (13 men, 12 women; age differences in knee extension torque increasing trend (p=.017) in duration. = 23.8 ± 3 years; height = 72.7 ± 14.5 in the absence of CAR differences There were no significant differences cm; mass = 175.3 ± 9.6 kg) may indicate a learned effect between for TH. Conclusions: Comparing RL, volunteered. Interventions: sessions, as technique-based V, and TH, the magnitude of CV range Participants completed two sessions instruction was provided. Quadriceps was equivocal; however, the reliability with a minimum of 48 hours between, CAR calculated in a CKC position may estimates (i.e. SEM, ICC(2,1)) were low in a test-retest fashion. Burst provide a more accurate representation for RL and between methods (ICC(2,k)). superimposition (SIB) testing was of muscle activity during function. Statistical outcomes and inferences performed bilaterally in a CKC Further consideration should be given regarding the relationship between foam position. Verbal technique-based to determine the reliability over a thickness and sEMG variables were instruction was given, directing the greater period of time to account for influenced by onset determination participant to focus on quadriceps the possibility of a learning effect. method. Even when reliability was contraction, maintain upright posture similar (LG: ICC(2,1)) between with appropriate contact between trunk methods, each of the three methods and back of the chair, and exhale while provided unique outcomes for a given contracting with arms across chest. muscle-thickness combination and Participants were firmly secured to a interpretation varied. Therefore, without dynamometer during testing. Main robust estimates of reliability for a Outcome Measures: Quadriceps relevant muscle and movement task, the CAR via the SIB technique and knee use of any onset method is cautioned. extension MVIC torque were the primary outcome measures of interest. CAR was measured via the SIB technique, and calculated as

Journal of Athletic Training S-185 13385DOPR 13336FONE

Development Of The Self- whether each item on the new scale Contractile Impulse Differences Efficacy Of Balance Scale was ‘essential,’ ‘useful, but not Between The Sexes During Time (SEBS) For Young Active essential,’ or ‘not necessary’ to the Critical Periods Individuals performance of assessing self- Johnson ST, Norcross MF, Baker CS, Capilouto G, Usher E, efficacy of balance. Main Outcome Doeringer JR, Pollard CD, Uhl T, Mattacola CG, McKeon PO, Measures: Feedback from Panel 1 Hoffman MA: Oregon State Medina McKeon JM: University was used to evaluate face validity, University, Corvallis, OR, of Tennessee at Chattanooga, meaning each item was perceived to and Oregon State University- Chattanooga, TN, and University test confidence in balance in a young, Cascades, Bend, OR of Kentucky, Lexington, KY active population. Responses obtained Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 from Panel 2 were used to assess Context: Contractile impulse, the area Context: Research suggests that injury content validity by calculating a under the torque-time curve, is an risk reduction is not feasible without Content Validity Ratio(CVR) and important strength measure because, behavioral change. Neuromuscular Content Validity Index(CVI), the mean unlike many other strength measures, assessment techniques used to identify for all retained items. Items with a it incorporates the time history of a balance deficits associated with the CVR<0, (majority of panelists did not contraction. During time critical risk of lower extremity(LE) injuries agree the item was essential) or a situations, which present the potential exist; however tools to assess CVR=0 (only half of the panel agreed for injury such as the initial 50 and/or psychological risk factors for LE the item was essential) were flagged 100 ms following ground contact, injuries are not currently available. for potential removal. Results: The rapid torque development is likely Self-efficacy of balance, a original 17-item scale was revised to necessary to control joint motion and psychological characteristic, may 21 items, reflecting suggestions made to provide dynamic joint stabilization. provide information regarding by Panel 1. Assessment of content Despite its importance and relevance psychological risk factors for LE validity revealed 16 items reached a to lower extremity injury, little injury. Validated instruments to assess positive CVR agreement (majority of information regarding contractile self-efficacy of balance do not panelists rated the item to be impulse differences between the currently exist. Objective: ‘essential’). A CVR of 0 was indicated sexes exists. Objective: To compare Determine the face and content validity for five items. The CVI was 0.46. isometric contractile impulses of the Self-Efficacy of Balance Items that reached a positive CVR were between the sexes. Design: Cross- Scale(SEBS) for an adolescent retained and items with a CVR of 0 sectional. Setting: Research population. Design: Cross sectional were flagged for further testing. laboratory. Patients or Other Setting: Conducted survey via Conclusions: Face validity of the Participants: Twenty-one healthy, electronic questionnaires. Patients SEBS has been established. physically active volunteers (12 or Other Participants: Eleven Furthermore, panelists were able to Males, 9 Females, Age: 20.91 ± 1.55 content experts participated (10 validate the content of the SEBS. years, Height: 1.70 ± 0.10 m, Mass: athletic trainers(ATs) with clinical and Further analyses are necessary to 72.76 ± 11.31 kg). Interventions: research expertise of LE injuries, 1 determine construct and convergent Isometric plantarflexion torque-time expert in self-efficacy research were validity, resulting in an objective curves of the dominant limb were assigned to 2 panels). Interventions: psychological measure for balance. recorded using a Biodex System 3 Panel 1 (5 ATs, 1 self-efficacy expert) Future use of the SEBS may provide dynamometer in terfaced with a Biopac assessed 17 items for face validity to important insights into how balance MP100 data collection system. determine if each item accurately self-efficacy in young, active Testing position was standardized so assessed an adolescent individual’s individuals affects risk of LE injury. that all participants were seated confidence in the ability to balance recumbently, the foot secured to a during athletic activities. The panel footplate attached to the dynamometer, also had the opportunity to add, delete, and the ankle and knee joints or suggest edits for wording or clarity. positioned in neutral and 60º of The scale was edited to reflect Panel flexion, respectively. Participants 1 recommendations, including adding were instructed to isometrically three items. Items suggested for plantarflex as hard and fast against the deletion were flagged for potential footplate as possible following the removal. Panel 2 was instructed to presentation of a light stimulus. Three assess content validity by determining trials with 60 seconds of rest between

S-186 Volume 48 • Number 3 (Supplement) May 2013 trials were performed. Main Outcome Measures: Contractile impulse was calculated by integrating the area under the torque-time curve during the initial 50ms (CI-50) and 100ms (CI-100) following torque onset. Onset was defined as the instant when the torque signal exceeded 2.5% of the recorded peak torque. The mean values across trials for each subject Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 were normalized to the product of body mass and height (BM*Ht). Differences in the CI-50 and CI-100 between sexes were assessed using one-tailed, independent t-tests ( d•0.05). Results: Males demonstrated significantly greater CI-50 (Males: 0.0030 ± 0.0011 Nm0s*(BM*Ht)-1 vs. Females: 0.0021 ± 0.0011 Nm0s*(BM*Ht)-1; p=0.049) and CI- 100 (Males: 0.0123 ± 0.0043 Nm0s*(BM*Ht)-1 vs. Females 0.0087 ± 0.0045 Nm0s*(BM*Ht)-1; p=0.041) than females. Conclusions: Previous reports have suggested peak torque and rate of torque development differences between the sexes. The current results suggest sex differences in joint work capability during time critical periods in which control of joint motion and dynamic stabilization are essential. As such, the assessment of CI may be useful for characterizing neuromuscular function over short timeframes likely pertinent to injury. Further research is needed to determine if these results hold true in other muscle groups.

Journal of Athletic Training S-187 Free Communications, Poster Presentations: Concussion 13004FOSP

An Investigation Of Concussion- allowed to clot and was spun down to Related Neuroproteins In separate plasma from serum. A pipette Collegiate Athletes: A transferred serum and plasma into five Comparison Of Gender sets of cryovials and stored at -80°F. Differences In High-Risk Sports Samples were kept frozen until sent to Hamson-Utley JJ, Schulte S, the lab for testing. Data gathered were Hansen RA, Rink D, Glodowskk C, analyzed using One-way ANOVA and Donahue MS, Bass JA, Podlog L, descriptive analyses. Main Outcome Scharmann S, Schmolesky M, Measures: The following neuro- Fowler L, Ashley A: Weber State proteins were measured in the blood Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 University, Ogden, UT; University samples: ANGF-2, FGF-Basic, HGF, of Utah, Salt Lake City, UT; Porter IL-8, PDGF-BB, TIMP-1, TIMP-2, Family Clinic, Ogden, UT TNFa, and VEG-F. These markers were chosen as the literature suggests they Context: In the United States, more relate to inflammation and than 1.6 million sport-related neurological tissue damage. One-way concussion injuries occur annually, ANOVA compared theses biomarkers with the majority resulting from by gender. Results: One-way ANOVA contact sports such as football and analyses produced a significant soccer; research reports the highest difference in PDGF-BB [F(1,98)=8.81, incidence for female athletes in the p=.004, ˜ 2=.369] between males sport of soccer. Neuropsychological (M=1420.04 ± 483.04) and females evidence-based guidelines stand to aid (M=1114.47 ± 250.70). Conclusions: in diagnosis of severity and return to Our analyses revealed a significant play (RTP) decisions. In addition, difference in PDGF-BB with male sport-concussion in early-adulthood football athletes having increased has been correlated with levels in comparison to female soccer neurodegeneration resulting in athletes. PDGF-BB, platelet-derived impaired movement and memory later growth factor, is a protein that in life. Objective: To identify if regulates cell growth and division. physiological biomarkers (neuro- Athletes in the current sample proteins) associated with concussion participated in high-risk contact sport and sub-concussive blows due to and were likely to have experienced participation in high-risk sports of unreported concussion or multiple football and soccer differ based on sub-concussive events during sport gender. Design: Longitudinal repeated participation. While yet in the novel measures, mixed design. Setting: stages, the identification of higher Controlled laboratory environment. levels of DGF-BB in males should be Patients or Other Participants: examined further to solidify the Volunteer sample of collegiate relationship between concussive athletes (age = 19.45 ± 1.51 years, events and brain healing across years in college sport = 2.18 ± 1.47; genders. In addition, the exploration of N=100, 76% male, 24% female), diagnostic biomarkers could prove including football (n=76) and soccer vital to understanding immediate and athletes (n= 24) were recruited delayed neural damage associated with through sport team meetings to gather concussion and is promising for the baseline blood neuroproteins and field of athletic training. demographic information. Inter- ventions: Blood was drawn into two red top vacutainers from veins in the cubital fossa at 1500 hours on three separate week days. The blood was

S-188 Volume 48 • Number 3 (Supplement) May 2013 13073UOSP

Comparisons of Performance subjects performed 6 trials of a On A Clinical Test Of Reaction preseason baseline test of RTclin Time Between Sport And Sex (Eckner et al., 2010) by catching a Sheldon AM, Montgomery MM: measuring apparatus as quickly as California State University, possible after it was unexpectedly Northridge, Northridge, CA dropped by a researcher. The distance the apparatus fell before being caught was measured (cm). Main Outcome Context: Recently, much attention has Measures: The average distance (cm) been given to the importance of proper across the middle four trials was Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 evaluation of concussions in order to converted to RTclin (ms). A one-way combat the short- and long-term ANOVA compared RTclin between all effects on neurocognitive and sports. Independent t-tests then psychomotor function. Using a battery compared soccer and basketball males of tests has been suggested to be most and females on RTclin. Results: There effective for diagnosing concussion were no differences in RTclin and guiding return to play decisions. (F2,191= 1.41, p=0.25) between Sex differences in pre- and post- football (197.2±7.9ms), soccer concussion assessments have been (199.2±7.9ms) or basketball reported for several tests. Recently, a (198.2±5.1ms) athletes. Females novel test for assessing clinical displayed significantly faster (t123=- reaction time (RTclin) (Eckner et al, 2.2, p=0.03) RTclin than males 2010) was presented as a simple and (197.4±6.1ms vs. 200.3±8.1ms). clinician-friendly test to evaluate Conclusions: Current findings psychomotor function. However, as indicate that performance during a this work was primarily performed with baseline test of RTclin is similar across football players, it is unknown whether sports, which may aid in future normative data from this group is interpretability of existing normative accurately representative of a broader data. When stratifying by sex, it population of athletes. Further, it is appears that females performed better unknown whether sex differences than males. However, the clinical exist in the performance of this test. significance of this finding (i.e. 3ms Objective: To examine performance difference) remains unclear. Overall, of RTclin across multiple sports and the findings point positively to the to explore potential sex differences in potential utility of this test. Given its RTclin in healthy collegiate athletes. simplicity, this test may be most Design: Descriptive Cohort. Setting: valuable for ATˆs with limited Controlled Laboratory. Patients or resources and time. Further work is Other Participants: 68 football needed to validate this test against (1.9±0.7m, 94.9±15.8kg, 19.1± other established testing protocols and 1.6yrs), 96 soccer (46F: 1.6±0.6m, also to investigate this test in a 60.3±10.9kg, 19.1±1.2yrs; 50M: younger population. Future 1.8±0.7m, 71.3±8.4kg, 19.8±1.8yrs), investigations should also evaluate and 29 basketball (12F: 1.8±0.1m, potential sex differences in RTclin 70.7±23.7kg, 19.2±1.0yrs; 17M: during post-concussion follow-ups. 1.9±0.9m, 87.6±12.7kg, 19.4±1.0yrs) NCAA Division I and Community College athletes with no current concussion symptoms or injury to the dominant upper extremity. Interventions: While sitting in a standardized position with their dominant forearm resting on a table,

Journal of Athletic Training S-189 13333DOBI 13158DOSP

Evaluation Of Supplemental Peak impact force (PIF) and percent Forward Head Posture Football Helmet Protection change in severity index compared Increases The Risk Of Crown Of Krzeminski DE, Lippa NM, Gould to control condition (%SI). Results: The Head Impacts In Football

TE, Rawlins JW, Piland SG: For setup 1, mean PIF were: AnvilA Schmidt JD, Guskiewicz KM,

University of Southern Mississippi, (13975 N ±245), AnvilB (13345 Mihalik JP: The University of

Hattiesburg, MS N ±205), AnvilC (12779 N ± 181), and North Carolina, Chapel Hill, NC

AnvilD (12624 N ± 145). Significant Context: Efforts to reduce the main effects were observed for PIF Context: Forward head posture (FHP) (F =28.86, p<.01, f=3.28). Anvil incidence of sports-related 3,8 A is the anterior translation of the head was greater than Anvil , Anvil , concussion have elicited aftermarket, B C in the sagittal plane relative to the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and Anvil (p=.019, p<.001, p<.001), supplemental protection for helmets. D trunk. Football athletes with FHP may respectively. Anvil was greater Products claim substantial additive B be less able to resist the draw of than Anvil (p=.033) and Anvil effects to football helmet C D gravity causing them to have a tendency performance parameters which are (p=.009). For setup 2, mean PIF were: to lower the head prior to contact. PF (5340 N ±47), PF (5093 N ±89), purported to reduce the brain injury A B Objective: 1) To compare the risk of PF (4835 N ±41), and PF (4798 N of concussion. However, neither C D sustaining impacts to the back, front, product systems nor the components ±38). Significant main effects were side, and top of the head between observed for PIF (F =42.79, p< have been validated by peer-reviewed 3,8 athletes with and without FHP. 2) To .01, f=3.99). PF was greater than PF , literature. Objective: To characterize A B compare the risk of sustaining mild, PF , and PF (p=.008, p<.001, and evaluate the impact attenuation C D moderate, and severe head impacts p<.001), respectively. PF was greater of a supplemental helmet protection B between athletes with and without FHP. than PF (p=.006) and PF (p=.003). system. Design: Post-test only C D Design: Prospective quasi- control group design. Setting: Mean %SI were calculated to be experimental. Setting: Clinic/On-field. PF (-4.2%), PF (-7.0%), and PF Research laboratory. Patients/Other B C D Patients or Other Participants: Thirty- Participants: Kevlar® fiber mesh, (-7.2%). Conclusions: Addition of three high school football players polyurethane-based foam system the Kevlar-PUFoam product to were categorized into either the non- (Kevlar-PUFoam) (n=6), Kevlar a helmet surrogate statistically FHP group (n=18; height=180.2±7.4 fiber mesh component (Kevlar) (n=6), reduced PIF and subsequently cm; mass=94.0±20.6 kg) or the non- and polyurethane-based foam decreased SI, which provided FHP group (n=15; height=180.5±7.4 component (PUFoam) (n=6). support to the impact protection cm; mass=77.8±12.9 kg) based on Interventions: Impact tests were product claims. However, no previously published FHP cutoffs. performed against (1) a flat steel differences between the Kevlar- Interventions: Participants stood in anvil (Anvil) or (2) with the addition PUFoam and the PUFoam front of a leveled marker, marched of a helmet surrogate plaque-foam component suggested that the in place five times, squatted once, system (PF) comprised of a stacked polyurethane-based foam provided and were instructed to stand looking injection molded 1/8” helmet outer the primary linear, compressive straight ahead in a natural resting shell-grade material plaque atop 1” impact management mechanism. position. Three sagittal still images VN600 foam using an instrumented Finally, supplemental protection were captured for each player from drop tower (Dynatup 9250HV, to the inner liner of a helmet should 200 cm distance. Images were leveled Instron, Norwood, MA) at 5.5 m/sec lower PIF and better SI, but clinicians and digitized. Forward head angle was with a 4.9 kg drop weight containing should be cautious when measured as the angle between a rounded polyurethane dart (150M, recommending such systems a reflective marker placed over C7, Lixie Hammers, Central Falls, RI). as no scientific information is the tragus, and the horizontal. We used For impact setups 1 and 2, four available to address the clinical the Head Impact Telemetry System sample conditions were evaluated: significance of these products. to record head impact biomechanics A) Control, B) Kevlar, C) PUFoam, at all practices and games (FHP: and D) Kevlar-PUFoam. The control n=8,079; Non-FHP: n=6,035 head condition was devoid of impacts). Main Outcome Measures: 1) supplemental technology. Two We identified the location (back, front, separate one-way ANOVAs were side, top) using measures of elevation performed with post-hoc Tukey HSD and azimuth captured for each tests, where alpha was set a priori to head impact. Relative risks for ˜=.05. Main Outcome Measures: sustaining impacts to the back, front,

S-190 Volume 48 • Number 3 (Supplement) May 2013 13366MOSP

side, and top of head were computed Effect Of Ball Speed During and King Devick Test (KDT). Group for the FHP group relative to the Soccer Heading On Concussion (3) by time (2) MANOVAs and Non-FHP group. 2) Using previously Assessment Scores ANOVAs with repeated measures on published values, the linear and Hoogeveen AM, Tierney RT, time were performed using SPSS v19, rotational acceleration of each head McDevitt JK, Dorminy ML, p < .05. Results: There were no impact was categorized as mild (d•66g; Higgins M: Temple University, statistically significant differences d•4600 rad/s2), moderate (>66g or Philadelphia, PA, and Towson between ball speed groups on any <106g; 4600> or <7900 rad/s2), or University, Towson, MD concussion assessment measures over severe (e”106g; e”7900 rad/s2). time. There was a statistically Relative risks of sustaining mild, significant main effect, F(1,13) = Context: Due to the increasing Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 moderate, and severe head impacts popularity of soccer in the US, the 9.08, p = .010, in KDT for time where were computed for the FHP group numbers of brain injury due to the posttest KDT time (37.6 + 6.8 sec) relative to the Non-FHP group. repetitive head impact have also was lower than the pretest (40.0 + 5.1 Results: Players with FHP were at increased. Certified athletic trainers sec). Slight symptoms (1 of 6 severity an increased risk of sustaining have used sideline concussion tests to endorsed), such as headache, pressure impacts to the top of the head indicate whether or not an athlete has in the head, neck pain, and fatigue, (RR=1.76, 95%CI:1.61-1.92) impairments that can be indicative of were elicited post-heading in some and,conse-quently, a reduced risk of a concussion. Soccer heading ball players during the SCAT2 evaluation. sustaining impacts to the back speeds may influence injury risk, but Conclusions: Heading a soccer ball (RR=0.82, 95%CI:0.77-0.87) and have not been evaluated in a controlled, at 30, 40, 50 mph did not cause front (RR=0.91, 95%CI:0.87-0.94) yet functional, setting. Objective: To statistically significant increases in of the head. Players with a FHP were determine the influence of soccer concussion assessment scores. The at a reduced risk of sustaining both heading ball speed on concussion KDT significant result in overall time moderate (RR=0.64, 95%CI:0.53- sideline assessment scores. Design: could be attributed to a learning effect. 0.78) and severe (RR=0.55, Pre-test post-test repeated measures Although no statistically significant 95%CI:0.32-0.95) rotational head research design. Setting: Athletic results were identified in the impacts. Conclusions: High school training laboratory and gymnasium. concussion assessments over time, football players with FHP may have Participants: Sixteen current division slight symptoms were elicited in some a propensity to lower the head prior one collegiate soccer players (age= players post heading. These transient to collision rather than utilizing a 20.4 ± .96; M = 10; F = 6) with no slight symptoms following high-speed heads-up tackling technique. Loading history of head or neck injury in 6 head impacts in sports are common, through the spine may reduce resultant months prior to testing, no braces on but their significance is not well rotational acceleration of the head, but their teeth, and at least 5 years of understood. Sports medicine health poses a serious threat to the cervical soccer heading experience care professionals need to remain vertebrae if in a flexed position. Football participated. Intervention: The proactive and conservative in their players may benefit from interventions independent variables were ball speed concussion management strategies. aimed at correcting posture. (30, 40, and 50mph; randomized) and time (pretest vs. posttest). Ball speed was a between-subjects factor (30mph n = 5, 40mph n = 5, 50mph n = 6) and time was a repeated-measure. Soccer balls were projected from a JUGS soccer machine at 30, 40 and 50 mph. Subjects performed at least 5 standing headers at their respective ball speeds. Concussion assessments were performed approximately 1 week prior to and immediately post soccer headings. Main Outcome Measures: Sideline concussion assessments included the Standard Concussion Assessment Tool 2 (SCAT2), Balance Error Scoring System Score (BESS),

Journal of Athletic Training S-191 13167FOSP

Balance And Cognitive intervention program (3x per week improved regardless of intervention Performance Under A Divided including 1 home session). Individuals group. Single task complex attention Attention Task Prior To And in the dual-task group performed training appears to lead to greater Following Two Different 4-Week balance and cognitive activities improvements during a divided Training Interventions: concurrently (e.g. concentration task attention task. Both paradigms may Preliminary Implications For while performing a single leg balance be feasible for rehabilitation Concussion Rehabilitation task) during training sessions while programs. Future research should Register-Mihalik JK, Ingriselli JM, the single-task group performed address applications of more Schmidt JD, Littleton AC, Mihalik activities separately. Main advanced dual-task rehabilitation JP, Giovanello K, Marshall SW, De Outcome Measures: Outcomes paradigms aqnd the effects on divided Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Maio VJ, : WakeMed Health and included Sensory Organization Test attention in the management of Hospitals, Raleigh, NC, and (SOT) eyes-open equilibrium scores concussed individuals. This study was University of North Carolina, (conditions 1, 3, 4, and 6) and funded by NCTraCS. The NCTraCS Chapel Hill, NC complex attention reaction times Institute is supported by grants for correct responses on an UL1TR000083, KL2TR000084, Context: Concussion rehabilitation incongruent Stroop task assessed TL1TR000085 from the National has emerged as a priority among individually and under a divided Center for Advancing Translational clinicians tasked with caring for brain- attention paradigm. All outcomes Sciences, National Institutes of Health. injured athletes. Little evidence exists were assessed pre- and post- on the utility and feasibility of intervention (time between concussion rehabilitation paradigms. assessments=34.0±4.2 days). Mixed Objective: To examine differences in model ANOVAs were used to cognitive and balance performance examine all measures (˜=0.05 a under a divided attention paradigm priori). Results: Following prior to and following a dual-task or a intervention, divided attention reaction single-task training intervention in times were faster (F1,26=5.03; healthy individuals. We hypothesized P=0.033) in the single-task group that the dual-task group would have (pre=643.6±60.7 ms; post= 611.7 greater improvements in divided ±64.5 ms) and slower in the dual-task attention performance following the group (pre= 569.4±198.6 ms; intervention. Design: Prospective post=612.4 ±212.1 ms). Divided cohort with stratified (gender), attention balance scores improved randomized intervention group between pre- and post-intervention for assignment (dual-task or single-task). all four SOT condition equilibrium Setting: Clinical research center. scores in both groups (Condition 1: Patients or Other Participants: A pre=89.8±6.3 vs. post=92.8±3.1, convenience sample of 30 healthy, P=0.011; Condition 3: pre=89.3±3.9 recreational athletes (15 male, 15 vs. post=91.4±3.3, P=0.005; female; 15 dual-task, 15 single task) Condition 4: pre=81.9±8.4 vs. served as participants (age=20.3±1.9 post=85.9±6.2, P<0.001; Condition 6: yrs; height=1.7±0.2 m; mass= pre=71.0±12.9 vs. post=74.2±6.2, 68.3±13.8 kg). Interventions: P=0.045). No test-session effect was Intervention group (dual-task vs. single observed for divided attention reaction task) and test-session (pre- time (P=0.477). No group or intervention vs. post-intervention) interaction effects were observed for served as independent variables. All any of the SOT condition scores. No participants completed a divided cost differences to balance or attention assessment including a cognitive performance under the concurrent balance and cognitive exam divided attention task compared to the prior to and following the single task were observed. Participants interventions. Both groups completed were able to comply with the a 4-week mass progression interventions. Conclusions: Divided attention balance performance

S-192 Volume 48 • Number 3 (Supplement) May 2013 13086MOSP 13394MCS

A Descriptive Analysis Of Concussion mental confusion without Decreased Sport-Related Clinical Findings At Discharge loss of consciousness (20.2%, n=38), Concussion Incident Rates Following Sport-Related and 850.5-Concussion with loss of Following Intervention At The Concussion: A Report From consciousness (2.7%, n=5). The Middle School Football Level: The Athletic Training Practice- majority occurred in football (63.6% Case Series Based Research Network n=119) and soccer (12.2%, n=23). Werner JL, Uhl TL: University of Baker R, Anderson B, Lam KC, Only 11.7% (n=22) were considered Kentucky, Lexington, KY Valovich McLeod TC: A. T. Still normal within 15 minutes and 26.1% University, Mesa, AZ (n=49) reported delayed onset of Background: Sport-related con-

symptoms after the concussion. Most cussions have the highest incidence in Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: With many concussion state (97.8%, n=184) were not allowed to football. According to injury laws, the return-to-play decision (RTP) RTP on the day of injury. While the surveillance study from 2005-2006, is restricted to qualified healthcare majority of concussions recovered practice and competition injury rates providers, including athletic trainers gradually (symptoms present for 1-7 of concussions at the high school (ATs). While ATs are educated and days) (51.1%, n=96), recovery in other football level are 2.54 and 12.09 rate trained to manage concussive injuries, cases was rapid (symptoms present <1 of injury per 1000-athlete exposures, it is unknown whether ATs are day) (13.3%, n=25), prolonged respectively. The prevalence of sport- following current recommended RTP (symptoms present for >7 days) related concussions has not been guidelines in clinical practice. (31.9%, n=60), or with persistent defined at the middle school football Objective: To describe the course of symptoms (symptoms present at end level. In this case series, four middle clinical recovery and the rationale of of season) (3.2%, n=6). Time lost from school football players (age range 11- RTP decision-making at discharge competition was 14.5±17.6 days and 12 years old, all males) sustained following a sport-related concussion. patients were symptom free for sport-related concussions during Design: Retrospective analysis of 7.8±10.3 days prior to returning to practice (n=3) and at competition electronic medical records (EMR). competition. Eight percent (n=15) of (n=1). No loss of consciousness Setting: Athletic Training Practice- patients were disqualified for the occurred; all athletes were given an on- Based Research Network (AT-PBRN). remainder of the season. The athletic field concussion evaluation by the Patients or Other Participants: trainer served as the primary decision- athletic trainer and then referred for Discharge records of 188 patients maker for the patient in 69.7% further evaluation by a physician, based (141 males, 47 females, age= (n=131) of cases and the majority of on NATA Position Statement: 16.7±1.7) diagnosed with a cases (70.2%, n=132) were not graded Management of Sport-Related concussion by an AT. Interventions: with a classification system. RTP Concussions. The mechanism of all Patient records from the period of guidelines were used in 77.1% four concussions was the same with October 2009-October 2012 were (n=145) of cases, with the Zurich either head-to-head or head-to-person reviewed. All records were created by progression (36.2%, n=68) cited most contact; specifically all tackles lead an AT utilizing a web-based EMR frequently. Conclusions: The vast with the head. Common chief within the AT-PBRN. Concussed majority of concussed patients did not complaints were headache, nausea, and patients were identified by RTP on the day of the injury, following dizziness, lasting on average four days. concussion-specific diagnostic codes current recommendations and many Treatment: All cases received (ICD-9: 850.0, 850.5, 850.9). Main state laws. The majority of cases had physician clearance at one week and Outcome Measures: Frequency and symptom resolution within 7 days, successfully progressed through a descriptive statistics were calculated indicating a relatively quick recovery. return to play protocol following a for each variable of interest from the The decisions by the majority of ATs concussion and were able to return to discharge form: diagnostic code, to not grade the concussion and to use full completion two weeks following recovery time, delayed onset of a RTP progression concur with current onset. Recognizing the commonality symptoms, course of recovery, time recommendations, suggesting ATs are between these three cases, covering a loss, primary decision-maker, following best practices. period of one week, and observing in concussion classification system, and practice that athletes were leading with criteria guiding return-to-play the head during tackles, the Athletic decisions. Results: The majority of Trainer advised proper hitting cases were coded as 850.9- mechanics should be taught. The Concussion (77.1%, n=145) with athletic trainer approached the first- fewer being coded as 850.0- year middle school head coach

Journal of Athletic Training S-193 13360FOSP regarding the need to correct the problem, the effort and enthusiasm No Factorial Validity Support improper hitting mechanics, especially displayed by the Athletic Trainer For Revised Baseline And in those of the younger athletes. The influenced the coach to dedicate a Injured Factor Structures Of football coach expressed disbelief and significant amount of practice to Response To PCSS stated if the athletic trainer felt such, improve hitting technique. Although Piland SG, Byon KK, Gould TE, she could make the changes herself. concussions are acknowledged at the Curry PR, Miles JD, Ferrara MS: All three levels (6th-8th grade) were national level, further emphasis on the University of Southern Mississippi, spoken to as a group regarding the risks and severity of concussions needs Hattiesburg, MS, and The severity and implications of to be done at the fundamental level. University of Georgia, Athens, GA concussions by the Athletic Trainer.

The incidence of sport-related Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 The Athletic Trainer then explained and concussions in this case series was Context: A recent study published in demonstrated proper hitting decreased after the Athletic Trainer 2012, provided “revised” factor mechanics – athletic position, leading identified the improper hitting structures for both non-injured with the facemask looking at the mechanics and worked with the (baseline) and injured (concussed) numbers of the opponent, wrap up, coaches to address a problem with a responses to the 22-item, ImPACT© keep the feet moving and tackle the positive result of reduced incidence. Post Concussion Symptom Scale opponent. The coach divided the team (PCSS). Employing Exploratory by grade level and further Factor Analysis (EFA), the study demonstrated proper hitting suggested that both samples of mechanics. Following the responses maintained four symptom- demonstration, athletes began clusters. However, the symptom- practicing supervised hitting, 6.25 clusters and construct definitions not athletes to 1 coach. The Athletic only varied from previously reported Trainer floated around to assist factor structures, but also between coaches. Two days of practice (3 hours baseline and concussed responses. The total) were devoted to specific hitting strength of inferences drawn from and tacking drills, progressing from composite scores depends upon the one-on-one to live play, emphasizing quality and quantity of available validity the basics. Results: Three sport- evidence. Such evidence to support the related concussions were sustained proposed use of the PCSS composite within the first five days of full-pads scores is minimal. However, 4-factor practice. Following the intervention, measurement models have been the incident rate dropped from 8.33 to suggested by a few studies employing 0.434 per 1000-athlete exposures EFA methods (e.g., PCA). Thus, more over a course of two-months. rigorous confirmation is warranted. Uniqueness: The role of an athletic Objective: To confirm the factorial trainer has been well defined at validity of the 4-factor response assessing and treating athletic injuries, structures of both non-concussed and as well as preventing them. This case concussed athlete responses to the series illustrates the importance of this PCSS found within the ImPACT© role in recognizing potential athletic computerized neurocognitive exam. injuries and implementing an Design: Retrospective Analysis intervention. This case demonstrates Settings: University Laboratory. the coach and Athletic Trainer can work Participants: Non-concussed together to reduce injury rates. (N=908) and concussed athletes Conclusions: Although the incidence (N=146) enrolled at a southeastern rate of concussions is not known at the Division I institution. Interventions: middle school level it obviously Baseline and concussed responses to occurs. This series demonstrates the 22-item PCSS instrument. Main teamwork between a coach and the Outcome Measures: Two separate Athletic Trainer to emphasize proper Confirmatory Factor Analyses (CFAs) hitting mechanics. Although the coach (i.e., one CFA with baseline data set and initially did not believe there was a the other CFA with injured sample)

S-194 Volume 48 • Number 3 (Supplement) May 2013 13255OOEM were performed to fit the specified A Comparison Of Emergency conditions (RS360-FMR; RS360-HR; PCSS model, for which the baseline Facemask And Helmet Removal ION4D-FMR; ION4D-HR). An eight- was hypothesized as 4-factor with 20/ Effectiveness With Various camera three-dimensional motion 22 items (i.e., Cognitive-Sensory, Football Helmets And Facemask system and two, three-point segment Affective, Vestibular-Somatic, and Attachment Systems marker sets (head and torso) were used Sleep-Arousal) and the injured sample Al-Darraji SJ, Swartz EE, Bric to record head motion in a live model as 4-factor with 17/22 items (i.e., JD, Decoster LC, Mihalik JP: wearing properly fitted helmets and Cognitive-Migraine-Fatigue, University of New Hampshire, shoulder pads. Total time was recorded Affective, Somatic, and Sleep). Several Durham, NC; New Hampshire with a digital stopwatch. The difficulty

model fit indexes were employed, Musculoskeletal Institute, for the task reported by the participant Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 including ˜ 2, ˜ 2/df, CFI, and RMSEA. Manchester, NH; University of was recorded after each trial using a Results: The first data set (N = 908) North Carolina, Chapel Hill, NC modified Borg CR-10 scale. Main with baseline was subject to a CFA. Outcome Measures: Dependent Goodness of fit indices revealed that Context: The National Athletic variables included motion, total time the 4-factor model did not fit the data Trainers’ Association recommends and perceived difficulty. A 2x2 (helmet well (˜ 2 = 2350.04; ˜ 2/df = .164; CFI facemask removal (FMR) for x technique) within-subjects repeated = .670; RMSEA = .600). Goodness of emergency access to football players’ measures ANOVA was employed for fit indices for the injured sample airways with limited research each dependent variable (Pd•0.05). (N=146) revealed that the injured comparing helmet removal (HR) and Due to our participant pairing, our responses to the 4-factor PCSS FMR. Recent changes in football analyses were based on a sample of model also did not fit the data well helmet and facemask designs have n=20. Results: We observed a (˜ 2 = 369.03; ˜ 2/df = .113; CFI = implemented quick-release systems significant helmet-by-technique .809; RMSEA = .12). Conclusion: aimed at reducing FMR time. interaction (F1,19=349.12; P=0.001); Responses of both non-concussed Comparing the relative efficacy of RS360-FMR took longer (31.22±7.89 and concussed athletes failed to these two new systems to access the s) than ION4D-FMR (20.45±3.57 s) support the posited 4-factor airway during FMR and HR tasks has or ION4D-HR (26.40±6.29). Helmet measurement model of the PCSS. not yet been investigated. Objective: removal (sagittal: 14.88±2.48ˆ; Such evidence severely reduces the To compare the amount of head frontal: 7.00±1.14ˆ; transverse: strength of inferences that can be movement, time to task completion, 7.00±1.08ˆ) resulted in greater drawn from the clinical use of the and perceived difficulty during FMR motion than FMR (sagittal: four symptom clusters within the and HR across two different helmet 7.04±1.80ˆ; frontal: 4.73±1.14ˆ; PCSS. Clinicians should be designs. We hypothesized that FMR transverse: 4.49±0.89ˆ) in all three cautioned before using a composite would result in less motion, time to planes of motion (sagittal: score from the 22-item PCSS or its task completion, and perceived F1,19=187.27; frontal: F1,19=65.34; constituent clusters in prognosis. difficulty than HR. Design: Quasi- transverse: F1,19=68.36; P<0.001 for experimental. Setting: Research all). Our ATs reported equal task laboratory. Patients or Other difficulty across both helmet designs Participants: Forty athletic trainers and airway access techniques (ATs) free of physical pathology (F1,19=0.56; P=0.462). Conclusions: preventing them from completing the As hypothesized, FMR induced less required tasks were recruited motion than HR when accessing (males=21; females=19; age= the airway, validating current clinical 33.7±11.2 yrs; mass=80.7±17.1 kg; recommendations. Quick-release height=173.1±9.2 cm; AT experience loop straps allow FMR to be =10.6±10.4 yrs). Interventions: completed in clinically acceptable Independent variables consisted of times with less motion in all planes. helmet (Riddell Speed 360— Future research should continue to RS360—or Schutt ION 4D—ION4D) examine the effects of helmet designs and technique (facemask removal vs. on emergency airway access. This helmet removal). After familiarization, study was funded by the Eastern paired participants conducted 4 Athletic Trainers’ Association. successful trials in random order for each of four helmet-technique

Journal of Athletic Training S-195 13100FOBI 13337FOSP

Head And Trunk Acceleration differences for the three trials were The Influence Of Mood State During Intermediate Transport averaged. The independent variables On ImPACT Baseline Test On Medical Utility Vehicles were the vehicle (HUV and Gator) and Performance Swartz EE, Tucker WS, Hornor interval (Interval 1 and Interval 2). Resch JE, Brown CN, SD: University of Central Main Outcome Measures: The Baumgartner TA, Walpert K, Arkansas, Conway, AR, and dependent variables were the average Macciocchi SN, Ferrara MS: University of New Hampshire, peak acceleration differences in the The University of Texas at Durham, NH three planes (sagittal, frontal and Arlington, Arlington, TX; The transverse). The influence of vehicle University of Georgia, Athens,

Context: Medical utility vehicles are and interval on the average peak GA; Georgia Neurological Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 used for intermediate transport of acceleration differences was Associates, Athens, GA; The athletes with suspected catastrophic compared using a two-within factors Shepherd Center, Atlanta, GA neck injuries from the field to an ANOVA (Pd”0.05). Tukey post hoc ambulance. Various vehicles differ in testing was applied in the event of a Context: Baseline assessments using their axle suspension systems, axle significant interaction. Results: Main computerized neuropsychological location relative to patient position, effects were detected in the frontal (CNP) testing has been advocated for and bi-axle distance. Objective: To plane for vehicle (F1,36=4.93; the management of sport concussion. analyze and compare neck motion P=0.033) and interval (F1,36=20.27; ImPACT is a commonly used CNP test during transport on two different P<0.001); in that the Gator used in sport concussion management medical utility vehicles. Design: (6.55±3.46m/s/s) was greater than the protocols. A potential extraneous Within subject. Setting: Controlled HUV (4.80±3.52m/s/s) and Interval 2 variable which may influence baseline laboratory. Patients or Other (7.16±4.2m/s/s) was greater than ImPACT test performance is mood. Participants: Nineteen males Interval 1 (4.19±1.94m/s/s). A main Sources of random error such as mood (21.8±1.4 years, 176.5±5.5 cm, effect was detected in the transverse may limit the clinical utility of the 90.3±16.1 kg) with no previous history plane for interval (F1,36=4.1; P=0.05) baseline ImPACT assessment of injury to the spinal column. in which Interval 1 (4.08±2.2m/s/s) following sport concussion. Interventions: Participants were was greater than Interval 2 Objective: To examine the effect of secured to a spine board and stretcher (3.23±2.00m/s/s). There was an mood state on ImPACT performance using standard protocols and loaded interaction for the transverse plane in a healthy collegiate sample. onto one of two medical utility (F1,36=18.01; P<0.001) in which the Design: Repeated Measures. Setting: vehicles: Husqvarna HUV 4421DXL HUV during Interval 1 (5.27±2.32m/ Research laboratory. Patients or ambulance (HUV) or modified John s/s) was greater than the Gator during Other Participants: One hundred and Deere Gator TH (Gator). Vehicles Interval 1 (2.90±1.30m/s/s) and HUV four (32 males and 72 females) healthy were driven 60 yards; consisting of 30 during Interval 2 (2.63±1.76m/s/s). college students aged 20.9 + 1.45 yards of artificial turf transitioning to There were no main effects for the years participated in this study. concrete slab (Interval 1) then 30 yards sagittal plane. Conclusions: Interventions: Participants of concrete slab transitioning to Differences in relative accelerations completed the Profile of Mood States natural grass (Interval 2). Subjects exist in the frontal and transverse Brief Form (POMS-B) prior to completed three counterbalanced planes in healthy spine-boarded completing ImPACT at three clinically trials for each vehicle. Vehicle speed participants who are secured relevant time points (days 1, 45, and was standardized (6.46-7.22 mph) to different intermediate transport 50). The Green’s Word Memory Test using an infrared timing system. vehicles. This suggests differences in (WMT) was also delivered to assess During the trials, three-dimensional surface-type and vehicle specifications effort. Main Outcome Measure: accelerometers (Noraxon USA Inc., create lateral and vertical perturbations Pearson correlation coefficients were Scottsdale, AZ) recorded peak head that may be conveyed to the patient. calculated for each of the seven and trunk acceleration data in the POMS-B factors (fatigue-inertia, sagittal, frontal and transverse planes. vigor-activity, tension-anxiety, For each plane, absolute peak depression-dejection, confusion- acceleration of the trunk was bewilderment, anger-hostility and total subtracted from the absolute peak mood disturbance) and ImPACT acceleration of the head to yield peak composite and symptom scores. acceleration differences. For each Repeated measures analysis of vehicle, the peak acceleration variance (ANOVA) was used to

S-196 Volume 48 • Number 3 (Supplement) May 2013 13182DOSP determine significant differences Baseline SCAT2 Scores In subcomponents (orientation (5), across time in regards to POMS-B, Middle And Secondary School immediate memory (15), ImPACT, and Green’s WMT composite Student-Athletes concentration (5), delayed recall (5)). scores. Greenhouse-Geisser Glaviano NR, Benson S, Goodkin Points are awarded for correct corrections were used to correct for HP, Broshek DK, Saliba S: responses or deducted for symptom violations of sphericity. Post-hoc University of Virginia, scores (22 minus number of analyses were performed using Charlottesville VA, and Saint symptoms) or poor GCS responses. dependent t tests. All analyses were Anne’s Belfield School, Results: There were no statistical performed with = .05. Results: Our Charlottesville, VA differences on gender between SCAT2 analyses revealed significant

scores (F=0.0326, p=0.569, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 differences across time for composite Context: The Sport and Concussion females=91.9±4.9, males=91.6±4.5. ImPACT verbal memory (Wilk’s = Assessment Tool 2 (SCAT2) is All subjects scored 100% for GCS and .824, F = 10.86, p < .001) and (2,214) recommended to assess post the subcomponent sign score. Females visual motor speed (Wilk’s = .867 concussion neurocognitive and reported more symptoms (F=12.56, F = 7.80, p = .001). Post hoc (2,214) balance ability. The components of p<0.000, female= 19.6±3.2, males= analyses revealed significant the SCAT2 have demonstrated face and 20.7±2)(lower scores=more improvements between day 1 and day content validity, but the use has symptoms), higher BESS scores 45 (t = -4.0, p < .001) and day 1and (103) primarily been incorporated into (F=6.89, p=0.009, females=27.3±2.2, day 50 (t = -4.39, p < .001). (103) college and adult populations. SCAT2 males=26.5±3.1), and higher SAC Significant improvements were also has been suggested for use in children immediate recall scores (F=9.705, observed for visual motor speed as young as 10 years old. p=0.002, females=14.6±0.9, males= between day 1 and day 45 (t = -2.00, (103) Representative baseline scores have 14.2±1.3). Comparison by age p = .05), day 1 and day 50 (t = - (103) only been reported for high-school and identified a significant difference 3.965, p < .001) and between day 45 college-aged student-athletes. To date (F=2.77, p=0.012) in the and 50 (t = -2.378, p = .02). At time (103) there are no published data on concentration subscale. Tukey’s Post point 1 ImPACT impulse control was representative baseline scores in the Hoc testing reported 12 year olds significantly correlated to POMS-B middle-school level. Objective: To (3.2±1.3) scored lower than 15 year fatigue-inertia (-.228, p = .02). determine normal baseline SCAT2 olds (3.8±1.0) and 16 year olds ImPACT’s total symptom score was scores for middle school athletes and (3.9±1.1) (p=0.048 and p=0.043 most consistently correlated to compare scores by age and gender. respectively). Conclusion: The multiple POMS-B factors with Design: Cross sectional. Setting: SCAT2 test is a widely used correlations coefficients ranging from Single private high-school and middle- concussion assessment tool that has -.23 to .57. No additional significant school (grades 7-12). Participants: been recommended for children as correlations were observed between 324 student-athletes (170 males, 154 young as 10 year old. Subcomponents the remaining ImPACT composite females, age=14.44±1.74) completed of the SCAT2 test show differences scores and the varying mood states. the SCAT2 as a part of pre- between gender and age. Conclusions: Our results suggest that participation screening. Inter- Consideration should be given for although mood factors as measured by vention: Baseline SCAT2 scores were demographic differences in middle the POMS-B were significantly individually obtained in a quiet setting. school athletes, with baseline testing correlated to total symptom score of Scores were grouped by age (12-18 being conducted annually. Additional ImPACT, performance remained either years old) at the time of the test and data from multiple sites is needed to consistent or improved over time. rounded to the nearest whole year. determine normalized values for both Future research is needed in a Descriptive statistics were reported by the SCAT2 test and the collegiate athlete sample to determine age and gender using separate ANOVAs subcomponents. SCAT2 tests should if potentially higher mood state values (p<0.05) and Tukey’s post hoc testing be used in conjunction with other tests influence computerized were reported used to identify in scholastic age student-athletes to neuropsychological test results. differences between age. Main make return to play decisions. Outcome Measures: Maximum scores are: SCAT2 (100) symptom score (22), sign score (2), GSC (15), BESS (30), coordination (1) and total SAC (30) as well as its four individual

Journal of Athletic Training S-197 13071OOIN 13271MOSP

An Examination Of Risk Factors CI) by year in school [p = 0.896], Prior Concussion History And For Sport Related Concussion (freshmen (8.4, 5.9 -11.9), Newly Diagnosed Concussions In High School Football Players sophomores (8.8, 6.0-12.5), juniors Are Elevated Among Students McGuine TA, Brooks MA, Hetzel (9.5, 6.7-13.2) and seniors (7.8, 5.1- With Self-Reported Learning S, Rasmussen J, McCrea M: 11.6), or competition level [p = Disability And Attention Deficit University of Wisconsin, Madison, 0.768], (freshmen (8.8, 6.1 -12.5), Hyperactivity Disorder WI junior varsity (9.4, 6.7-13.0) and Shepherd LI, Bay RC, Valovich varsity (8.1, 6.2-10.6), or previous McLeod TC: A. T. Still University, Context: Approximately 40,000 Sport playing experience [p = 0.205], (0 to Mesa, AZ 2 years (9.7, 6.6 -14.1), 3 to 5 years Related Concussions (SRC) occur Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 annually in high school football. To (9.5, 7.4 -12.0) and 6 to 8 years (6.6, Context: Concussion management date, most epidemiologic studies of 4.5 -9.6). The rate of SRC was higher relies on clinical judgment exercised SRC have not reported variables that [RR = 2.21, 1.54 – 3.17] in players on an individualized basis. Clinical may be associated with increased risk with a history of SRC (15.5, 11.4 - judgment includes considering the of SRC in this population. Objective: 20.8) than players without a history of patient’s personal and medical history. Determine the association of various SRC (7.0, 5.6-8.8), [p < 0.001]. Learning disabilities (LD) and intrinsic and demographic factors with Conclusion: Increased risk of SRC attention deficit hyperactivity disorder the incidence of SRC in high school was not associated with a player’s age, (ADHD) have both been identified as football players. Design: Prospective BMI, grade in school, level of potential modifying factors that cohort. Setting: Data were collected competition or years of football warrant consideration when assessing by Athletic Trainers (ATCs) at 36 experience. However, players with an athlete with a concussion. However, public and private high schools in a history of SRC were twice as likely little research exists regarding the Wisconsin during the 2012 football to sustain an SRC compared to players potential impact of LD and ADHD on season. Participants: A convenience without a history of SRC. ATCs need the likelihood of sustaining a sample of 1,332 football players to screen for SRC history to identify concussion.Objective: To investigate (grades 9 – 12, age: 15.9 + 1.8 yrs, those high school football players the relationship between self-reported BMI: 24.3 + 4.3, with 4.1 + 1.0 years at increased risk of SRC. learning disability (LD) or attention of football experience) enrolled in this deficit hyperactivity disorder (ADHD) study. Interventions: During the pre- and self-reported history of season, subjects completed a concussion and sustaining a diagnosed questionnaire to measure age, height, concussion. Design: Prospective weight, year in school, level of cohort. Setting: High school athletic competition, years of football training facilities. Patients or Other experience and SRC history. ATCs at Participants: A convenience sample each school recorded the incidence of of 8811 adolescent athletes (2809 SRC throughout the season. Main females, 6002 males, age=15.7±1.2 Outcome Measures: Dependent years, grade=9.3±1.1 level) variables included the incidence of participating in interscholastic contact SRC. T-tests were used to compare the sports. Interventions: All subjects incidence of SRC for age and BMI. completed the Immediate Post- Chi-square tests were used to compare Concussion Assessment and Cognitive the incidence of SRC among grade, Testing (ImPACT), as part of a competition levels, years experience, concussion baseline assessment and history of SRC. Relative Risks protocol. Independent variables [RR, 95% CI] were calculated for included self-reported LD or ADHD, variables with significant tests (p as determined by the participants’ <.05). Results: A total of 115 (8.6%) responses to questions about LD and players sustained 116 SRCs. No ADHD within the ImPACT differences were found in the age (p = demographic section. Any participant 0.587) and BMI (p = 0.490) of players sustaining a concussion during this 2- who sustained an SRC compared to year prospective study completed their non-injured peers. There was no ImPACT within 48 hours of the difference in the rate of SRC (%, 95% concussion and serially during

S-198 Volume 48 • Number 3 (Supplement) May 2013 13305MOSP recovery as indicated by their Increasing The Interpretability ascertain the patient-perceived respective athletic trainer. Main Of Patient-Rated Outcome magnitude of change in health status Outcome Measures: Dependent Measures For Evaluating since concussion. Patients were variables included the self-reported Concussed Patients dichotomized as improved (GROC history of prior concussion as Rodriguez J, Michener LA, Bay ‘much better’ or higher) or unimproved documented in the ImPACT RC, Valovich McLeod TC, Snyder (GROC less than ‘much better’) on D3 demographic section and any Valier AR: A.T. Still University, and D10. Improvement was determined subsequent concussion diagnosed by Mesa, AZ through receiver operator an athletic trainer that resulted in the characteristic curves by identifying the participant completing at least one point of maximum sensitivity and 1- Context: A limitation of using patient- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 post-injury ImPACT test. The rated outcome instruments (PROMs) specificity. Area under the curve relationship between each independent with injured athlete populations, such (AUC) determined discriminative and dependent variable was evaluated as those suffering concussion, is lack ability of the improvement cutpoint, with separate Chi-Square analyses of information to guide interpretation with values >0.70 considered (P<.05). Results: A total of 158 of scores. Scores indicative of satisfactory. Means and standard participants (1.8%) indicated they had improvement have not been defined for deviations are reported for PROMs. LDs; 375 (4.3%) noted they had been the PedsQL, MFS, and HIT-6 PROMs, Cutpoint data are presented as diagnosed with ADHD, and 1583 limiting the ability to accurately (cutpoint, AUC). Results: At D3, 106 (18.0%) reported a prior history of interpret scores as patients recover patients were classified as improved concussion. A total of 632 from injury. Identifying a score (PedsQL total=92.7±8.3; MFS- concussions (incidence=7.2%) were cutpoint that defines athletes as GF=88.0±14.1; MFS-SLF= 82.8± diagnosed during the 2-year study improved or unimproved in the days 18.1; MFS-CF=84.8±16.0; HIT-6 period. Self-reported LD was following concussion would increase total=56.0±7.7) and 110 as significantly associated with a higher PROMs’ clinical utility. Objective: To unimproved (PedsQL total= 79.8± report of prior concussions (p<.001, estimate a score for concussion 12.1; MFS-GF=62.5±23.0; MFS- 31.6% vs. 17.7%) and diagnosed PROMs that accurately classifies SLF=60.6±24.1; MFS-CF=61.9 concussions (p<.001, 14.6% vs. athletes as improved or unimproved at ±23.7; HIT-6 total=46.6±7.4). PROM 7.0%). Likewise, participants with days 3 (D3) and 10 (D10) post- cutpoints and AUC values at D3 were: self-reported ADHD were more likely concussion. Design: Pre-post, within- PedsQL total=89, .83; MFS-GF=73, to report a prior history of subject. Setting: Secondary school .83; MFS-SLF=77, .78; MFS-CF=77, concussions (p<.001, 27.7% vs. athletic training facilities. Patients or .78; and HIT-6 total=51, .81. At D10, 17.5%) and sustain a newly diagnosed Other Participants: 218 adolescent 187 patients were defined as improved concussion (p<.001, 12.8% vs. 6.9%). athletes who sustained a concussion (PedsQL total=94.4±8.2; MFS- Conclusions: These findings diagnosed by their athletic trainer (184 GF=91.7±14.4; MFS-SLF=89.1 suggest that self-reported LD and males, 34 females, age=15.7±1.1 ±14.2; MFS-CF=89.1±15.7; HIT-6 ADHD are both associated with a years, grade=10.0±1.0 level). total=46.0±8.6) and 25 as unimproved higher rate of prior concussion and Interventions: Patients completed the (PedsQL total=79.0±13.4; MFS- newly, athletic trainer-diagnosed Pediatric Quality of Life Inventory GF=69.0±24.7; MFS-SLF=70.8 concussion. Athletic trainers should (PedsQL), PedsQL Multidimensional ±18.8; MFS-CF=64.7±25.2; HIT-6 ask about and document these Fatigue Scale (MFS), Headache Impact total=59.0±6.6). PROM cutpoints and comorbid factors as part of the pre- Test (HIT-6), and Global Rating of AUC values at D10 were: PedsQL participation examination and Change (GROC) on D3 and D10 post- total=92, .86; MFS-GF=85, .79; MFS- consider them in assessing the concussion. Main Outcome SLF=90, .79; MFS-CF= 85, .82; and potential for concussion, and the Measures: Dependent variables HIT-6 total=53, .87. Conclusions: management of concussed athletes. include the PedsQL total score, 3 Our results define PedsQL, MFS, and Future studies should investigate the subscale scores of the MFS [general HIT-6 scores as they relate to mechanisms underlying the (MFS-GF), sleep (MFS-SLF), and improvement following concussive increased rate of concussion cognitive (MFS-CF) fatigue], and the injuries. All cutpoints suggest greater associated with LD and ADHD. HIT-6 total score. Higher scores on than 70% probability of correctly Funded by a grant from the National HIT-6 and lower scores on PedsQL and classifying concussed patients as Operating Committee on Standards MFS indicate lower HRQOL. The improved as demonstrated by greater for Athletic Equipment (NOCSAE). GROC, scored as 1=very much worse; than satisfactory AUC values. These 15= very much better, was used to cutpoints should help clinicians better

Journal of Athletic Training S-199 13125SC interpret concussion PROMs and Closed Traumatic Head Injury In Injury, Concussion, Subdural manage concussed patients overtime. A High School Football Athlete Hematoma Treatment: Athlete Frymyer JL, Felton SD, Cox SJ: reported to ER and attending physician Naples Community Hospital, ordered a CT scan. CT Scan revealed Naples, FL, and Florida Gulf Coast a left periventricular hemorrhage. The University, Fort Myers, FL athlete was admitted to the hospital for overnight observations. Athlete had Background: Athlete is a 17 year-old follow-up CT scan the next day which Caucasian male high school football demonstrated no exacerbation of focal bleed; thus, released from hospital. linebacker. The athlete’s medical Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 history revealed an episode of acute Athlete was scheduled for follow-up pancreatitis within the past year. appointment two weeks following Athlete was on punt return team when the release from hospital. Athlete he made helmet to helmet contact and returned to school following the fell to the ground creating a second weekend and completed post- head impact. Athlete walked off the concussion assessment including, field on his own volition. Athlete SAC test, BESS, and Immediate Post- reported to Certified Athletic Trainer Concussion Assessment and (ATC) complaining of headache and Cognitive Test (ImPACT) which dizziness. He denied any nausea or revealed a statistically significant other symptoms. ATC began side-line deviation from baseline. Athlete examination which consisted of reported daily to ATC for clearing any neck pathologies through monitoring, completion of symptom palpations and evaluations of extremity cards, and updates on his status. The myotomes and dermatomes. In athlete’s symptoms included addition, he was assessed for a dizziness, sensitivity to light, and concussion and vital signs were nausea lasting five days in duration. monitored. Within concussion Athlete continued to be withheld assessment, ATC noted cranial nerve from competition. At the subsequent function WNL, Standardized 2 week follow-up with neurologist, Assessment of Concussion (SAC) test repeat CT Scan revealed that the 21/30, and Balance Error Scoring periventricular hemorrhage had re- System (BESS) revealed balance absorbed and thus cleared to full deficits. Athlete was removed from participation by the neurologist. ATC competition with clinical examination administered follow-up ImPACT test leading to diagnosis of concussion. where athlete was at baseline and per Immediate plan of care was discussed District School policy, athlete was with parent and educational materials allowed to begin four-day describing potential signs and progressive return to play protocol symptoms requiring immediate (RTP) as described in the NATA referral were provided to the parent for position statement on management further monitoring. ATC continued to of concussions. The athlete monitor the athlete for changes in proceeded through the 4 day RTP status throughout the competition. with no complications or During the half-time, athlete reported reoccurrences of signs or symptoms. to ATC and admitted that he had Eighteen days after initial injury the immediately vomited after initial head athlete was cleared by the trauma. With the updated athlete neurologist and RTP protocol. history of vomiting, the ATC, in Uniqueness: Periventricular consultation with his parent, hemorrhages are an extremely immediately referred the athlete to the common type of brain bleeds found ER. Differential Diagnosis: Cervical in pre-term infants. In adults, acute Neck Pathology, Transient Brian periventricular hemorrhages have

S-200 Volume 48 • Number 3 (Supplement) May 2013 13147MOSP been linked to vicious head injuries Establishing 3-Day And 7-Day 15.55 ± 1.33yrs) who were given the such as skull fractures, falling from Symptom Clusters For Hawaii PCSS within 4-7 days (mean days a height, or accelerated backward High School Student Athletes 5.16± 1.31) of injury. Interventions: falls. However, a search of the During The First Week Of A All athletic trainers were required to literature found no cases of Sport-Related Concussion follow a standardized concussion periventricular hemorrhage with an Oshiro JY, Oshiro RS, Uyeno RK, management protocol including post associated athletic concussion. Tamura K, Furutani TM, Wahl TP, injury assessment utilizing ImPACT. Conclusions: This case highlights Kocher MH, Murata NM: The PCSS within the ImPACT were the diagnosis of an athlete with a Department of Kinesiology and extracted. Main Outcome Measures: periventricular hemorrhage resulting Rehabilitation Science, University Exploratory Factor Analysis (EFA) was Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 from a sports-related coup and of Hawaii at Manoa, Honolulu, HI; applied to the PCSS of both groups. counter-coup concussion. This case State of Hawaii Department of Factors were extracted using the is extremely unique due to no similar Education, Honolulu HI; University principal component analysis with documented sport-related cases of Hawaii Honolulu Community orthogonal rotation (Varimax with found through a literature review. College, Honolulu, HI Kaiser normalization). Results: An This case highlights the need for EFA provided two 4-factor structure proper evaluation, recognition of Context: Post concussion symptom models containing cognitive- atypical head injuries, referral, and reports are useful for assessing sport- migraine, emotional, somatic and need for individualized plans of related concussions. The Post- sleep clusters. The factors explained care. The athlete made a full return Concussion Symptom Scale (PCSS) 57.08% of variance for group one and to participation three weeks allows clinicians an objective 66.01% for group two. Conclusions: post injury and has had no measurement of subjective symptoms. The cognitive-migraine cluster further problems or complaints. Previous studies have used the 22-item between the two groups differed in PCSS to group the symptoms into symptoms loading. Group one related factor structures; these studies symptoms included headache, have been limited to specific vomiting, dizziness, fatigue and populations. Objective: The purpose difficulty remembering. Group two of this study was to examine factor symptoms included trouble falling structures of high school athletes’ asleep, sensitivity to light, difficulty symptoms during the acute stage of remembering and feeling mentally sport-related concussions. Design: A foggy. The changes in cognitive- retrospective analysis was conducted migraine cluster during the acute using data from the State of Hawaii phase of a concussion suggest Department of Education’s (DOE) different accommodations should records of Immediate Post- be considered during 0-3 day and 4- Concussion Assessment and Cognitive 7 days. Identifying how symptom Test (ImPACT) from School Years clusters change during the acute 2010-2012. Setting: High school phase of a concussion, will allow athletes participating in interscholastic athletic trainers to make the most athletics were prospectively recruited beneficial accommodation for for the current study. Participants: athletes during the first week of Participants were participating in 11 a sport-related concussion. sports who sustained a concussion were diagnosed, treated, and followed until return to full participation by the high school athletic trainer. Participants where divided into two groups: group one (N=437, males=292, females=145, mean age 15.49 ± 1.33yrs) who were given the PCSS within 3 days (mean days 1.88± 0.91) of injury and group two (N=231, males=139, females=92, mean age

Journal of Athletic Training S-201 13102FOBI 13229FOSP

The Relationship Between appropriate. Results: There was a The Relationship Between Concussion History And significant main effect for all four Coping, Neurocognitive Postural Control Impairments dependent variables. Post-hoc testing Performance, And Concussion Buckley TA, Munkasy BA, Tapia- identified a continuum of Symptoms In High School And Lover TG, Krazeize DA, Ingram performance whereby the controls Collegiate Athletes RL: Georgia Southern University, performed best, the multiple group was Covassin T, Elbin RJ, Crutcher B, Statesboro, GA, and Stetson in the middle, and the acute group Burkhart S, Kontos A: Michigan University, Deland, FL performed worst. The posterior COP State University, East Lansing, MI, displacement during the APA was and UPMC Sports Medicine significant between all three groups Concussion Program, University Context: Impairments in dynamic Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 postural control are a known (6.4+1.1cm, 5.0+1.2cm, and 2.3+1.0 of Pittsburgh School of Medicine, consequence of an acute concussion. cm respectively, p<0.001 for Acute vs Pittsburgh, PA Some evidence suggests that a history Control and Multiple, p=0.002 for of 3 or more concussions predispose Control vs Multiple). The lateral COP Context: The inconsistent an individual to long term neurological displacement during the APA was presentation of concussive symptoms sequela. Objective: The purpose of significant between Acute and Control in conjunction with the uncertainty of this study was to investigate (2.6+1.2 and 6.4+2.2cm, p<0.001) prognosis (i.e., return to play) can impairments in dynamic postural and Acute vs Multiple (5.8+1.2cm, result in a difficult and frustrating time control between individuals following p<0.001), but not different between for the injured athlete. Although an acute concussion and those with a Control and Multiple. Step length was previous researchers have reported that history of at least three concussions. only different between Acute and effective coping efforts are linked to Design: Cross sectional. Setting: Control (0.57+0.09m and 0.71+ improved outcomes following Biomechanics laboratory. Patients or 0.11m, p<0.001). Step velocity musculoskeletal sports injuries, the Other Participants: There were a differed between Control and Acute relationship between coping efforts total of 45 participants divided into (0.75+0.13m/s and 0.56+0.09m/s, and concussion is unclear. Objective: three groups, 15 participants (8 p<0.001) and Control vs Multiple The purpose of the study was to explore Female, Age: 20.4+1.6 years, Height: (0.64+0.08m/s, p=0.021). Con- the relationship of neurocognitive 1.74+0.15m, Weight: 70.6+18.9kg) clusion: These results indicate a performance and symptoms to coping tested within 24 hours of a concussion potential continuum of performance responses at 3 and 8 days post- (Acute), 15 participants (8 Male, Age: whereby acute concussion concussion. Design: Prospective 20.0+1.5 years, Height: 1.78+0.12m, demonstrates the greatest impair- cohort study Setting: This study was Weight: 83.6+23.0kg) with a history ments in postural control. Individuals performed in a controlled laboratory of at least 3 documented concussions with 3 or more concussions and field setting. Patients or Other (Multiple), and 15 healthy student- demonstrated impairments, compared Participants: A total of 104 athletes (8 Female, Age: 19.9+1.3 to healthy controls, in the posterior concussed athletes volunteered to years, Height: 1.75+0.09m, Weight: displacement of the COP and the initial participate in the study (73 males: age 74.2+10.9kg) who denied a step velocity with their results being = 16.26 + 2.07 years, mass = 77.2 + concussion history (Control). similar to what is commonly seen in 16.8 kg, height = 178.4 + 8.15 cm, 31 Interventions: All participants healthy elderly studies. Recent female: age = 16.77 + 2.45 years, completed 5 trials of self-paced cued position and consensus statements mass = 62.03 + 7.82 kg, height = 166.7 gait initiation (GI). Participants began agree there is no magic number linking + 7.57 cm). Interventions: The each trial standing on two forceplates concussions and later-life independent variable in this study was and initiated gait in response to a verbal neurological impairments; however, time (baseline, 3, and 8 days post- cue, stepped onto a third forceplate, these results add to the growing body concussion). Participants completed and continued down a 4.9m walkway. of literature suggesting 3 or more the Immediate Post-concussion Main Outcome Measures: The concussions may be a risk factor. Assessment and Cognitive Test displacement of the center of pressure This study was funded, in part, by a (ImPACT), Post-concussion Symptom (COP), both posterior and lateral, grant from the National Institute of Scale (PCSS), and Brief COPE at during the anticipatory postural Health/Neurological Disorders and baseline; and at 3 and 8 days post- adjustment (APA) phase of GI and the Stroke: 1R15NS070744–01A1. concussion. A series of multiple initial step length and velocity were regressions were performed with each compared between groups with a one- of the three coping response factors way ANOVA and tukey post-hoc when as the outcome variables and the four

S-202 Volume 48 • Number 3 (Supplement) May 2013 13291MOSP neurocognitive composite scores and Gait Stepping Characteristics performed 10 trials of self-selected total symptoms as predictors. A series Are Not Impaired In Individuals paced gait along a 4.9m instrumented of repeated measures (RM) analysis of With Multiple Concussions walkway. The walkway has been covariance (ANCOVA) were Krazeise DA, Munkasy BA, previously established as both valid performed on the Brief COPE Joyner AB, Buckley TA: Stetson and reliable. Main Outcome subscales and three coping response University, DeLand, FL, and Measures: The mean gait velocity, factors. History of concussion was Georgia Southern University, step length, and percentage of the gait used as the covariate for all ANCOVAs. Statesboro, GA cycle in single support were calculated Main Outcome Measures: by the instrumented walkway based on Dependent variables included ImPACT footfall kinematics. Dependent Context: Recent evidence has Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 composite scores (verbal/ visual suggested that a history of multiple variables were compared between memory, reaction time, processing concussions, typically defined as three groups with one-way ANOVAs. speed), PCSS, and Brief Cope or more, may result in long-term Results: There were no between individual and three coping response neurological impairments. The group differences in anthropometric factors (approach, avoidance, social). influence of multiple concussions has characteristics. There were also no RM ANCOVAs with Bonferroni typically been evaluated using differences between Multiple and correction and post-hoc means cognitive or neuropsychological Control groups for gait velocity (1.29 comparisons were performed using testing with limited investigations on + 0.09m/s and 1.31 + 0.09m/s, Tukey’s HSD. Statistical significance postural control in this population. p=0.715), step length (0.67 + 0.03m was set at apior at p<0.05. Results: Further, there have been limited and 0.67 + 0.04m, p=0.982) or the Concussed athletes reported more examinations on otherwise healthy percentage of the gait cycle in single frequent use of self-distraction young adults with a history of multiple support (38.2 + 1.0% and 38.3 + 1.1%, (M=3.34+1.49: 3.16+1.56, p=.046), concussions. Objective: The purpose p=0.977). Conclusion: The results of behavioral disengagement (M=2.29 of this study was to investigate this study suggest that a history of at +.90: 2.14+.51, p=.039), religion kinematic stepping characteristics in least three concussions does not alter (M=2.58+1.38: 2.48+1.27, p= individuals with a self-reported history kinematic stepping characteristics .014), and self-blame (M=2.48+.97: of three or more concussions. We during level over ground gait. While 2.27+.69, p=.001) at 3 days post- hypothesized that individuals with a recent evidence supports some concussion compared to 8 days post- history of multiple concussions would supraspinal control of gait; level over concussion. Concussed athletes demonstrate a conservative gait ground walking is generally reported more use of avoidance strategy evidenced by reductions in considered to be regulated by the coping behavior at 3 days than 8 days gait velocity, step length, and time in central pattern generators located in (F =4.71, p=.032) post-injury. the spinal cord; thus offering a [1, 100] single support. Design: Cross Total symptoms was a significant sectional study. Setting: potential rationale why gait would not (p=.001) predictor of avoidance Biomechanics research laboratory. be adversely influenced by potential coping at 3 days post-concussion and Patients or Other Participants: supraspinal impairments. Further, decreased performance on visual Ten individuals, current or recent these otherwise healthy young adults memory was associated with student-athletes with a history of at may have sufficient compensatory increased avoidance coping (p= .03) least three self-reported mechanisms to adapt to any potential at 8 days post-injury. Conclusion: concussions (6M/4F, age: 20.6 + 1.2 postural challenges. Future studies Time since injury likely plays a years, height: 1.77 + 0.12m, weight: should investigate either greater role between neurocognitive perfor- 83.8 + 23.9kg, 3.5 + 1.0 previous challenges to the postural control mance, symptom reports, and coping. concussions, range: 3 – 6) (Multiple) systems or additional cognitive Clinicians should be aware of were closely matched to 10 current dual task challenges. patients who report higher symptoms student-athletes (6M/4F, age: 20.5 + early in the course of recovery 1.6, height: 1.76 + 0.11m, weight: and have lingering visual memory 83.6 + 23.0 kg) (Control) of the same deficits 1 week post-injury as they may sport with no self-reported history of use more potentially maladaptive concussion or concussion symptoms; avoidance coping following concussion. direct or indirect head impacts associated with loss of consciousness, post-traumatic amnesia, or similar. Interventions: Both groups

Journal of Athletic Training S-203 13302MOSP 13438MOSP

Gait Variability Following A width variability, and step time Health-Related Quality Of Life In Sports-Related Concussion variability. These variables were Pediatric Patients Following Hunter LA, Joyner AB, Munkasy expressed using a coefficient of Mild Traumatic Brain Injury: A BA, Buckley TA: Georgia Southern variation which is (standard deviation/ Systematic Review University, Statesboro, GA mean) *100. Dependent variables of Purdoff MJ, Snyder Valier AR, interest were compared with three 2x2 Valovich McLeod TC: A.T. Still Context: Impaired postural control is (group x day) repeated measures University, Mesa, AZ a cardinal post-concussion symptom. ANOVAs. Results: There was no Traditional clinical measures of post- group by time interaction (p=0.964, Context: Pediatric patients are p=0.779) or main effects for time concussion postural control are static commonly affected by mild traumatic Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 stances; however, some studies have (p=0.757, p=0.226) for step length brain injury (mTBI), with investigated changes in gait stepping gait variability (Concussion baseline: approximately 475,000 children under characteristics. Gait variability is 2.65 + 0.29, post-injury: 2.94 + 0.67; the age of 14 suffering from mTBI potentially a more sensitive measure Control baseline: 2.68 + 0.57, day 1: annually. Studies in adults have of postural control and has 2.98 + 0.37) or step width variability reported that mTBI causes a wide successfully identified impairments in (Concussion baseline: 3.08 + 0.67, variety of changes in health-related populations with central neuro- post-injury: 3.17 + 0.69; Control quality of life (HRQoL), including physiological disorders. Objective: baseline: 2.32 + 0.71, day 1: 2.51 + emotional status, neurobehavioral The purpose of this study was to 0.37). There was no interaction disturbances, and cognitive examine gait variability following a (p=0.824), but there was a main effect impairments. However, it is unclear concussion. We hypothesized that for time (p=0.004) for step time whether the same HRQoL deficits those with concussions would variability (Concussion baseline: 2.65 occur in younger patients and whether demonstrate increased gait variability + 0.29, post-injury: 2.94 + 0.67; any deficits are consistent across compared to healthy subjects. Control baseline: 2.68 + 0.57, day 1: studies among the pediatric Design: Prospective longitudinal. 2.98 + 0.37). Conclusions: The population. Objective: To Setting: Biomechanics laboratory. results of this study suggest that systematically evaluate the evidence Participants: Ten participants (6 athletes suffering from sports-related regarding HRQoL in pediatric patients Female, age: 18.9 + 1.1 years old, concussion do not display altered gait following mTBI. We hypothesized that height: 1.75 + 0.05m, weight: 77.7 + variability compared to healthy following mTBI pediatric patients 18.8kg; 10% LOC rate, 40% PTA rate, controls. This is surprising as previous would demonstrate decreased all Grade II concussions on the Cantu studies have identified differences in HRQoL, specifically in physical, revised grading scale) who suffered stepping characteristics and center of psychosocial, and social domains. sports-related concussions during mass sway, suggesting a conservative Data Sources: A systematic search of intercollegiate athletic participation gait strategy had been adopted. computerized bibliographic databases were matched to ten healthy control Potentially, these results indicate that was performed using PubMed, participants based on gender and otherwise healthy post-concussion CINAHL, ERIC, and OVID. Study height. Interventions: Both groups student-athletes have sufficient Selection: Studies were included if performed 10 trials of self-selected compensatory mechanisms and/or they focused on human subjects, paced gait along a 4.9m instrumented strategies to reduce gait variability. pediatric mTBI patients, measured walkway. The walkway has been Reductions in postural variability have HRQoL or related components of previously established as both valid previously been hypothesized in static HRQoL, included a full abstract, and and reliable. The concussion postural stability studies which utilized were peer reviewed. Keywords used in participants baseline testing was approximate entropy measures. This the search included mTBI, concussion, performed during pre-participation study was funded, in part, by a grant pediatric, child, adolescent, HRQoL, physicals prior to participation in from the National Institute of Health/ quality of life, emotional, intercollegiate athletics and their Neurological Disorders and Stroke: psychosocial, social, cognitive, second testing session was within 24 1R15NS070744–01A1. school, and physical. Search terms hours of suffering a sports-related were combined with the AND Boolean concussion. The control participants term. The link-out feature of PubMed were tested on two separate occasions. was used to search for related articles Main Outcome Measures: The and a hand search of references from dependent variables of interest retrieved articles was performed. Data included step length variability, step Extraction: Each study was

S-204 Volume 48 • Number 3 (Supplement) May 2013 13256MOIN independently evaluated by two The Effects Of Cognitive Fatigue The three trials of each condition of investigators using the STROBE On Balance In A Moderately the SOT were averaged together to Checklist and articles were assessed Active Population create one score for each of the six for relevance, completeness of Sheaffer AE, Greenwood LD, conditions. Reaction time, movement information, and methodological Boucher TM: Baylor University, velocity, and directional control from quality. Data extracted included the Waco, TX, and Texas A&M the LOS, the averages of the six number of patients, age, length of time University, College Station, TX conditions of the SOT, and the post-mTBI, outcomes instrument cognitive fatigue surveys were used, subscales of outcomes Context: Balance is an integral part measured and compared. Results: A instrument, inclusion of a control significant difference was found of activity and plays a key role in injury Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 group, and HRQoL outcomes. Data prevention. Because student-athletes between control and cognitive fatigue Synthesis: 582 studies were found are expected to meet certain academic conditions in the LOS test with 33 studies relevant to the standards while also excelling in their measurement for reaction time in inclusion criteria and included in the respective sports, it is necessary to condition three; right forward (pre- review. These studies used 88 different determine if they are at greater risk control: .69 ± .15 s; post-control: .78 outcomes instruments. Four studies for balance disturbances due to ± .23 s; pre-fatigue: .8 ± .25 s; post- evaluated symptoms and found cognitive fatigue. Objective: To fatigue: .94 ± .32 s; p = .033) and in headache as the most commonly discover the relationship between the LOS test measurement for reported symptom. Two studies cognitive fatigue and balance. Design: movement velocity in condition two; evaluated sleep-related HRQoL, with Randomized Controlled Trial with right forward diagonal (pre control: sleep problems occurring more often Crossover Study Design. Setting: 7.83 ± 1.67 m/s; post-control: 7.34 ± in the first 6 months following injury. University Laboratory. Patients or 2.37 m/s; pre-fatigue: 6.71 ± 2.54 m/ Behavior was evaluated in 20 studies, Other Participants: Eighteen s; post-fatigue: 5.79 ± 2.21 m/s; p = with 5 studies reporting worsening healthy, college-aged students (5 men, .044). There were no significant behavior in mTBI patients and the other 13 women; age = 20.94 ± 2.07 years; differences found between conditions 15 finding no differences in behavior height = 170.60 ± 11.17 cm; mass = for the SOT (p e•.05). All questions of when compared to a control group. 63.84 ± 11.85 kg). Interventions: the cognitive fatigue survey were Studies evaluating interactions with Cognitive fatigue and measures of analyzed and 13 had significant family and friends reported no issues balance were assessed before and after differences between conditions with reintegration into these social both a cognitive fatigue task and indicating increased cognitive fatigue environments. Conclusions: Results control task completed two to four (p d•.05). Conclusions: Reduction in indicate that mTBI may impact HRQoL days apart. The cognitive fatigue task static balance performance on certain in pediatric patients, with lingering consisted of two hours of the Paced measurements was demonstrated with symptoms and behavioral problems Auditory Serial Addition Test (PASAT), cognitive fatigue. Further research is most commonly reported. However, and the control task consisted of needed to determine if cognitive the variety of outcomes measures watching a two-hour PBS documentary fatigue has an affect on dynamic used, varied age groups assessed, and on train travel. Main Outcome balance or balance in other populations inconsistent follow-up time points Measures: A 2 (treatment groups) x 2 such as highly trained athletes. make it difficult to determine the (time: pretest, posttest) repeated exact nature and extent of HRQoL measures ANOVA was used to deficits in this population. Future determine if there were any studies are needed to evaluate the most differences between all pre-task and meaningful of current outcome tools post-task balance assessments and and to recommend a specific tool that cognitive fatigue surveys. Measures of should be used when evaluating the balance data were collected on the HRQoL of concussed adolescents. NeuroCom Smart Equitest System® using the Limits of Stability Test (LOS) and Sensory Organization Test (SOT). Cognitive fatigue was assessed using the Fatigue Assessment Scale (10 questions) and the Multidimensional Fatigue Symptom Inventory-Short Form (30 questions).

Journal of Athletic Training S-205 Free13161DC Communications, Poster Presentations: Ankle Instability

Examining Morphological instructed to reduce activity to allow return the athlete back to sport as Changes Of The Anterior more time for healing. The athlete efficiently as possible. In this case, Talofibular Ligament In A returned to sport-specific activities 3 even with 3 months of rest from sport- Female Collegiate Volleyball months post-injury. With continuing specific activities, the athlete still Player Following A Severe rehabilitation and taping of the ankle, currently complains of substantial Lateral Ankle Sprain the athlete has returned to full residual symptoms. In severe ankle Liu K, Butterworth C, Gustavsen participation but still complains of sprains such as this case, G, Kaminski TW: University of pain, instability, and weakness. understanding the healing process of Delaware, Newark, DE, and Uniqueness: Musculoskeletal the ligaments of the ankle through

University of Evansville, ultrasound (MSUS) images of the MSUS may assist in the progression Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Evansville, IN athlete’s ATFL were obtained pre and of rehabilitation to prevent further post injury. During preseason damage or residual symptoms that may Background: This case involves a 20 screening, a MSUS image was occur after the initial injury. year-old female collegiate volleyball acquired prior to injury. After the player withno prior history of an ankle injury, MSUS images were taken 6 sprain. The athlete jumped up at the net days, 1 month, 3 months, and 7 months to block a spike,landed on the foot of post-injury. These images were used the opposing player, and collapsed to to track the healing process of the the ground. She complainedof pain (8/ ligament after a complete tear to the 10), immediate swelling, and needed ATFL. Prior to injury, the MSUS image to be assisted off the court. of the ATFL showed a clean, paralleled Uponinspection, the athletic trainer fibrous nature of the ligament. The determined a positive anterior drawer MSUS image 6 days post-injury and talar tilt test.Range of motion and revealed large pockets of edema strength test were not conducted due around the ankle joint and a detached to pain. Differential Diagnosis: ATFL. The MSUS image 1 month post- Anterior talofibular ligament (ATFL) injury still presented with edema in the sprain, calcaneofibular ligament area and a detached ATFL, though parts sprain,distal tibia-fibula fracture, high of the ATFL can now be seen in the ankle sprain, metatarsal sprain. image. The MSUS image 3 months Treatment: The athlete’sankle was post-injury displayed the form of the immediately iced, wrapped, and ATFL but a gap within the ligament elevated. The athlete’s ankle was indicated that complete healing had not tapedovernight with a horseshoe and occurred yet. Despite the expected given a walking boot and crutches with healing time of the ATFL, the MSUS an initial noweight bearing status. Due image 7 months post-injury still to the severity of the swelling and exhibited abnormalities in the ecchymosis, an MRI wasordered, ligament. Conclusions: Though the revealing a complete tear of the ATFL, injury presented in this clinical case sprained calcaneofibular ligament, doesn’t involve a unique injury, the bonebruise on the medial neck of talus, distinctive nature of this study involves strain of peroneus longus, and a small visual images of the healing process split tear ofthe peroneus brevis. Twelve of the ATFL through ultrasound days post-injury, the athlete was imaging techniques. Since MRI’s are transitioned from thewalking boot to expensive with particular an Aircast. Twenty days post-injury, the contraindications, they are not athlete was transitioned out ofthe normally ordered for ankle sprains. Aircast to full weight bearing status. MSUS, which is much safer and cost- The athlete was released to jog 1 month effective, can provide quality images postinjury. The athlete sought out a that can identify a torn ATFL. One of foot and ankle specialist and was the roles of an athletic trainer is to

S-206 Volume 48 • Number 3 (Supplement) May 2013 13044FOMU 13395FOMU

Relationship Between Weight until they could no longer maintain Weight-Bearing Dorsiflexion Bearing Lunge And Non-Weight contact with the anterior knee or the Restrictions Are Present On Bearing Dorsiflexion Range Of heel. Once the maximal distance (cm) The Self-Reported Worse Limb Motion Measures was obtained, a measure of distance In Those With Chronic Ankle Hankemeier DA, Thrasher AB: from the wall was collected. Measures Instability Ball State University, Muncie, IN were taken bilaterally on all McKeon PO, Wikstrom EA: participants and all ROM measures University of Kentucky, Context: The weight bearing lunge were counterbalanced to improve Lexington, KY, and University of (WBL) is a reliable method of internal validity. Main Outcome North Carolina at Charlotte, NC assessing dorsiflexion range of motion Measures: Pearson correlation

(ROM) in a more functional position coefficient (r) (d”.05) was used to Context: Chronic ankle instability Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 than traditional open kinetic chain determine the relationship between (CAI) is a self-reported condition in methods. While the WBL is more measures. Means and standard which those who sustain an ankle functional, little research has been deviations were used to report sprain go on to have residual conducted to determine the normative data. Results: A moderate symptoms and episodes of giving way. relationship between the WBL and the positive correlation was shown One of the potential contributing long-sit (LS) or short-sit (SS) between the WBL and LS on both the factors to CAI is a dorsiflexion range measures of dorsiflexion ROM. right (r=.671,P<.001) and left of motion (DFROM) restriction. It is Objective: To determine the (r=.643,P<.001) limbs. The SS and currently unclear whether DFROM relationship between WBL and non- WBL measures also demonstrated a restrictions contribute to self- weight bearing SS and LS dorsiflexion moderate positive correlation for the reported functional limitations ROM measures while establishing right (r=.722,P<.001) and left associated with CAI. Objective: To normative values for the WBL measure (r=.690,P<.001) limbs. WBL mean determine whether dorsiflexion is in a young adult population. Design: values reported for males (right reduced in the self-reported worse Descriptive cohort study. Setting: =10.91±4.10 cm, left=11.10±4.31 limb relative to the self-reported better Research laboratory. Patients or cm) and females (right=11.35±2.89 limb in subjects with CAI. Design: Other Participants: 107 healthy cm, left=11.40±3.6 cm). Cross-sectional study. Setting: college-aged participants (57 females, Conclusions: While the WBL has Laboratory. Participants: 41 50 males; 20.52±1.92 years; gained popularity, the relationship participants with self-reported CAI 172.10±1.46 cm; 72.52±15.99 kg) between the WBL and the goniometric (18 males, 23 females; age: 23.7±5.1 free of current ankle or lower measures of ROM are not strong yrs; height: 1.7±0.9 m; mass: extremity injuries volunteered for this enough to use these methods 75.9±15.4 kg) participated. All study. Interventions: An experienced interchangeably. The WBL could be subjects had a history of at least 1 examiner performed the assessment on used to assess a patients’ functional ankle sprain with current symptoms of each participant in a single session. dorsiflexion ROM more effectively CAI on at least 1 side including Dorsiflexion ROM was measured in unless weight bearing is contra- recurrent episodes of giving way at the two different positions (LS and SS) indicated. Normative values for the ankle. Interventions: Each with a long axis goniometer. For both WBL can be used as a reference for participant self-identified which ankle measures, the examiner placed the clinicians as they implement the WBL was considered to be the more participant in 90° of dorsiflexion with with a collegiate population. functionally limited by using the Ankle the goniometer fulcrum on the lateral Instability Instrument (AII). A score malleolus and aligned the arms with the of e”5 on the AII was considered as an fibular head and parallel to the 5th ankle with CAI. All subjects also metatarsal. The WBL was assessed by completed the Foot and Ankle Ability asking the participant to stand facing a Measure (FAAM) Activities of Daily wall with the great toe on a tape Living (ADL) and FAAM Sport scales measure six inches from the wall. for the right and left ankles. These Participants then lunged forward in an scales provide information about a attempt to touch the anterior aspect of participant’s perception of disability, their knee to the wall while keeping associated with ADL and sport their heel in full contact with the activities respectively within the past ground. Participants continued to week due to their ankle instability. The move their foot away from the wall weight-bearing lunge test (WBLT) was

Journal of Athletic Training S-207 13450FOGA used to measure DFROM. Subjects Subjects With Chronic Ankle gait cycle was normalized to 100 performed 3 trials of the WBLT in Instability Present With Altered increments. Sagittal and frontal plane which they kept their test heel firmly Proximal Kinematics During knee and hip angles were calculated at planted on the floor while they flexed Shod Gait On A Treadmill each increment. Group means and their knee to the wall. Maximum Chinn L, Dicharry J, Hart J, associated 90% confidence intervals dorsiflexion was defined as the Saliba S, Wilder R, Hertel J: (CIs) were calculated in each plane distance from the great toe to the wall Kent State University, Kent, OH; across the entire gait cycle. To based on the furthest distance the foot Rebound Physical Therapy, identify significant differences, was able to be placed without the heel Bend, OR; University of Virginia, increments where the CI bands for the lifting. Main Outcome Measures: Charlottesville, VA two groups did not cross each other Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 The independent variable was side were identified. Mean differences and (self-reported worse vs. self-reported Context: Ankle kinematic differences standard deviations were calculated for better). The dependent variables were have been found between individuals increments in which the CI bands did the FAAM-ADL (%), FAAM-Sport with chronic ankle instability (CAI) not cross. Main Outcome Measures: (%), and the mean WBLT distance compared to healthy controls. Sagittal and frontal kinematics at the (cm). Paired t-tests were used to However, there is limited research knee and hip were measured compare the dependent variables comparing more proximal joint throughout the entire gait cycle. between sides. Alpha was set a priori kinematics. Because distal kinematic Results: During shod walking, at p<0.05. Results: The self-reported differences between groups have been individuals with CAI presented with worse ankles had higher AII scores identified, it is important to evaluate less knee flexion compared to healthy (6.7±1.2) compared to the self- kinematics up the kinetic change to controls (mean difference = reported better ankles (2.9±2.75, potentially elucidate adaptations made 3.32±0.06°) from mid-stance to toe p<0.001). There were significant by individuals with CAI. Objective: To off (49-54% of gait cycle).While deficits in the FAAM-ADL and FAAM- determine if there are knee or hip jogging, the CAI group presented with Sport when comparing the self- kinematic differences, in the sagittal more hip flexion (mean difference = reported worse (FAAM-ADL: and frontal planes, in subjects with CAI 6.34±0.27°) from loading to toe off 80.0±11.7%; FAAM-Sport: 64.9± compared to controls while walking (12-34% of gait cycle) and more knee 13.3%) to the self-reported better side and jogging on a treadmill in shoes. flexion than controls (mean (FAAM-ADL: 93.4±11.2%, p<0.001; Design: Descriptive laboratory study difference 7.52±1.36°) during swing FAAM-Sport: 86.7±17.5%, p<0.001). Setting: Motion analysis laboratory (77-91% of gait cycle). No frontal The self-reported worse ankle Patient or Participants: Twenty- plane differences were noted at either (9.2±3.9 cm) also had significant seven subjects with self-reported CAI joint at either speed. Conclusions: DFROM deficits compared to the self- (9 males, 18 females; age = 24.56 Proximal kinematic alterations from reported better ankle (10.9±4.03 cm, ±5.37 years; mass = 71.44±11.93kgs; mid-stance to toe off as well as during p=0.002). Conclusion: Significant height = 170.93±8.37m; Foot and swing varied between individuals with functional limitations associated with Ankle Ability (FAAM) score = and without CAI. These changes may ADL and sport activities on the self- 89.8±8.1; FAAM-Sport score = help explain the perceptions of reported worse side were found in 73.1±12.9; number of previous sprains instability and the recurrent sprains conjunction with significant DFROM = 4.89±3.20), and 27 healthy controls that occur in individuals with CAI. deficits on the worse side. These (11 males, 16 females; age = 22.56 findings indicate that DFROM ±3.49 years; mass = 65.80±13.72kgs; restrictions potentially contribute to height = 167.51±15.44m; FAAM score functional limitations in ADL and sport = 100.0±0.0; FAAM-Sport score = activities in those with CAI. 100.0±0.0) participated. . Inter- ventions: Subjects walked (speed =1.34 m/s) and jogged (speed=2.68 m/ s) on a treadmill with embedded force plates while a 12-camera motion analysis system captured 3-D lower extremity kinematics. One 15-second period of gait (average walking strides=10; average jogging strides=20) was captured at each speed for analysis. Each stride of the

S-208 Volume 48 • Number 3 (Supplement) May 2013 13194MONE 13095DOBI

Balance Training Changes activity levels across the study period. Preparatory Movement Patterns Center Of Pressure Location Main Outcome Measures: All During A Laboratory Recorded During Unipedal Standing In subjects performed three successful Ankle Sprain Subjects With Chronic Ankle 10-second single limb balancing trials Terada M, Thomas AC, Instability on a force plate with eyes open and Pietrosimone BG, Gribble PA: Mettler A, Chinn L, McKeon PO, closed before and following the 4 University of Toledo, Toledo, OH Saliba S, Hertel J: University of week intervention. COP data was Virginia, Charlottesville VA; Kent collected at 50 Hz resulting in 500 data Context: Establishing the injury State University, Kent OH; points in each trial. Each subject’s foot mechanisms of recurrent ankle sprains University of Kentucky, Lexington, was modeled as a rectangle into four is a critical step in developing Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 KY quadrants. Additionally, the foot was preventative interventions. In the also divided into anterior and posterior research laboratory, it is unethical to Context: Individuals with chronic halves and medial and lateral halves. produce an injury for the examination ankle instability (CAI) demonstrate The frequency of COP data point of biomechanics during a real altered postural control and utilize a location in each region was recorded recurrent ankle sprain. However, we more anterolateral center of pressure across the length of each trial and observed an accidental acute ankle (COP) location during unipedal quiet served as the dependent variable. The sprain in a participant with chronic standing compared to healthy independent variables were group ankle instability (CAI) during individuals. Postural control can be (balance training, control) and time biomechanical testing in an ongoing improved after balance training, but the (pre, post). For each region, separate research study. Altered feed-forward mechanism of this improvement is 2x2 ANOVAS with repeated measures sensorimotor control has been unknown. Changes in the spatial were computed for eyes open and eyes suggested as a consequence of CAI. A location of COP location following closed data. Alpha was set a priori at more definitive description of feed- balance training are a potential p<0.05. Results: Changes in COP forward movement patterns of an mechanism of improved postural location following balance training actual ankle sprain case would improve control. Objective: To determine if a were seen in the anterior-posterior the understanding of recurrent ankle 4-week balance training program direction, but not in the medial-lateral injury mechanisms and may contribute changes the location of COP during direction. After the intervention, COP to the development of prevention unipedal stance in subjects with CAI. location in the balance training group strategies for recurrent ankle sprains. Design: Randomized control trial. shifted from a more anterior to less Objective: Present preparatory Setting: Laboratory. Patients or anterior in both eyes open movement patterns of an acute ankle Other Participants: 31 individuals (pre=319.1±165.4, post= 160.5± sprain during a stop-jump task. with self-reported CAI were randomly 149.5; p=.004) and eyes closed trials Design: Single-subject descriptive assigned to a balance training group (6 (pre=387.9±123.8, post= 189.4± laboratory. Setting: Research males, 10 females; age=22.2±4.5 102.9; p<.001) while the non-balance laboratory. Patients or Other years; height=168.9±7.7cm; mass= training group did not shift Participants: A recreationally active 63.0±8.1kg; previous sprains = substantially in the eyes open male (180.34cm, 79.45kg, 20yrs) with 6.3±7.1; Foot and Ankle Disability (pre=214.1±193.3, unilateral CAI [Foot and Ankle (FADI)=85.5 ± 8.4%; FADI-Sport= post=230.0±176.3) or eyes closed Disability Index (FADI)=28.85%, 69.9±12.1%) or a control group (6 trials (pre=326.9±134.3, post= FADI sports=15.63%] volunteered for males, 9 females; age=19.6±1.3 years; 338.2±126.1). Conclusions: The an IRB-approved case-control study height=173.3±9.8cm; balance training program resulted in a investigating the effect of CAI on the mass=67.7±13.7 kg; previous COP location shifted from a more location of center of mass (COM) sprains=4.6± 2.5; FADI=82.9 ± 7.4%; anterolateral position to a more during a bilateral stop-jump task. FADI-Sport=66.5±9.8%). posterolateral one which more closely Interventions: The participant Interventions: The balance training resembles healthy subjects. This may experienced a mild recurrent right group performed a 4-week supervised be due to behavioral changes as a result ankle sprain during the third of five balance program that was progressed of a more optimally functioning and trials of the stop-jump task. in an individualized manner. Exercises less constrained sensorimotor system. Kinematics and kinetics were recorded included static and dynamic single with a motion capture system limb balancing tasks. The control group interfaced with two force platforms. did not perform any balance training Main Outcomes: The location of and was asked to maintain their normal COM and sagittal-and frontal-plane

Journal of Athletic Training S-209 13079MOBI kinematics for the knee and ankle joint Functional Performance Tests limb. The average SEBT reach distance were calculated during a preparatory In A Recreationally Active of 3 trials was normalized to % leg phase that was defined as the time Population With Chronic Ankle length, with higher % indicating better interval of 200ms before initial Instability And A Healthy Control function. Both SLHT and TIB were contact with the force platforms. The Group reported as time in seconds, and the injury trial was compared with the Ko JP, Rosen AB, Brown CN: average of 2 trials and 3 trials, ensemble average of the two non- University of Georgia, Athens, GA respectively, were calculated. Shorter injury trials performed by this times indicated better performance. participant. Due to the nature of the Context: Functional performance Group means were compared via observed data from a single trial from independent samples T-tests. Results: deficits may be present in a population Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 a single participant, data are presented with chronic ankle instability (CAI). The CAI group had CAIT scores of without statistical comparisons. However, few clinical tools have been 20.84 ± 4.45, while the control group Results: During the injury trial, there able to differentiate between had 29.72 ± 0.54. SEBT reach distance was greater average ankle plantar performance ability in a CAI and was significantly different between flexion (18.1°), ankle inversion uninjured population. Objective: To control (93.67 ± 10.15%) and CAI (9.4°), and knee adduction (4.1°), as determine if there are differences in groups (85.30 ± 7.54%) (p=0.002). well as less knee flexion (22.9°) functional performance between a CAI SLHT was also significantly different during the 200ms preparatory phase and control group in a recreationally between control (15.32 ± 5.01sec) and compared to mean values from the active population. Design: Cross- CAI groups (18.64 ± 5.57sec) 200ms preparatory phase of the sectional. Setting: Biomechanics (p=0.031). TIB was not significantly ensemble curves of the two non-injury Laboratory. Patients or Other different between control (44.46 ± trials (plantar flexion=7.5°, Participants: Fifty volunteers were 14.42sec) and CAI groups (41.02 ± inversion=0.01°, knee adduction= divided into two groups of 25 each. 14.22sec) (p=0.40). Conclusions: 1.1°, knee flexion=25.5°). In the injury The CAI group (6 male, 19 female; These results suggest that participants trial, COM was located 2cm higher age=20.60 ± 1.47yrs; height=166.22 with greater perceived instability (1.35m) and shifted 4 cm more ± 8.52cm; mass=67.33 ± 11.93kg) had in their ankle (lower CAIT scores) contralaterally (0.61m) toward the at least 1 moderate-severe ankle also tended to exhibit performance non-involved side during the sprain, 2 episodes of giving way at the deficits on the SEBT and SLHT when preparatory phase compared to the ankle and a Cumberland Ankle compared to healthy controls. non-injury trials (height=1.33m, Instability Tool (CAIT) score d”26 Conversely, there was no significant side=0.57m). Conclusion: We indicating poor function. The control difference between groups on TIB. observed differences in preparatory group (11 Male, 14 female; age=20.16 The SEBT and SLHT may provide movement patterns at the knee and ± 1.25yrs; height=167.47 ± 8.94cm; clinicians cost and time-effective ankle during a trial in which a recurrent mass=65.22 ± 11.67kg) had no history clinical tools for screening ankle injury occurred. These data may of ankle injury and a CAIT score e”28 and rehabilitation purposes. contribute to understanding the injury indicating good function. mechanisms of recurrent ankle sprains Interventions: In a single testing and provide an insight into how to session participants completed the develop more effective preventative CAIT questionnaire and performed the interventions for recurrent ankle sprains. Star Excursion Balance Test (SEBT) in the posteromedial direction, Single Leg Hop Test (SLHT), and Time in Balance Test (TIB) in a randomized order. The SLHT and TIB were videotaped. After testing, a single rater, with reliability > 0.80, watched the video and recorded the time to complete SLHT and the length of time the participant maintained the testing position for TIB. Independent sample T-tests were performed with ˜<0.05. Main Outcome Measures: CAIT scores were calculated for the test

S-210 Volume 48 • Number 3 (Supplement) May 2013 13423MONE 13327DOBI

Plantar Cutaneous Sensory held in place for 1-2 seconds. Based Does Previous History Of Ankle Deficits Are Present In Those on the perceptual response of the Sprain Alter Muscle Strength With Chronic Ankle Instability participant, a heavier or lighter weight And Hip Kinematics During A Powell MR, Houston MN, Powden SWM was presented for the Jump-Landing Task In An CJ, Hoch MC: Old Dominion subsequent stimulus. An adapted Adolescent Population University, Norfolk, VA staircase algorithm was used to Martinez JC, Kerner M, determine the lightest weight SWM Crowley E, Matteau E, Trojian Context: Sensory deficits have been which could be identified, representing TH, DiStefano LJ: University identified on the plantar aspect of the the detection threshold. SWM of Connecticut, Storrs, CT detection thresholds are reported as an foot in individuals with chronic ankle Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 instability (CAI). While these deficits index value ranging from 1.65-6.65. Context: Ankle sprains are among the have been identified using custom- Main Outcome Measures: The most common injuries sustained in an designed laboratory instruments, it is dependent variables were the SWM active population. Previous research unclear if plantar cutaneous detection threshold at each site (1st- has identified an association between somatosensory alterations can be met, 5th-met, and heel), while the previous history of an ankle sprain and detected using common clinical independent variable was group (CAI, hip abductor weakness. It is not known techniques for assessing sensation healthy). Detection thresholds if this weakness affects movement such as Semmes-Weinstein associated with greater SWM weights patterns in adolescents with a history Monofilaments (SWM) in these represented lesser sensitivity, while of ankle sprain. Objective: To identify individuals. Objective: To compare lower SWM weights represented if differences in hip kinematics during plantar cutaneous detection thresholds greater sensitivity. Separate Mann- a jump-landing task and hip muscular between individuals with and without Whitney U tests were used to examine strength are present in adolescents CAI using SWM. Design: Case-control group differences for each site. with a history of ankle sprain and their study. Setting: Laboratory. Patients or Descriptive statistics were reported as non-injured peers. Design: Cohort Other Participants: Ten participants mean±standard deviation. Alpha level study Setting: High School Setting with CAI (2 males, 8 females, was set a priori at p<0.05 for all Patients or Other Participants: 61 age=22.4±2.7 years, height= analyses. Results: Significant healthy, active local high school 171.6±10.1cm, mass=71.4±13.2kg, differences were identified between students (32 males, 29 females, Age: Foot and Ankle Ability Measure- groups for detection thresholds at 15.98+1.35years; Mass: 63.45+ Sport=75.93±19.6%) were gender and the1st-met (CAI=4.19±0.44, Healthy 11.77kg; Height: 170.52+10.0cm) side matched to ten healthy =3.57±0.46; p=0.01), the 5th-met were placed in either the uninjured participants (age=22.4±1.7 years, (CAI=4.31±0.26, Healthy= 3.73± (UNI) group (n=48) or injured (INJ) height=166.9±9.3cm, 0.40; p<0.001), and the heel group (n=13) based on previous mass=65.9±13.6kg, Foot and Ankle (CAI=4.52±0.30, Healthy=4.10±0.27; history of an ankle sprain. Ability Measure-Sport=100.0±0.0%). p=0.009). Conclusions: The main Interventions: Subject’s isometric Participants in the CAI group reported finding of this study is that those with strength of the hip musculature was at least one ankle sprain, two episodes CAI have decreased cutaneous assessed using a handheld dynamotor. of giving way in the past three months, sensation at the1st-met, 5th-met and Each strength test utilized two trials and answered “yes” to at least five heel compared to healthy individuals and all strength data were normalized items on the Ankle Instability when examined with clinical measures to body mass. Subjects completed Instrument. Interventions: Each of sensation. These somatosensory three trials of a jump-landing task participant reported to the laboratory deficits may be related to where they were asked to jump forward on a single occasion. Three sites on sensorimotor alterations demon- from a 30-cm high box a distance of the foot sole were assessed in a strated by those with CAI such as half their body height. The trials were counterbalanced order including the deviations in gait and postural control. recorded using an electromagnetic head of the first metatarsal (1st-met), Plantar cutaneous sensation should be motion analysis system. Main the base of the fifth metatarsal (5th- a consideration in the rehabilitation Outcome Measures: Normalized met), and the center of the heel. strategy for patients with CAI. peak isometric strength of the hip Cutaneous sensation of the foot sole extensors, hip abductors, hip internal was assessed using a 20-pen SWM kit. rotators, and hip external rotators were SWM were applied perpendicular to measured. Three-dimensional hip the skin, pressed until the kinematics at initial ground contact and monofilament formed a ‘C’ shape, and peak angles (normalized to

Journal of Athletic Training S-211 13238DONE bodyweight and height) were Noise-Enhanced Center Of posterior tibialis, and gastrocnemius calculated using the average of the Pressure Complexity In muscles of the leg with CAI or a three trials. Independent t-tests were Individuals With Chronic Ankle matched test leg. Testing order was a used to compare kinematic and hip Instability block randomized design. Main strength measurements between the Glass SM, Rhea CK, Arnold BL, Outcome Measures: Sample Entropy UNI and INJ groups (d”.05) Results: Ross SE: University of North (SampEn) of the Anterior/Posterior The only significant difference Carolina at Greensboro, (AP) and Medial/Lateral (ML) COP between INJ and UNI hip kinematics Greensboro, NC, and Virginia displacement time series (unitless). was hip adduction at initial contact Commonwealth University, Lower values indicate more (p=. 049; INJ= -18.73+7.24; UNI= Richmond, VA constrained balance. Planned Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 -13.95+7.71). This indicates that INJ comparisons were performed with landed in significantly more hip Context: Chronic Ankle Instability one-tailed independent t-tests for: (1) abduction at initial contact than UNI. (CAI) has been shown to impair group differences during SRSoff and (2)

Although it was not significant there balance in single-leg, but not double- CAI SRSon versus No CAI SRSoff (alpha was a trend for INJ to have higher leg, quiet stance. However, nonlinear level=0.05). Results: During SRSoff, peak hip adduction (p=.051; INJ= measures of center-of-pressure (CoP) AP SampEn was significantly lower in -9.21+ 8.98; UNI=-3.94+8.24) signal complexity may be sensitive for the CAI group (CAI=0.51±0.08, No indicating that INJ go through more detecting bipedal impairments. CAI group 0.58±0.09; t(28)=-2.09, hip abduction throughout the Furthermore, if bipedal balance P=0.02). AP SampEn (0.53±0.13) in jump-landing task. There were no deficits exist, then a therapy such as the CAI group during the SRSon other significant differences found stochastic resonance stimulation condition was not different than AP for hip strength measurements of (SRS) may enhance balance by making SampEn of the No CAI group during the UNI and INJ groups. postural control less constrained. the SRSoff condition (t(28)=1.21, Conclusions: Although we did not Objective: (1) Examine CoP P=0.12). No significant differences find a significant difference in hip complexity to determine if CAI were observed in the planned abductor strength it is still important influences balance in double-leg quiet comparisons for the ML SampEn to note that a difference was stance (group effect) and (2) data (P>0.05). Conclusions: The observed in the movement pattern determine whether SRS influences present findings suggest that of adolescents with a history of CoP complexity in CAI subjects SampEn may be used to identify an ankle sprain. Further research (condition effect). Design: A cross- differences in bipedal CoP should be conducted to identify over design with two groups (CAI and complexity between CAI and No potential contributing factors to No CAI) and two treatments (SRS , CAI groups. Lower SampEn values this change in movement pattern. on in the CAI group indicate a loss SRSoff). Setting: Research Laboratory. As a result, clinicians should assess Patients or Other Participants: of complexity and suggest that and address any changes in frontal Fifteen subjects presenting with CAI postural control in this group is plane hip motion when treating (171.7±8.2 cm, 66.5±10.5 kg, overly constrained and less adaptive. patients with ankle sprains. 22.7±2.6 yrs) and fifteen healthy CoP dynamics in the CAI group

subjects without CAI (169.6±7.7 cm, during SRSon were no different than

63.8±11.1 kg, 23.1±3.8 yrs). Inclusion in the No CAI group during SRSoff, criteria for the CAI group included which may reflect the relaxation of feelings of “giving way” at the ankle system constraints with SRS (0.57±0.54 “give-ways” per week) and treatment. Future research should be repeated sprains during activity directed at identifying these (3.2±2.5 sprains per subject). constraints and the mechanisms by Interventions: Quiet double leg which SRS may reduce them. stance trials without vision or shoes were collected on a force plate at 50 Hz for 20 seconds in a control

condition (SRSoff) and an optimal SRS

intensity condition (SRSon). The SRS signal was applied through vibrating tactors placed on the skin over the peroneus longus, anterior and

S-212 Volume 48 • Number 3 (Supplement) May 2013 13213FONE 13198MONE

Ankle Copers Demonstrate 2400Hz. Main Outcome Altered Ankle Kinematics During Altered Muscle Activation Measures: Mean EMG (%MVC) Gait Following Prolonged Strategies For Maintaining was calculated for 250ms prior to Exercise In Subjects With Joint Stiffness (PRE), 250ms following (POST-1), Chronic Ankle Instability Swanik CB, Needle AR: University and 250-500ms following (POST-2) Podell JT, Chinn L, Hart JM, Hertel of Delaware, Newark, DE the perturbation. Differences J: University of Virginia, between groups were tested with a Charlottesville, VA, and Kent State Context: The prevention of repeated-measures ANOVA with 2 University, Kent, OH ligamentous injury is dependent on the within-subjects factors (Time, 3 levels; Muscle, 3 levels) and 1 ability to regulate joint stiffness by Context: Kinematic differences in Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 preparing for and responding to between-subject factor (Group, 3 gait have been shown between potentially harmful loads. While levels). Results: A significant Time individuals with chronic ankle studies have identified changes in joint by Group interaction effect instability (CAI) and healthy controls. stiffness and laxity in patients with (F4,94=3.78, p=0.007) was Specifically, individuals with CAI tend recurrent instability versus those observed. No other group effect was to be more plantar flexed and inverted without symptoms (copers); no significant. Pairwise comparisons before, at, and post initial contact. studies have investigated revealed the pooled average of However, it is unknown if these neuromuscular factors that may muscle activity was lowest in the kinematic differences are exacerbated regulate joint stiffness among this coper group following the after exercise, which may increase subset of patients. Objective: To perturbation (POST-1: COP= 0.11± sports-related re-injury risk. investigate muscle activation 0.02, CON=0.14±0.02, UNS= Objective: To compare ankle strategies from the lower leg during 0.16±0.02; POST-2: COP=0.10± kinematics during walking and jogging an ankle perturbation between 0.02,CON=0.13±0.02, UNS=0.16 on a treadmill between subjects with patients with ankle instability, ±0.02). Conclusions: Previous data CAI and healthy controls following a healthy controls, and copers. has suggested that ankle copers may prolonged period of exercise. Design: Design: Post-test only with control have a higher degree of joint stiffness Descriptive laboratory study. Setting: group. Setting: Biomechanics measured both passively and Motion analysis laboratory. Patients laboratory. Patients or Other reactively. Our data suggests that or Other Participants: 15 physically Participants: Fifty-eight subjects copers may be able to achieve this active young adults with self-reported (22.6±3.3yrs; 171.0±9.7cm; optimal joint stiffness regulation by CAI (5 male, 10 female; age= 71.8±18.0kg) were stratified using using a decreased amount of overall 23.6±4.2years; height=171.8±9.9 cm; the Cumberland Ankle Instability muscle activity. Further analysis may mass=72.9±12.6 kg; Foot and Ankle Tool into healthy control (CON, reveal more complex selective Ability Measure (FAAM)=86.9±8.2%; n=19), functionally unstable (UNS, recruitment and/or coactivation FAAM-Sport (FAAMS)=69.6±9.6%) n=19), and coper (COP, n=20) strategies to explain this and 15 healthy controls (5 male, 10 groups. Interventions: Subjects phenomenon. This highlights a female; age=21.8±1.8 years; height were tested on a custom-built potential adaptation following injury =166.1±8.1cm; mass=64.1±11.8kg; stiffness device with the hip and knee that may prevent subsequent FAAM=100.0 ± 0.0%; FAAMS= flexed and the ankle secured to a foot instability, and future research may 100.0±0.0%) participated. Inter- plate. Surface electromyography attempt to identify interventions that ventions: Subjects walked (3.0mph) (EMG) was collected from tibialis may optimize joint stiffening and then jogged (6.0mph) while shod anterior (TA), peroneus longus (PL), strategies following injury. As on a treadmill after a 36-minute and soleus (SOL) muscles. After previous studies have suggested exercise protocol. The exercise collecting maximal voluntary stiffness of the passive structures protocol consisted of six 6-minute contractions (MVC) for all muscles, are decreased among ankle copers, cycles that included 5 minutes of subjects were asked to pronate the future research may investigate inclined treadmill walking (3.0mph) ankle (30% effort) as a rapid the relationship between stiffness followed by 1 minute of anaerobic inversion (20°) perturbation was of the capsuloligamentous jumping activities. As subjects applied to the joint at a random point. structures, selected muscle ambulated on an instrumented Subjects were instructed to hold the activation and co-contraction. treadmill with embedded force plates, contraction through the perturbation. a 12-camera motion analysis system Joint position and EMG activity were captured 3-D ankle kinematics during collected in custom software at one 15-second trial of walking and

Journal of Athletic Training S-213 13187DOBI another of jogging (average walking Ankle Joint Coupling During indicating the relative direction of the strides=10; average jogging Jogging With Chronic Ankle coupled motions, while m represents strides=20). For each trial, individual Instability the magnitude of relative motion strides were normalized to 100 Herb CC, McKeon PO, Hertel between the two segments. Each stride increments. Main Outcome J: University of Virginia, cycle was normalized to 100 data Measures: Frontal and sagittal plane Charlottesville, VA, and points representing the full gait cycle. ankle kinematics were recorded University of Kentucky, At each point in the stride cycle, the throughout the entire gait cycle for Lexington, KY average values for m and theta across each speed. Group means and the three strides were calculated for associated 90% confidence intervals each individual and used for statistical Context: Altered joint coupling Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (CI) were calculated for each group. patterns between tibial internal/ analysis. Means and 90% confidence Significant differences in the gait external rotation and rearfoot intervals for each group were cycle were determined by identifying inversion/eversion during gait may play calculated at each of the 100 points of increments where the CI bands for the a role in chronic ankle instability the stride cycle. Group differences two groups did not cross each other. (CAI). Objective: To identify were determined by identifying Mean differences and standard differences in the shank-rearfoot periods in the gait cycle where the deviations between groups were coupling magnitude (m) and direction confidence intervals did not overlap. calculated for these significant (theta) throughout the gait cycle Group means (+SD) were calculated intervals. Results: While walking, the between CAI and healthy control across these intervals and are CAI group was less dorsiflexed than groups during barefoot and shod presented as descriptive statistics. the control group from 33 to 52% of jogging. Design: Case-control. Results: In shod jogging, group the gait cycle (mean difference Setting: Motion analysis laboratory. differences in theta were found during =3.34±0.19ˆ) and more plantar Patients or Other Participants: mid-stance (18-21%, control= flexed from 65 to 77% of the gait Twenty-eight young adults (CAI: n=15, 60.27±4.09º, CAI=47.22±3.47º), cycle (mean difference=5.22±0.72ˆ). #previous ankle sprains=4.9±2.5; early-swing (72-75%, control= While jogging, CAI subjects were less Control, n=13, #previous ankle 51.31±2.24º, CAI=39.35±2.26º) and dorsiflexed than the control group sprains=0±0) participated. The Foot late-swing (84-87%, control= from 5 to 14% of the gait cycle (mean and Ankle Ability Measure (FAAM) 61.83±2.26º, CAI=52.82±3.57º) difference=5.65±0.53ˆ). No and FAAM-Sport (FAAM-S) were used between CAI and controls. No significant differences were found in to identify the level of self-reported differences in m were found in jogging the frontal plane between groups at function of CAI subjects compared to shod. In barefoot jogging, theta either speed. Conclusions: Following controls (CAI: FAAM=92.1±5.8%, differences were found during mid- a prolonged period of exercise, FAAM-S=74.8±13.3%, Control, stance (40-43%, control= 69.80± individuals with CAI tended to be in FAAM =100±0.0%, FAAM-S= 7.15º, CAI=59.72 ±4.71º), and mid- a more plantar flexed position during 100±0.0%). Interventions: Subjects swing (81-84%, control= gait compared to healthy controls. jogged (2.68m/s) for 5 minutes on an 76.51±0.65º, CAI=65.89±3.13º) These kinematic changes may instrumented treadmill in both phase of gait. Differences in m were predispose patients with CAI barefoot and shod conditions. Main found in mid-swing (76-84%, to increased re-injury risk after Outcome Measures: Using a 12 control=2.77±0.17º, CAI= 1.33± prolonged physical exertion. To our camera motion analysis system, shank 0.41º), and late-swing (97-100%, knowledge, this is the first study rotation and rearfoot inversion/ control=2.48±0.31º, CAI= 2.95± that has examined gait kinematics eversion kinematic data were collected. 0.01º). Conclusion: Differences in in individuals with CAI following Theta and m values were calculated the direction and magnitude of the prolonged exercise. throughout the entire gait cycle for 3 intersegmental joint coupling of consecutive strides using the Tepavac frontal plane rearfoot and transverse method of vector coding analysis for plane shank motion indicate that joint coupling. This method estimates individuals with CAI exhibit alterations the coupling behavior between the two in movement coordination during gait. coupled segments (in our case, shank These altered movement patterns rotation and rearfoot inversion/ associated with CAI may reveal eversion) at each pair of consecutive information on the internal data points throughout the stride cycle. constraints associated with CAI. Theta represents the vector coding angle between the two segments

S-214 Volume 48 • Number 3 (Supplement) May 2013 13181MONE 13171DONE

Lower Extremity Surface was calculated as the proportion of the Individuals With FAI Display Electromyography Measures total time across the stride cycle that Decreased Fibularis Reflex During Walking In Subjects the amplitude was greater than the Response During Dynamic With And Without Chronic Ankle previously described threshold. Inversion Perturbations Instability Independent t-tests were performed Donahue M, Docherty CL, Riley Feger M, Donovan L, Hart JM, for each dependent variable to compare Z: Indiana University, Bloomington, Hertel J: University of Virginia, groups. The level of significance was IN Charlottesville, VA set a priori at pd”0.05 for all analyses. Results: The PL and RF were activated Context: Symptoms of Functional significantly earlier in the CAI group Context: Ankle sprains are among the Ankle Instability(FAI) typically Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 most common musculoskeletal compared to the controls (PL: CAI=- present during dynamic activities. injuries and many patients develop 66±98ms, Control=158±165ms, However, neuromuscular deficits in chronic ankle instability (CAI) p<.001; RF: CAI=-144±147ms, participants with FAI are often following an initial sprain. Individuals Control=-36±111ms, p=.03). No other investigated during static, standing with CAI exhibit proprioceptive and significant differences were noted conditions. In order to create a more postural control deficits as well as between groups for time of activation accurate model, individuals with FAI altered osteokinematics during gait. (AT: CAI=-359±156ms, Control=- should be investigated during more Neuromuscular activity is theorized to 285±180ms, p=.24; LG: CAI= dynamic movement patterns. play a pivotal role in CAI but deficits 179±136ms, Control=247±133ms, Objective: Investigate reflex during walking are currently unclear. p=.17; BF: CAI=-225±98ms, responses in muscles throughout the Objective: To compare neuro- Control=-180±80ms, p=.18; GM: lower limb and low back during sudden muscular activity in terms of time of CAI=-80±99ms, Control=-60±124 inversion perturbations in individuals activation and percent of activation ms, p=.63). The PL was activated with and without FAI while walking. time as demonstrated by surface significantly more time across the Design: Cohort Setting: Research electromyography (sEMG) amplitudes stride cycle (p=.05) in the CAI group Laboratory Participants: Forty during walking between CAI and (36±10%) compared to the control subjects (Control Group [n=20, matched controls. Design: group (23±22%). No other significant 1.7m±1.1, 65.6kg±12.9, 20yo±2] FAI Descriptive laboratory study. Setting: differences were noted between Group [n=20, 1.7m±1.3, 74.9kg±16.1, Laboratory. Patients or Other groups for measures of percent of 22yo±3]) participated in the study. Participants: 15 adults with CAI activation time across the stride cycle Subjects with no history of previous (height=173±11cm, mass=72±14kg, (AT: CAI=53±27%, Control= ankle sprains were placed in the control age=23±4, sex=M:5 F:10) and 15 53±25%, p=.96; LG: CAI=21±19%, group, while subjects who scored less matched controls (height=173±9cm, Control=19±12%, p=.58; RF: than 27 on the Cumberland Ankle mass=71±18kg, age=23±3, sex=M:5 CAI=37±25%, Control=27±22%, Instability Tool and answered ‘yes’ to F:10) participated. Intervention(s): p=.24; BF: CAI=29±20%, Control at least 5 questions on the Ankle Subjects walked on a treadmill at 4.83 =28±18%, p=.81; GM: CAI= 27± Instability Instrument were placed in km/h as sEMG signals were recorded 25%, Control+23±22%, p=.62). the FAI group. Subjects were excluded from the tibialis anterior (TA), Conclusions: Activating the peroneus if they had a history of bilateral ankle peroneus longus (PL), lateral longus for a greater duration may sprains, previous lower extremity gastrocnemius (LG), rectus femoris increase fatigability and pre-activating surgery, neurological disorders of the (RF), biceps femoris (BF), and gluteus prior to initial contact may decrease lower-limb, or other balance-affecting medius (GM). Stride time was available motor units capable of disorders. Interventions: Surface determined with footswitches. Main protecting against inversion moments EMG data were obtained from the Outcome Measures: Time of during episodes of ankle fibularis(FIB), gluteus medius(GM), activation relative to initial contact and hyperinversion. Collectively, the and erector spinae(ES) of the injured/ percent of activation time across the demonstrated coping strategy in the matched side as well as the stride cycle were calculated for each CAI group may be physiologically fibularis(FIB_CLS), gluteus medius muscle. Muscle activation was inefficient when compared to healthy (GM_CLS), and erector spinae determined for each muscle if the counterparts. Targeted therapeutic (ES_CLS) of the uninjured/matched amplitude was 10 SD over the mean interventions for CAI may need to contralateral side. All data were amplitude during quiet standing. A focus on restoring normal collected as subjects walked down a negative value for time to activation neuromuscular function during gait. custom-built 7.2-meter long walkway. represents muscle activation prior to For each trial a random segment of the initial contact. Percent of activation

Journal of Athletic Training S-215 13082FOBI walkway would open to 30° causing the Mechanical Laxity Is Greater In ANOVA with Tukey post-hoc testing ankle to invert. EMG signals were An Unstable Ankle Population was utilized with ˜ =0.05. Main recorded with a BIOPAC Systems MP Compared To Copers And Outcome Measures: CAIT scores 150 telemetry system(BIOPAC Controls were calculated and the maximum talar Systems Inc, Goleta, CA) at 2kHZ, Brown CN, Rosen AB, Ko JP: tilt angle was recorded and averaged hardware filtered(500Hz) and University of Georgia, Athens, GA across 3 trials. Group means were rectified. Short-latency reflex (SLR) compared via one-way ANOVA. onset was calculated from door Context: Chronic ankle instability Results: Groups were not different in opening until EMG activation. (CAI) commonly develops following age or mass (Pe”0.09). The coper Amplitude of SLR and long-latency group was taller than the controls lateral ankle sprain and appears to be Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 reflex (LLR) were calculated and multifactorial in nature. It is unclear (P=0.003). The CAI group (20.6±5.6) normalized using z-scores. For each to what extent mechanical laxity is had significantly lower CAIT scores dependent variable, group differences present in a CAI population. (P<0.001) than the control (29.8±0.5) were evaluated using independent Objective: To determine if there are and coper (29.3±0.9) groups indicating sample t-test’s. Main Outcome differences in inversion talar tilt laxity decreased function. The CAI group Measures: Onset of the SLR and measures between recreational (26.6°±8.4°) demonstrated greater normalized SLR and LLR amplitudes athletes with CAI, a coper group with talar tilt inversion than the control of 6 muscles (GM,FIB, ES,GM_CLS, a history of ankle injury, and a control (16.2°±11.0°) and coper (16.9°±9.8°) FIB_CLS,ES_CLS). Results: The group with no history of ankle injury. (P=0.003). Conclusions: The CAI onset of the SLR of the FIB was We hypothesized the CAI group would group appeared to demonstrate significantly later in the injured side demonstrate significantly greater talar decreased self-reported ankle function of the FAI individuals (46.5 ± 6.8ms) tilt laxity. Design: Cross-sectional. and increased mechanical laxity in the when compared to the control Setting: Biomechanics Laboratory. lateral ligaments as measured by group(41.8±3.7ms; P=0.009). Both Patients or Other Participants: instrumented talar tilt compared to the the SLR and LLR amplitude were Fifty-six volunteer recreational control and coper groups. There were significantly smaller in the FIB athletes divided into 3 groups. CAI: 8 no differences in laxity between muscle in the FAI group than in the males, 11 females, age 20.7±1.5 years, controls and copers. In this control group([SLR: 3.95±2.08ms height 169.9±9.0 cm, mass 72.0±17.0 recreationally active population, vs. 7.99±4.01; P< 0.001] [LLR: kg; Copers: 12 males, 3 females, age mechanical laxity may be a factor in 3.99± 2.27ms vs. 6.98 ± 4.18; 22.2±4.3 years, height 176.7±10.8 cm, decreased ankle function. Copers, who P<0.008]). No significant mass 74.6±13.1 kg; Controls: 6 males, had an injury, may have reported better differences in latency or amplitude 16 females, age 20.4±1.4 years, height function because they were not lax and reflex responses were identified 166.0.1±8.0 cm, mass 64.9±11.5 kg. were comparable to controls. We between the two groups in the CAI and coper groups reported history attribute the group difference in height GM, ES, FIB_CLS, GM_CLS, of previous moderate-severe ankle to unequal gender distribution. Future or ES_CLS (P>.05). Conclusions: sprain. CAI group reported e”2 research should clarify the role of The results of this investigation episodes of ankle instability in the last mechanical laxity in contributing to CAI. indicate that during a dynamic 12 months while copers and controls perturbation task individuals with had none. CAI group had Cumberland FAI demonstrate longer fibularis Ankle Instability Tool (CAIT) score muscle latencies on the injured side d”26, indicating poor function. Copers but display no significant changes in and controls scored e”28, indicating the proximal muscle groups. good function. Interventions: In a Additionally, short and long latency single test session, participants reflex amplitudes were significantly completed the CAIT and underwent decreased in the FAI group. lateral ankle ligament instrumented arthrometry for inversion talar tilt. A rater, with established reliability >0.80, performed the arthrometry. Participants’ were positioned with the ankle in neutral and the knee slightly flexed while a 15dN force was applied. Three trials were collected. A one-way

S-216 Volume 48 • Number 3 (Supplement) May 2013 13003MOBI

Plantar Pressure Distribution medial midfoot (MM), lateral FAI. Alterations in movement Differences In Physically Active (LR)and medial rearfoot (MR)]. patterns identified by plantar Individuals With And Without Both measures were normalized to pressure may be useful for future Functional Ankle Instability body weight. Separate 2(group) x research in understanding During A Side Cut Maneuver 6(masks) repeated measures contributing factors to FAI. Pittman J, Gaven SL, Cortes N, ANOVAs were used to assess Walker ML, Hoch MC, Van Lunen differences for each dependent BL: Old Dominion University, variable (PP and FTI) (˜<0.05). Post Norfolk, VA, and George Mason hoc analyses were conducted using University, Fairfax, VA T-tests with a Bonferroni correction. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Results: For FTI a main effect was Context: Functional ankle instability detected for mask(P<0.001) (LF= (FAI) is a common condition in the 5.52+1.63%bw/s, MF= 14.01 ± physically active population. 3.78%bw/s, LM=2.17±1.10%bw/s, Individuals with FAI exhibit alterations MM=3.35±1.38%bw/s, LR= 3.19 in plantar pressure during gait when ±1.74%bw/s, MR=3.54±1.79%bw/s) compared to healthy individuals; with MF> LF,LM,MM, LR,MR however, it is unknown if individuals (P<.001), LF>LM,MM, LR,MR with FAI demonstrate deviations in (P<.001), and LF

Journal of Athletic Training S-217 13F03DONE 13055FOTE

Postural Modulation Of modulation was quantified with the The Relationship Between Joint

Hoffmann Reflex Strongly percent change scores in Hmax:Mmax Laxity And Physical Activity Correlates With Postural ratios calculated between: prone-to- Levels Control In Patients With bipedal (P-Bi) and bipedal-to-unipedal Hubbard-Turner T, Turner MJ: Chronic Ankle Instability (Bi-Uni). Center of pressure (COP) University of North Carolina at Kim KM, Hart JM, Saliba SA, data were used to compute 10 specific Charlotte, Charlotte, NC Weltman AL, Hertel J: Texas COP parameters including standard State University, San Marcos, deviation, range, velocity, area, and Context: Ankle sprains remain one of TX, and University of Virginia, time-to-boundary (TTB) minima. the most common musculoskeletal Charlottesville, VA Pearson correlation coefficients (r) pathologies. Objective: To determine Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 were calculated between H-reflex if there is a relationship between ankle modulation and postural control joint laxity and physical activity levels Context: Decreased modulation of measures. Results: There were 5 in those with chronic ankle instability Hoffmann reflex (H-reflex) of the strong correlations (all Pd”0.05) (CAI). Design: Case Control Study. ankle stabilizing muscles during between P-Bi modulation and bipedal Setting: Controlled, research changes in body positions has been COP measures found only in the CAI laboratory. Participants: Fifteen found in patients with chronic ankle group with a range of r=-.639 to -.725 subjects with unilateral CAI (6 males instability (CAI) suggesting that neural for 3 traditional COP measures and and 9 females, age=21.2± 1.9yr., alterations may be an underlying r=.588 to .608 for 2 TTB measures. mass=71.9±11.7kg, ht=174.3±6.9cm) neurophysiological mechanism of Lower traditional COP and greater and fifteen healthy subjects (6 males postural control deficits associated TTB measures reflect better postural and 9 females, age=20.4±2.1yr., with CAI. However, it is currently stability, thus indicating that as H- mass=73.1±13.4kg, ht= 172.1± unknown whether this modulation is reflex was more down-regulated, 5.5cm) participated in the study. related to postural control measures postural control measures improved. Interventions: Mechanical joint in patients with CAI. Objective: To When pooling the data from both stability was measured with an determine relationships between the groups, there were 9 moderate instrumented ankle arthrometer. The H-reflex modulation of the soleus and relationships found in a range of arthrometer measured ankle joint fibularis longus and postural control r= -.374 to -.465 for 7 traditional COP motion for anterior/posterior measures in an upright position in measures and r=.490 to .493 for 2 TTB translation and inversion/eversion patients with and without CAI. Design: measures. For relationships between angular displacement. All subjects Descriptive. Setting: Laboratory. Bi-Uni modulation and unipedal COP also filled out the foot and ankle Patients or Other Participants: measures, there were 3 strong ability measure (FAAM) and the Fifteen subjects with CAI (9 males, 6 correlations found in the CAI group in FAAM sports subscale. After initial females; age=23±5.8 years; height= a range of r=-.606 to -.690 for testing, all subjects were provided 174.7± 8.1cm; mass=74.9±12.8kg) 3 traditional COP measures, and 1 with a Digi-Walker SW-200 and 15 controls without any history of strong relationship (r=-.759) found pedometer (New Lifestyles, Inc., ankle sprains (9 males, 6 females; age in the healthy group. When combining Lees Summit, Missouri). 24±5.8 years; height=171.9±9.9 cm; group data, there were 7 moderate Participants were instructed to wear mass=68.9±15.5 kg) participated. to strong correlations found in a range the pedometer everyday for seven Interventions: Maximum H-reflexes of r=-.394 to -.554 for 7 traditional days and complete the daily step log. (H-max) and motor waves (M-max) COP measures. Conclusions: The Bivariate correlations using Pearson from the soleus and fibularis longus results indicate that as H-reflex Product Moments were made of the CAI-involved or side-matched amplitude in a more challenging between all dependent variables limbs were recorded while subjects position is more down-modulated, taken on the CAI and health ankles. lied prone and then stood in bipedal and the corresponding postural stability The level of significance was set a unipedal stances. Postural tasks of improves. This relationship was priori at p < 0.05 for all analyses. quiet bipedal and unipedal standing more evident in the CAI group. Main Outcome Measures: with eyes closed for 10 seconds were Anterior displacement (mm), assessed with a forceplate. Main posterior displacement (mm), Outcome Measures: H-max was inversion rotation (°), eversion normalized to M-max to obtain rotation (°), and average daily step

Hmax:Mmax ratios for the three count. Results: Subjects with CAI positions. For each muscle, H-reflex had significantly less steps (p=.04)

S-218 Volume 48 • Number 3 (Supplement) May 2013 compared to the healthy group. The average daily step count for the CAI group was 8,694.47+1,603.35 and for the healthy group 9,831.01 +2,290.01. Subjects with CAI had significantly more (p = .001) anterior displacement (14.2mm + 2.7) compared to the healthy ankles (10.6mm + 1.8). There were no significant differences for posterior displacement or inversion/eversion Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 rotation. Several significant bi- variate correlations were identified. The strongest relationship was between anterior laxity and average daily step count (r = -.84, p < .02). As anterior displacement increased average daily step count decreased. There was also a significant relationship with inversion rotation and average daily step count (r = - .78, p< .047). As inversion rotation increased average daily step count decreased. Conclusions: The results of this study indicate increased laxity in those with CAI may contribute to the decreased physical activity levels of these subjects. It is unknown if the decreased step count is due solely to increased joint laxity or potentially the corresponding changes in neuromuscular control that occur with joint instability. Decreased physical activity levels in this population is a concern, and interventions need to be designed to improve ankle stability and neuromuscular control to ensure subjects can participate in physical activity/exercise programs.

Journal of Athletic Training S-219 Free Communications, Poster Presentations: Lower Extremity Injury 13378UC 13042SC

Posterior Hip Dislocation With successful procedure with the hip Hip Injury In A Youth Football Acetabular Wall And Femoral complex in a concentric position. The Player Head Fractures: A Case Report patient was discharged six days post- Waugh AM, Hosey RG, Wright Yim DW, Gildard M, Powers ME: surgery. Uniqueness: Hip RD, Howard JS: University of Marist College, Poughkeepsie, NY dislocations are relatively uncommon Kentucky, Department of during athletic events. When they do Orthopaedic Surgery and Background: We present the case of occur, they are usually associated with Sports Medicine, Lexington, KY a posterior hip dislocation complicated high-energy impact events like by a posterior acetabular wall fracture football and rugby. Dislocations Background: A 10yo football player Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and a femoral head fracture. A healthy complicated by fractures of both the with no past history of lower extremity twenty-two year old male division I club acetabulum and femur are even more injury was running the football when rugby athlete was running with the ball uncommon. These injuries generally he was brought to the ground and when he was tackled by two opposing require open reduction and internal landed under multiple players. The players. During the tackle, his left knee fixation because of the instability athlete experienced immediate pain directly impacted the ground while in a created by the acetabular wall defect. and difficulty bearing weight but was flexed and fixed position while his This was not indicated for our patient able to ambulate with a limp from the torso was forced anteriorly. The patient however, as he was managed with a field. He was removed from play. Pain immediately complained of severe pain closed reduction only. Conclusion: was diffuse about the hip, ROM was in the area of his hip and thigh and was Posterior hip dislocations with limited secondarily to pain. He unable to move his left leg. During posterior acetabular wall and femoral reported no numbness or radiating pain physical examination his hip was found head fractures are rare injuries that following the injury. Differential to be in a position of flexion, adduction result from high-trauma mechanisms. Diagnosis: Contusion, slipped capital and internal rotation. The patient was When these injuries occur, early femoral epiphysis (SCFE), Legg- diagnosed on the field as having a reduction procedures are indicated to Calvé-Perthes disease, labral tear, posterior hip dislocation. An on-field reduce the risk of long-term avulsion fracture, or hip dislocation. reduction was not attempted. Instead, complications such as avascular Treatment: Athlete was referred to he was immediately immobilized to a necrosis and degenerative joint the local emergency department for spine board in a position of comfort and disease. Post reduction imaging is then evaluation. No abnormalities were transported to the local emergency required to rule out associated noted on plain radiographs. Athlete was department. Differential Diagnosis: fractures and intra-articular loose sent home on crutches and told to Pelvic ring fracture, acetabular bodies. If loose bodies are found, as follow-up with his pediatrician. Upon fracture, femoral head or neck fracture, in the current case, surgical removal seeing his pediatrician he was acetabular labral tear, sciatic nerve is necessary to prevent abrasive wear diagnosed with a contusion and injury. Treatment: Radiographs taken of the articular cartilage. Upon instructed to remain on crutches until at the emergency department revealed discharge, patient education regarding he could walk without a limp. Twenty- a posterior hip dislocation with potential complications such as seven days post injury he was referred posterior acetabular wall and medial osteonecrosis of the femoral head, to a primary care sports medicine femoral head fractures. Following a posttraumatic osteoarthritis and physician for further evaluation. At this closed reduction, radiographs recurrent dislocation is also time the athlete’s primary complaint confirmed alignment of the femoral important. The acetabular and femoral was pain mostly in the groin region with head however a fracture fragment was head fractures increase the risk of some pain in the lateral hip. He had full noted at the inferior aspect of the posttraumatic osteoarthritis and other ROM with flexion and extension of the acetabulum. The patient was complications. At one year post- hip, knee and back, limited ROM with immediately referred to another surgery our patient has progressed internal and external rotation of the hospital where an orthopedic surgeon through rehabilitation and is now hip. These deficits were further noted performed an open arthrotomy with a participating in lower extremity with the hip in a flexed position. posterior approach to remove the resistance training. However, he is Manual muscle testing for strength was fragments. The procedure required still prohibited from running and 5/5 at the hip, knee and ankle. Straight surgical dislocation of the femoral head participating in any contact sports. leg raise test was negative bilaterally to obtain a clear view of all fragments. and he reported mild discomfort with Post-surgery computed tomography logrolling of his left hip. Plain (CT) scan and radiographs revealed a

S-220 Volume 48 • Number 3 (Supplement) May 2013 13210MC radiographs again revealed no bony signs and symptoms of a severe hip Unicameral Bone Cysts Of The abnormalities. Given the patient’s injury. These injuries can go Proximal Femur With decreased hip motion and continued misdiagnosed if symptoms such as Subsequent Pathological pain, he was referred for an MRI. This reduced rotational ROM are ignored Fracture: A Case Report revealed a displaced posterior wall and further assessment is not pursued. Schmidt RMS, Companioni GR, acetabular fracture, labrum avulsion as Lopez RM: Tampa Orthopedic well as a subchondral fracture of the Clinic, Tampa, FL, and University medial femoral head. The patient was of South Florida, Tampa, FL then referred to a trauma surgeon for possible acetabular repair. Thirty days Background: An 18 year-old Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 post injury the athlete was seen in physically active female (5’7”, 120 trauma clinic. Exam was essentially pounds), presented with left hip pain unchanged from 3 days prior. Patient of approximately three weeks was diagnosed with a posterior wall duration, progressively worsening. acetabular fracture secondary to hip She reported pain with hip flexion, posterior dislocation with spontaneous external rotation and weight-bearing. reduction. Surgical repair of the There was no acute trauma or specific fracture was determined to be the best injury that could be determined. The option to return this patient to high initial examination by an athletic level function given his age and risk trainer demonstrated reduced range of for instability if not repaired. Surgery motion secondary to pain during was performed 37 days post injury. An flexion, adduction, and external open posterior approach was used and rotation, the presence of a rightward a pelvic reconstruction plate was antalgic gait, and pain during weight- utilized to secure the posterior wall bearing. The patient was given pieces. The patient was released 3 days crutches, instructed to be non-weight s/p procedure with home exercise bearing (NWB), and was referred to an program and instructions to be toe orthopedic surgeon due to loss of touch weight bearing for 6 weeks post- function and pain level. X-rays of the surgery. At last follow-up the patient left femur and pelvis demonstrated was healing well, hip rotational profile multiple lucencies. Physical was symmetric, and all lower extremity examination demonstrated continued muscles were firing appropriately. pain with hip flexion, external rotation, Patient will continue long-term and weight-bearing. Differential follow-up with repeat radiographs to Diagnosis: Hip sprain/strain, muscle monitor for avascular necrosis but is tear, fracture, unicameral bone cysts, expected to return to full function. sarcoma, osteomyelitis, leukemia, Uniqueness: Hip dislocations in osteoporosis. Treatment: Immediate athletics are rare. Less than 5% of referral for an MRI, CT scan, and an traumatic hip dislocations occur in evaluation by a musculoskeletal individuals under age 15 and most are oncologist were ordered. The associated with high impact vehicular musculoskeletal oncologist trauma. Pelvic fractures in adolescents confirmed the diagnosis as multiple are rare and only 10% of these benign neoplasms of the proximal fractures involve the acetabulum. In femur. Following the two specialists’ instances where spontaneous evaluations, the athlete continued reduction occurs, diagnosis can be NWB status while awaiting outpatient challenging, particularly when surgery, approximately 2 weeks later. radiographs are normal. Conclusion: The initial surgery for unicameral bone While hip dislocations are rare in the cysts of the femoral neck and lesser athletic population it is important for trochanter and pathological fracture of athletic trainers to be aware of the the femoral neck consisted of

Journal of Athletic Training S-221 13206MC curettage and packing of the lesion with stabilizing or spontaneously The Evaluation And Treatment OsteoSet Pellets, a synthetic bone resolving following skeletal Of A Femoroacetabular graft. The patient was NWB until maturity. These lesions can cause Impingement In A Young Soccer approximately two weeks status-post severe, performance-limiting pain Player: A Case Report surgery when sutures were removed in young adults during strenuous Ross RG, Neefe HI, Lopez RM: and formal physical therapy was activity but minimal to no pain All Children’s Hospital, St. initiated. Gentle progression from during sedentary activities. Petersburg, FL, and University partial weight-bearing to full weight- Conclusions: Athletic trainers of South Florida, Tampa, FL bearing was achieved over a period of should consider the possibility four weeks. X-rays were repeated of oncology-related diagnoses when Background: This case involves a Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 at each post-operative visit at evaluating young athletes for male, 15-year-old avid soccer player approximately six week intervals. orthopedic injuries as they (5’6”, 118.8 lbs); he is a right-foot Once discharged from physical may present similar to common dominant defensive right back. The therapy, the patient continued a home sprains/strains and joint aches. athlete presented with left anterior exercise program (HEP). The athlete Radiographic imaging should hip, groin, and buttock pain for over a was advised that she could return be obtained to rule out common year while playing competitive soccer. to participation in recreational and/ diagnoses, such as fracture or No specific incident of trauma or or competitive sport as long as she avulsions, and to rule out oncology- mechanism of injury was reported. His was pain-free. Almost two years after related diagnoses, such as UBCs, SBCs, symptoms progressively worsened surgery, the athlete still complained or other benign tumors of the bone. causing an abnormal walking gait. The of occasional pain and x-rays family scheduled a consultation with revealed that the synthetic graft did a pediatric orthopedic physician due to not satisfactorily obliterate the restricted movements, uncomfortable lesions as well as desired by the pain and declining athletic surgeon, and an open-reduction performance. Differential Diag- internal fixation (ORIF) was nosis: Adductor or flexor strain, recommended in anticipation of the apophysitis, internal or external patient’s start of a potentially snapping hip, athletic pubalgia, slipped physically strenuous program of capital femoral epiphysis, and labral study. An ORIF with curettage and tear. Treatment: Upon initial packing of the lesion with bone evaluation the physician immediately allograft was performed nearly 2 ordered magnetic resonance imaging years following the initial surgery. (MRI) of the pelvis and hip magnetic The patient was NWB for resonance arthrogram (MRA) that approximately two weeks status-post same day due to a positive hip scouring surgery when sutures were removed. and anterior impingement test. Clinical Only two to three visits of formal impression of the pelvis MRI produced physical therapy were ordered and abnormal morphology of both hips in then the patient was directed a fairly symmetric behavior. Next, a to repeat the HEP as previously left hip MRA was performed using prescribed on the initial surgery. The guided fluoroscopy. The results were patient was permanently restricted remarkable and compatible with from high-impact sports. femoroacetabular impingement (FAI) Uniqueness: Unicameral bone cysts both cam and pincer lesions bilaterally (UBCs) or simple bone cysts (SBCs) along with a left labral tear. Together are of an unknown etiology, though the family chose arthroscopic surgery it is suspected that venous of the FAI for debridement of the obstruction elevates interosseous osseous prominence, acetabular pressure, leading to cyst formation. overgrowth, and to repair the left labral These cysts are often asymptomatic defect of the hip in order to continue and found incidentally on imaging for playing at the elite level. Surgery was separate complaints. They are scheduled 6 weeks after the evaluation reported to be self-limited, and diagnostic assessments. The

S-222 Volume 48 • Number 3 (Supplement) May 2013 13104DOCE surgeon used a Smith and Nephew in order to make sure our athletes Alterations In Biomarkers distraction table and applied three continue to play their respected sport Following Anterior Cruciate knotless Smith and Nephew rapture without causing further damage. Ligament Injury: A Systematic anchors (2.9 cm) to repair the labrum, Future research should focus on FAI Review then, proceeded with the in the adolescent athlete since there Luc BA, Thomas AC, Driban JB, acetabuloplasty and femoroplasty. is limited literature readily available. Pietrosimone BG: University of Rehabilitation was prescribed with Toledo, Toledo, OH, and Tufts restrictions, including NWB for 6 Medical Center, Boston, MA weeks and TTWB to PWB for an additional 2 weeks. The protocol Context: Anterior cruciate ligament Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 advised for no hip adduction for 6 (ACL) ruptures occur in approximately weeks and included AROM limitations 250,000 Americans each year, with of hip flexion, extension, and external these patients experiencing an 8-10 rotation. Rehabilitation began with hip fold increase in risk of developing isometrics and progressed to full knee osteoarthritis. Osteoarthritis is AROM with NWB core exercises. He primarily diagnosed radiographically, began biking when hip flexion was but by the time radiographic changes tolerable. After week 8, he began appear, considerable damage has shuttle press, balance and occurred and treatment is challenging. proprioception exercises. Jogging was Biochemical markers (biomarkers) of introduced at week 10 using a cartilage degradation may be hydrotrack, with normal progressive detectable early following ACL injury running at 3 months. The final phase before radiographic osteoarthritis has began at 4 months and included soccer developed. Objective: Systematically specific drills, plyometrics and agility review the literature to determine the patterns. The athlete was cleared to magnitude of differences in biomarker play at 5 months and finished the entire concentrations following injury and club soccer season without setbacks. ACL reconstruction (ACL-R) Uniqueness: FAI is less common in compared to healthy controls. adolescent athletes. Previous research Sources: Web of Science was suggests that FAI in males typically searched from 1960 through produces only the cam lesion, making November 9, 2012 with the search this a rare case due to the athlete’s age, terms “anterior cruciate ligament sex and morphological mixture of injury” and an exhaustive list of osseous impingements (both cam and classifications of biomarkers. pincer lesions). In addition, the Bibliographies of pertinent studies timeframe between initial symptoms were cross-referenced for additional and medical treatment is remarkable relevant studies. Study Selection: since no signs of degenerative changes Five studies assessed biomarker within the left hip were reported. concentrations in either ACL- Conclusions: FAI leads to restricted deficient (ACL-D) or ACL-R patients hip motion, progressive damage to the compared to healthy controls. We labrum and degenerative intra-articular excluded studies if: treatments outside changes. Most reported adolescent of standard physical rehabilitation cases present with either the cam or were given in attempt to alter pincer lesion and not a combination of biomarker concentrations; a control both. It is important to understand the group was not used for comparison; etiology of FAI in order to stop further means and standard deviations were not damage of intra-articular structures. presented; or studies used animal Due to the underlying structures FAI models. Data Extraction: Means and can be difficult to diagnose. Athletic standard deviations were extracted trainers need to be aware of the from each study to compare biomarker etiology involved with hip pathologies concentrations in ACL-R and ACL-D

Journal of Athletic Training S-223 13249FOCE patients to healthy controls. Cohen’s studies should aim to determine which Elevated Biomarkers Of effect sizes (d=treatment–control/ biomarkers are the strongest Cartilage Catabolism And pooled standard deviation) with 95% predictors of osteoarthritis Inflammation In Athletes With confidence intervals (CI) were development following ACL injury and Femoroacetabular Impingement calculated for each biomarker to allow ACL-R, ultimately allowing for early Mendias CL, Gumucio JP, Lynch for comparisons between groups. Data detection of cartilage degeneration. EB, Sibilsky Enselman ER, Bedi Synthesis: For ACL-D patients, the A: University of Michigan, Ann strongest effect was found at 12 Arbor, MI months following injury for serum chondroitin sulfate epitope (WF-6; Context: Femoroacetabular Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 d=7.57,CI=6.43-8.60). A strong impingement (FAI) is a common hip effect for synovial fluid (SF) condition in athletes that leads to the glycosaminoglycan (GAG) con- development of early cartilage and centration was seen immediately labral damage in the non-dysplastic hip. following injury (d=1.06, CI=0.26- While FAI surgery improves the 1.81), and moderate effects were kinematics after surgical correction of found at 5.4 and 388.4 weeks post- FAI, no specific prognostic indicators injury (d=0.69,CI=-0.22-1.54; d=- of osteoarthritis that correlate with 0.56,CI=-1.32-0.23, respectively). joint injury or assess the efficacy of Weak effects were found for SF hip preservation surgery have been concentrations of aggrecan at all time reported to-date. Cartilage oligomeric points (0.7weeks:d=0.26,CI=-0.05- matrix protein (COMP) is an 0.99; 5.4weeks:d=0.35,CI=-0.52- extracellular matrix protein that is an 1.20; 67.3weeks:-0.14,CI=-0.98- established marker of cartilage 0.70; 388.4weeks:d=-0.13,CI=-0.88- catabolism, and C-reactive protein 0.64), as well as serum levels of (CRP) plays an important role in hyaluronic acid at 12 months in ACL- initiating inflammatory processes and D patients (d=-0.30,CI=-0.70-0.12). is commonly used as a biomarker of SF GAG concentrations at 67.3 weeks inflammation.Objective: To in ACL-D patients were weak (d=- determine if athletes with FAI have 0.39,CI=-1.22-0.47). Following ACL- elevated biomarkers of cartilage R, weak effects at all time points were metabolism and inflammation, we observed for urine levels of C- measured COMP and CRP levels in telopeptide fragments of type II asymptomatic athletes with FAI and collagen (CTX-II) following compared these to matched reconstruction (4weeks:d=0.15,CI=- asymptomatic athletes without hip 0.38-0.67; 8weeks:d=0.11,CI=-0.41- deformity. We hypothesized that 0.64; 12weeks:d=0.09,CI=-0.44- athletes with FAI would have elevated 0.61; 16weeks:d=0.01,CI=-0.52- levels of COMP and CRP. Design: 0.53), however moderate effects were Cohort study. Setting: Research seen for SF CTX-II one year following laboratory. Patients or Other injury in ACL-D patients (d= Participants: Male athletes with 0.53,CI=0.04-1.02). Conclusion: radiographically confirmed FAI Alterations in biomarker con- (N=10, mean age 23.1±6.4, Tegner centrations are present following ACL Activity Level 7.3±2.9, BMI 26.5±3.5) injury in both ACL-R and ACL-D were compared to age and activity patients, suggesting the process of matched males athletes with degeneration may begin immediately radiographically confirmed absence of following injury. The strongest effects FAI or dysplasia (N=19, mean age were found in ACL-D patients in serum 22.3±3.4, Tegner Activity Level levels of WF-6 one year following 7.7±1.0, BMI 26.2±6.5). This study had injury and GAG concentrations IRB approval. Interventions: immediately following injury. Future Radiographs were taken of subjects

S-224 Volume 48 • Number 3 (Supplement) May 2013 13033DOMU and a board certified, fellowship ACL Volume And Width Are (0.97±1.1°). Mean ACL volume = trained musculoskeletal radiologist Correlated With Anterior- 1320.6±183.5mm3; mean ACL width = determined the presence or absence of Posterior Knee Laxity 5.9±1.3mm; mean notch angle = FAI. Plasma was prepared from blood Wang HM, Schmitz RJ, Shultz SJ: 37.1±6.2°; mean AKL = 7.2 ± 1.9; that was drawn from an antecubital The University of North Carolina at mean PKL = -1.7± 0.3. ACL volume vein. Main Outcome Measures: Greensboro, Greensboro, NC was significantly correlated with ACL Circulating levels of COMP (R&D width (r= .907, P=.001), AKL (r= - Systems) and CRP (Calbiotech) were Context: Greater knee joint laxity has .676, P=.032), and PKL (r=.789, measured using ELISAs. Subjects also been associated with an increased risk P=.007). Smaller, but significant completed SF-12 and Hip disability of ACL injury. Mechanistically, correlations were noted between ACL Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 and Osteoarthritis Outcome Score multiple factors have been attributed width with AKL (r=. -.466, P=.029) (HOOS) surveys. Differences between to the magnitude of joint laxity. It is and PKL (r=.434, P=.049). There were groups were tested with t-tests unknown if knee joint laxity is related no correlations between notch angle (P<0.05). Results: Compared with to bony joint structure and ACL and AKL or PKL (P>.05). control athletes, athletes with FAI geometry. Objective: To determine Conclusions: Greater AKL and PKL had a 24% increase in COMP levels the relationship between ACL and were associated with an ACL that was (P<0.05) and a 376% increase in CRP femoral notch geometry obtained via smaller and thinner. Collectively, this levels (P<0.05), as well as a 22% magnetic resonance (MR) imaging work suggests that clinically available decrease in SF-12 physical component with anterior (AKL) and posterior measures of knee laxity are indicative scores (P<0.05), and decreases in (PKL) knee joint laxity. Design: of ACL geometry measures. A better all of the HOOS subscale scores Cross-sectional. Setting: Controlled understanding of the relationship (P<0.05). Conclusions: This is the Laboratory. Participants: Twenty- between ACL geometry and knee laxity first study to-date that demonstrates two recreationally active females may advance prevention efforts. Future significant increases in the levels of (1.67±0.7m, 65±12.1kg, 21.4± work should determine whether circulating biomarkers of 3.07yrs). Interventions: MR scans of alteration of ACL geometry as a result inflammation and chondral injury in the knee were performed and AKL and from repetitive loading can be athletes with FAI compared to control PKL were obtained via a commercial measured via simple clinical athletes. These results demonstrate joint arthrometer. Main Outcome measurement such as joint laxity. that chondral injury secondary to Measures: The entire ACL was the repetitive microtrauma of FAI segmented and manually traced across can be reliably detected, and offer multiple slices from which ACL future promise for the use these volume was calculated. ACL width was biomarkers as tools to identify at-risk calculated as the width of a line drawn athletes and assess the efficacy of perpendicular to Blumensaat’s line at therapeutic interventions such as the notch outlet that transected the hip preservation surgery in reducing ACL. Notch angle was measured as the inflammation, cartilage degeneration, angle formed by the intersection of the and reducing the likelihood line parallel to the posterior cortex of of developing osteoarthritis. the femur and Blumensaat’s line. Ten particpants’ MR data were assessed on two separate occasions to establish measurement reliability and precision. Joint laxity was measured as the anterior and posterior displacement of the tibia relative to the femur (mm) at 130N and 89N of force, respectively. Pearson correlations examined relationships among variables. Results: Strong measurement

consistency (ICC2,1) and precision (±SEM) were established for ACL volume (0.97±36.1mm3); ACL width (0.98±0.3mm); and notch angle

Journal of Athletic Training S-225 13304FOBI 13307UONE

Relationships Between ACL- and the peak knee extension (pKEM) The Relationship Between Injury Related Knee Mechanics and knee varus (pKVM) moments Performance On Clinical During Double-Leg Jump during the initial 20% of the loading Balance Tests After Anterior Landings And Side-Step Cuts phase were identified. The Cruciate Ligament Norcross MF, Pollard CD, Johnson relationships between the mean values Reconstruction ST, Doeringer JR, Hoffman MA: for each biomechanical measure Meyer JD, Martinez JC, Oregon State University, Corvallis, during the two movement tasks were Soontararak M, Rubino T, OR, and Oregon State University- assessed via Pearson correlation Trojian TH, Joseph MF, Veasley Cascades, Bend, OR coefficients ( d•0.05). Results: SJ, DiStefano LJ: University of Greater IC (1.74±2.88°) and peak (- Connecticut, Storrs, CT Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: One limitation of current 2.43±4.47°) knee valgus angles during anterior cruciate ligament (ACL) DLJL were associated with greater IC Context: Balance deficits have been injury research is that knee mechanics (0.11±3.45°) and peak (-2.51±3.28°) reported in individuals after anterior related to ACL-injury risk are often knee valgus angles during SSC (IC: r = cruciate ligament (ACL) injury. The evaluated during different types of 0.710, p < 0.001; Peak: r = 0.778, p < Balance Error Scoring System (BESS) movement tasks (e.g., landing vs. side- 0.001). Though not statistically test and the Star Excursion Balance step cut, double-leg vs. single-leg). significant, there was also a trend for Test (SEBT) are common clinical Two commonly used tasks are the greater pKEM during DLJL balance assessment tools. There are double-leg jump landing and the side- (159.79±40.22 Nm) to be associated limited data comparing performance step cut. However, it is currently with greater pKEM during SSC on these tests after an ACL unknown whether an individual’s knee (106.99±32.65 Nm; r = 0.418, p = reconstruction. Objective: To biomechanics during these tasks are 0.059). However, no relationships determine if there is a correlation related; and consequently, whether between IC knee flexion angles between the BESS and the SEBT tests findings from studies utilizing these (DLJL: 21.60±4.60°; SSC: in individuals who have had an ACL different tasks can be directly 25.97±6.81°; r = 0.181, p = 0.432) or reconstruction. Design: Correlation compared. Objective: To evaluate pKVM (DLJL: 25.50±15.04 Nm; study Setting: Laboratory Patients or relationships between ACL-injury SSC: 56.34±26.66 Nm; r = 0.110, p = Other Participants: 18 healthy and related knee biomechanics in 0.635) during DLJL and SSC were active participants (10 females, 8 participants performing double-leg identified. Conclusions: Participants males, Age: 21.8±4.4 years, Mass: jump landings (DLJL) and side-step exhibiting higher-risk frontal plane 75.2±10.43 kg, Height: 172.8±7.6 cuts (SSC). Design: Cross-sectional. knee positions do so during both DLJL cm) with a history of ACL Setting: Research laboratory. and SSC; but the magnitudes of IC knee reconstruction volunteered to Patients or Other Participants: flexion angle during these tasks appear participate in this study. Inter- Twenty-one healthy, physically active to be unrelated. Conversely, while ventions: Participants completed the volunteers (12 Males, 9 Females, Age: there was a trend for participants to BESS test and SEBT on their injured 20.9±1.5 years, Height: 1.70±0.10 m, exhibit greater pKEM during both (most recent reconstructed ACL) and Mass: 72.76±11.31 kg). Inter- tasks, we failed to identify a uninjured limbs in a randomized order. ventions: Lower extremity relationship between the magnitude of Participants were videotaped while biomechanics of the dominant limb pKVM during DLJL and SSC. As such, they balanced in 3 different stances were assessed via an optical motion caution should be exercised when (Double-limb, Single-limb, Tandem) capture system interfaced with two evaluating IC knee flexion and pKVM on two surfaces (flat or unstable) for force plates as participants completed results from studies utilizing these the BESS test. A single rater, blinded five DLJL from a 30 cm high box different movement tasks. to limb, recorded the errors from the positioned 50% of their height behind videotape. A single rater measured the the force plates; and five 45 SSC on participants’ reach distance of two the dominant limb. Main Outcome trials in three directions (anteriorly, Measures: Sagittal and frontal plane posteromedially, posterolaterally) for knee angles at initial contact (IC) and the SEBT. Main Outcome Measures: peak knee valgus angle during the The BESS test and SEBT are valid and loading phase (IC to peak knee flexion) reliable tools for measuring balance. were identified. Internal net joint The errors from each stance and moments were calculated using surface were summed to calculate a standard inverse dynamics procedures, Total BESS score. The average

S-226 Volume 48 • Number 3 (Supplement) May 2013 13407DOBI distances for each direction were Lower Extremity Biomechanics transverse plane knee and hip angles summed into a composite SEBT score In Individuals With And Without at initial contact(IC) and maximum normalized by leg length. Pearson Anterior Knee Pain During A knee flexion(MaxKF). Separate 2x3 correlation coefficients were Single Leg Drop Landing Task ANOVAs were performed for each calculated to evaluate the relationship Gaven SL, Glass MJ, Van Lunen variable. In the event of a significant between BESS test and SEBT on BL, Weinhandl J: Old Dominion (d”.05) interaction or main effect, both limbs (˜<.05). Results: There University, Norfolk, VA Fisher’s LSD post-hoc tests were was no significant correlation between performed on all pairwise the BESS test (Injured BESS Context: Individuals with anterior comparisons. Results: At IC there was Total=6.7±2.9, Uninjured BESS a main effect for box height for ankle knee pain (AKP) experience Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Total=6.5±3.1) and the SEBT (Injured peripatellar pain during repetitive knee dorsiflexion(P=0.012) with differ- SEBT Total=0.48 ±0.10, Uninjured flexion associated with weight-bearing ences between 20cm(-17.85+1 1.26o) SEBT Total=0.49±0.10) for injured activities. Differences in lower and 30cm(-21.05+8 .44o)(P= 0.027), limb (r=0.26, P=0.30) or for uninjured extremity(LE) kinematics during and 20cm(-17.85+11.26o) and 40cm limb (r=0.13, P=0.62). Conclusions: jumping tasks have been demonstrated, (-21.06+7.22o)(P=0.03), and hip The BESS test and SEBT appear however information on landing abduction(P=0.001) between 20cm to measure different aspects of balance utilizing a single leg drop does not (-6.42+10.78o) and 30cm(-8.58+ and function. Therefore, these clinical exist for AKP individuals. Objective: 12.94o) (P=0.007), 20cm(-6.42+ balance tests should not be used To examine differences in LE 10.78o) and 40cm(-9.4+ 14.45o) interchangeably in individuals after kinematics in individuals with AKP (P=0.009). At MaxKF there was a main an ACL reconstruction. Clinicians compared to healthy individuals during effect for box height (P=0.001) at may consider using both tests to single leg drop landings. Design: knee flexion (KFL) between 20cm evaluate balance deficiencies and assist Case-Control Setting: Laboratory (-49.81+7.08o) and 30cm(-52.13+ return to play decisions. Participants: Twenty-two physically 6.24o)(P=0.001), 20cm(-49.81+7.08o) active adults age 18-30 (11 and 40cm(-55.36+9.15o)(P=0.001), AKP;169.72+7.0cm; 67.08+15.81kg; 30cm(-52.13 +6.24o)vs. 40cm(-55.36+ Kujala:70.73+8.68) (11 Control; 9.15o) (P= 0.005) and hip flexion 170.23+7.24cm; 67.28+12.62kg) who (HFL) (P=0.002) between 20cm exercised a minimum of 3x/week for (23.13 +25.14o) and 40cm(28.02 at least 30 minutes volunteered for this +25.33o) (P=0.002), and 30cm study. AKP participants had pain for a (23.8+23.21o) and 40cm (28.02 minimum of 3 weeks, during physical +25.33o)(P=0.008). There was a main activity, prolonged sitting, jumping, effect for group for KFL(AKP: and/or squatting, and the control group -48.43+7.16o;Con: 56.43 +7.16o) was free of LE injury and had no (P=0.017). No other significant history of AKP. Intervention: Each findings were present. There were no subject performed five trials of a significant group x height interactions single leg drop landing task from three for any measure(P>0.05). different heights during one testing Conclusion: Individuals with AKP session. The task required the demonstrate biomechanical participant to perform a single leg differences in KFL at the drop landing from a 20, 30, and 40 instance of MaxKF during a centimeter(cm) high box placed 10cm single leg drop landing compared to behind a force plate and remain on the healthy individuals. The AKP group force plate for ~2 seconds. Three- demonstrated less KFL at MaxKF dimensional kinematics of the LE suggesting that they employ a stiffer were obtained using an 8 camera landing pattern and may not attenuate motion capture system. Main the forces imposed on the LE as Outcome Measurements: Inde- well as a healthy individual. The pendent variables were group [AKP, decrease in KFL may serve as a Control(Con)] and box height (20, 30, coping mechanism for the and 40cm). Dependent variables individuals with AKP to reduce pain included sagittal and frontal plane during landing activities.

Journal of Athletic Training S-227 13208DOBI 13145FOGA

Comparison Of Triceps Surae equivalent to 45% of maximal Combined Effect Of Static Musculotendinous Stiffness, voluntary isometric contraction And Dynamic Posture May Be Geometry, And Architecture In (MVIC) of the plantarflexors. Predisposition To Medial Tibial Male Runners With And Without Ultrasound imaging was used to Stress Syndrome A History Of Tibial Stress measure architecture and geometry Lee SY, Hertel J: Yonsei Fracture of the MG. Main Outcome University, Seoul, Korea, Pamukoff DN, Blackburn JT: Measures: Geometric and and University of Virginia, Neuromuscular Research architectural properties of the MG Charlottesville, VA Laboratory, University of North included CSA,MT, FL, and PA. MG Carolina at Chapel Hill, Chapel strength was estimated via Context: Characteristics of multiple Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Hill, NC plantarflexion MVIC. Triceps surae static postural measures among those MTS was standardized to body mass. with Medial Tibial Stress Syndrome Context: Previous research has All outcome measures were (MTSS) have not been examined. identified greater lower extremity compared between groups via Furthermore the difference of joint stiffness in runners compared to separate one-way analyses of dynamic postural measures between non-runners, and in runners with a variance. Results: Previously MTSS patients with and without static history of tibial stress fracture (TSF) injured runners had greater postural malalignments may provide compared to healthy runners. While normalized triceps surae MTS better information to understand the musculotendinous stiffness (MTS) is compared to healthy runners (178.4 importance of dynamic postural the largest contributor to joint ± 45.3 N/cm/kg vs. 112.7 ± 38.5 N/ measures that may elicit MTSS. stiffness, it is unclear what factors cm/kg; p = 0.007). No differences Objective: To identify multiple static contribute to greater MTS in runners were found in CSA (680.5 ± 131.1 postural characteristics of MTSS and 2 2 with a history of TSF. Objective: To mm vs. 619.8 ± 105.4 mm ; investigate the dynamic postural compare triceps surae MTS, and p=0.325), MT (18.3 ± 2.3 mm vs. characteristics of MTSS patients with muscle architecture and geometry 17.1 ± 3.0 mm, p=0.0.382), FL (58.4 and without static malalignments. between runners with and without a ± 11.4 mm vs. 53.0 ± 8.0 mm; Design: Case controlled study. history of TSF. We hypothesized that p=0.292), PA (25.3 ± 4.0° vs. 24.8 ± Setting: Laboratory. Patients or previously injured runners would 3.9°, p=0.810) or MVIC (51.5 ± 8.5 Other Participants: A total of 74 have greater MTS compared kg vs. 47.4 ± 15.2 kg; p = 0.518) recreational and competitive runners to healthy runners and differ in between previously injured and [37 normal (23.9±.4 years), 37 MTSS medial gastrocnemius (MG) healthy runners. Conclusion: MTS injured (24.0±.3 years)] were architecture and geometry is a modifiable characteristic, and recruited. Interventions: Seven demonstrated by greater cross- reducing triceps surae MTS alignments (standing rearfoot angle, sectional area (CSA), muscle may reduce the risk of TSF in male navicular drop, pelvic tilt, tibial thickness (MT), fascicle length (FL), runners. Muscle crossbridge torsion, tibial varum, femoral and pennation angle (PA). Design: formation at a given percentage anteversion, weight-bearing Q-angle) Cross-sectional. Patients or Other of MVIC, muscle architecture, and were measured and entered into a Participants: Eight healthy male muscle geometry did not vary hierarchical and K-means cluster runners (age = 20.8 ± 2.6 years; between groups. Therefore, the analysis to identify the cluster which mass = 66.5 ± 9.4 kg; weekly running difference in MTS between contained the majority of MTSS amount = 86.4 ± 31.8 km) and eight previously injured and healthy subjects. A total of three clusters were male runners with a history of runners is likely attributable identified. Seven [MTSS without TSF (age = 21.9 ± 3.0 years; mass = to differences in tendon stiffness. malalignment (MTSSdyn) out of 16 65.6 ± 5.4 kg; weekly running Future research is required subjects (the rest of 9 subjects were amount = 78.9 ± 22.2 km) were to determine the contribution of normal group) had MTSS in cluster recruited from community running tendon stiffness to MTS in one. Twenty-seven [MTSS with static groups and the university’s varsity the lower extremity. malalignment (MTSSmal)] out of 36 and club cross-country teams. Injury subjects [the remaining 9 subjects were status was determined via self- no MTSS with static malalignment report. Interventions: Triceps surae (noMTSSmal) had MTSS in cluster two. MTS was estimated from the damped Three (MTSSdyn) out of 22 subjects frequency of oscillatory motion (the rest of 19 subjects were normal) about the ankle following had MTSS in cluster three. Therefore, perturbation under loading a total number of subject in four S-228 Volume 48 • Number 3 (Supplement) May 2013 13189MOMU

Hamstring Strain Injury History groups were as follows: MTSSmal test and hip flexor flexibility was And Muscle Strength, Volume, (n=27), MTSSdyn (n=10), noMTSSmal assessed with the Thomas test with (n=9), and normal (n=28) groups. And Flexibility In Intercollegiate measures taken of both the shank and Main Outcome Measures: Sprinters And Jumpers thigh. Main Outcome Measures: In Maximum 3-D joint kinematics were Kramer N, Herb CC, Kuenze C, the injured group, limb-to-limb collected with Vicon motion analysis Fiorentino N, Blemker S, Hart JM, symmetry ratios of the injured to system while jogging (2.65m/s, Hertel J: University of Virginia, uninjured limb were calculated for all 120Hz). In order to confirm the Charlottesville, VA measures. In the control group, a characteristics of three clusters, a one- matching routine was used to assign way ANOVA was performed to examine each subject with a “sham” injured

Context: Sprinters and jumpers have Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 group (cluster) differences of static a high incidence hamstring strain limb prior to computation of symmetry postural measures. One-way ANOVA injury, but limited research has been ratios. Independent t-tests were used tests were performed to examine performed investigating long-term to compare the symmetry ratios differences across the 4 groups of effects of hamstring injury on muscle between groups. Results: The dynamic postural measures assessed characteristics. Objective: To previously injured group demonstrated during jogging. Results: The compare side-to-side symmetry in decreased total quadriceps volume characteristics of cluster two were measures of thigh muscle strength, compared to the non-injured group greater valgus standing rearfoot angle volume, and flexibility in (injured=.96±.04, healthy=1.0±.04, (cluster1: 5.60°±2.49°; cluster2: intercollegiate sprinters and jumpers p=.04). No significant symmetry ratio 7.14°±3.06°; cluster3: 5.14°±2.71; with and without a history of unilateral differences were found in any other P=.026), anteverted femoral head hamstring strain injury. Design: measures (semimembranosus volume: (cluster1: -6.75°±2.98°; cluster2: Descriptive laboratory study. Setting: injured=.96±.09, control=1.03±.10, 7.08°±3.22°; cluster3: 4.45°±4.16°; NCAA Division I university. Patients p=.13; semitendinosus volume: P<.001), valgus WB Q-angle or Other Participants: 21 injured=1.01±.10, control=.96±.12, (cluster1: 18°±4.29°; cluster2: intercollegiate sprinters and jumpers p=.34; biceps femoris long head: 19.53°±4.45°; cluster3: 11.52°± 3.98°; (12 males, 9 females; age=19.1±1.3 injured=.97±.13, control=1.02±.09, P<.001), and externally rotated tibia years; height=1.8±0.1 m; mass= p=.39; biceps femoris short head: (cluster 1: 24.13°± 7.34°; cluster2: 70.2±9.0 kg) participated. Seven (5 injured=.99±.08, control=1.03±.16, 30.42°±4.66°; cluster3: 17.64°± 5.18°; males, 2 females) had a history of p=.51; total hamstrings volume:

P<.001). MTSSmal (2.74°±.60°) showed unilateral hamstring injury while 14 (7 injured=.98±.04, control=1.01±.06, significantly higher max eversion males, 7 females) reported no history p=.31; isometric quadriceps: injured (F3,70=5.95; P<.001) as compared with of hamstring injury. Individuals =1.15±.35, control=1.12±.46, p=.89; normal (-.51°±2.47°); MTSS reporting bilateral hamstring injury isometric hamstrings: injured= (2.40°±.96°) showed significantly history were excluded from 1.14±.46, control=1.05±.54, p=.72; higher max eversion as compared with participation. Interventions: concentric quadriceps: injured= normal (-.51°±2.47°); MTSSmal Isometric, concentric, and eccentric 1.12±.47, control=1.07±.25, p=.74; (14.67°±.78°) showed significantly hamstring and quadriceps strength was concentric hamstrings: injured= higher max hip adduction (F3,70=3.32; collected using an isokinetic 1.04±.27, control=1.00±.18, p=.68; P=.025) as compared with normal dynamometer. Maximal isometric eccentric quadriceps: injured=

(11.91°±.72°); and MTSSmal contractions were performed at 60° .88±.22, control=1.07±.48, p=.32; (11.05°±1.56°) showed significantly knee flexion, while concentric and eccentric hamstrings: injured= higher max knee internal rotation eccentric isokinetic testing was .95±.20, control=.90±.23, p=.60; 90/ (F3,70=383.00; P=.00) as compared performed at 180°/s. Peak torques 90 test: injured=1.03±.08, control= with normal (2.12°±1.45°). were normalized to body mass. Muscle 1.0±.07, p=.38; isometric quadriceps: Conclusions: Individuals with static volumes of the semimembranosus, injured=1.15±.35, control=1.12±.46, postural measures such as increased semitendinosus, biceps femoris long p=.89; Thomas test-thigh: injured= standing rearfoot angle, femoral ante- head, biceps femoris short head, total .58±.83, control=1.69±.2.42, p=.26; verion,WB Q-angle, and external hamstrings, and total quadriceps were Thomas test-shank: injured=.88±.28, rotation of tibia may be predis- calculated from magnetic resonance control=.89±..24, p=.94). Con- posed condition for MTSS in images using an established clusions: Quadriceps volume was combination with joint kinematics such segmentation routine. Muscle volume decreased by approximately 4% on the as rearfoot everion, hip abduction, measures were normalized to a product involved limb in sprinters and jumpers and knee internal rotation. of subject mass and height. Hamstring with a history of unilateral hamstring flexibility was assessed with a 90/90 strain; however there were no

Journal of Athletic Training S-229 13135FODI symmetry deficits identified in A 4-Mile Run Decreases Achilles 90 degrees and held in place by a strap measures of hamstring muscle volume, Tendon Thickness And Cross- attached to a treatment table. The within quadriceps or hamstring strength, or Sectional Area In Collegiate group change was analyzed using a flexibility. The diminished quadriceps Female Cross-Country Runners paired T-test. The between group data volume may represent an adaptive Myrer JW, Neves KA, Johnson were analyzed by MANOVA. The alpha mechanism acquired post-injury. AW, Hunter I, Neves C, Bridges J: level was set at .05. Main Outcome Brigham Young University, Provo, Measures: The dependent variables UT were the Achilles tendon thickness and cross sectional area at 8 cm superior

Context: Recently, there has been to the plantar surface of the heel. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 interest in using ultrasound imaging of Results: There were significant tendons and muscles to assess injury decreases in tendon thickness of 7.4% and recovery. In runners, the Achilles (p<.0001) and cross-sectional area of tendon is the most frequently ruptured 9.6% (p<.0001) following the 4-mile tendon. Individuals suffering Achilles run by the cross-country runners. There tendon rupture are often physically were no significant decreases in active with high rates of sports tendon thickness (p=.470) and cross- participation pre-injury. It is important sectional area (p=.349) in the non- to understand the effects of running on runners following the 30 minute Achilles tendon thickness to better period of non-exercise. There were understand injury risk and to develop significant differences between the training protocols. Objective: To runners and non-runners in the change investigate acute changes in Achilles in Achilles tendon thickness (p=.008) tendon thickness and cross-sectional and cross-sectional area (p=.004) area in female cross-country runners between the pre and post after a 4-mile run compared to age measurements. Conclusions: There matched non-runners. Design: appears to be a thinning of the Observational study. Setting: Human tendon due to running. It is not known Performance Research Center. if the magnitude of thinning or lack Participants: 12 female collegiate of thinning or difference in the rate of cross-country runners (age:19.3±1.5 thinning is associated with the risk yrs, height:168.4±4.8 cm, weight: of Achilles tendon injury in runners. 55.2±4.8 kg) and 7 non-running female Further research should be undertaken volunteers (age:22.1±2.3 yrs, to investigate correlations between height:167.6±5.6 cm, weight: 67.1 Achilles tendon thickness and ±13.3 kg). Intervention: The Achilles the type of workout (e.g. hilly versus tendon of 12 female collegiate cross- flat), foot-strike pattern, and running country runners and 7 non-runners season (i.e. cross-country versus were measured 8 cm from the plantar track) and risk of injury. surface of the calcaneus using ultrasound imaging (GE Logic e). Both longitudinal and transverse images were taken before and after a 4-mile training run in the case of the cross country athletes and before and after a 30-minute period in the non-runners. The non-runners refrained from physical activity during the period between measurements. A mark was placed on the skin to ensure the same portion of tendon was measured pre and post-test. The ankle of the runners was maintained at a fixed position of

S-230 Volume 48 • Number 3 (Supplement) May 2013 13343OOBI 13081FOMU

Changes In Lower Extremity PVGRF). All variables except for time Comparison Of Trunk And Hip Biomechanics During Single- to peak force were normalized to body Strength And Flexibility Limb Forward Land Following weight (BW). Values from the right and Between Pilots With And Concussion In Collegiate left limbs were averaged to obtain one Without A Self-Reported History Football Players measure per variable, per subject. Of Low Back Pain DuBose DF, Herman D, Conrad Paired-samples t-tests were used to Nagai T, Abt JP, Sell TC, Keenan BP, Tillman SM, Jones DL, Pass determine differences in values of the KA, Smalley BW, Wirt MD, AN, Moser MW, Farmer KW, pre- and post-season measures. Lephart SM: Neuromuscular Dominguez JA, Chmielewski TL: Significance level was set at ˜=0.05. Research Laboratory, University Results: Average time from of Pittsburgh, Pittsburgh, PA; US University of Florida, Gainesville, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 FL concussion to post-season testing was Army School of Aviation Medicine, 75 ± 50.5 days. The APSI showed Fort Rucker, AL; Blanchfield Army a significant increase (0.065 ± .004. Community Hospital, Fort Context: More than 300,000 sports- versus 0.071 ± 0.007; p =0.026) Campbell, KY related concussions occur annually in and the time to PVGRF showed the United States. Altered a significant decrease (67.5 ± 5.4 Context: Low back pain (LBP) is one biomechanics observed in gait ms versus 63.5 ± 6.6 ms; p = 0.005) of the most common musculoskeletal following concussion may also exist from pre- to post-season testing. issues facing military personnel, with during jump landings, which may No statistical differences were found a high prevalence reported in increase risk of lower extremity injury. between pre- and post-season values helicopter pilots. Although several risk Objective: To examine changes in in PVGRF (3.5 ± 0.3 BW, 3.5 ± factors (age, history of LBP, total lower extremity biomechanics during 0.3 BW, respectively; p =0.572) or flight-hours, total night-vision goggle a jump landing in football players who in loading rate (55.78 ± 7.25 BW/sec, flight-hours) have been previously sustain a concussion. We hypothesized 52.7 ± 5.63 BW/sec, respectively; identified, modifiable musculo- that kinetics during a jump landing p=0.179). Conclusions: Following skeletal characteristics have not been would be negatively altered after concussion Division I collegiate investigated in this population. Less concussion. Design: Pre-test/post- male football players demonstrated trunk and hip strength and flexibility test study. Setting: Testing occurred an increase in anterior-posterior sway have been previously observed in in the Biomechanics and Motion and a decrease in time to PVGRF individual with LBP in civilian studies. Analysis Laboratory at the UF&Shands during a single limb forward land task. Objective: To compare trunk and hip Orthaepedics and Sports Medicine These results indicate poor postural muscular strength and flexibility in Institute. Patients or Other stability and reduced time to absorb pilots with and without a history of Participants: 13 male Division I impact loading, which may increase LBP. It was hypothesized that pilots football players (age 20.4 ±1.3 years) risk for lower extremity injury. with a history of LBP would exhibit that sustained a concussion during the Clinicians may need to incorporate less trunk and hip strength and competitive season. Interventions: neuromuscular training into flexibility than pilots without a history. Subjects performed a single-limb concussion rehabilitation protocols. Design: A cross-sectional design. forward land on each side during Setting: University sports medicine testing sessions before and after the laboratory. Patients or Other competitive season. Subjects jumped Participants: A total of 62 pilots with from a 25.4 cm step, landed on a force at least 100 flight-hours (previous 12 plate and held their position for 3 months), no current LBP, and no seconds. Main Outcome Measures: physical training restrictions on the Concussion history was collected day of testing participated in this study. from athletic training records. The 31 pilots (aircrafts: AH64=8, Variables measured during the single- UH60=10, CH47=3, OH58=10) with limb forward land included peak LBP history (29 males/2 females, Age: vertical ground reaction force 31.5±5.9years, HT: 177.1±6.3cm, WT: (PVGRF), anterior-posterior stability 84.4±11.3kg, total flight-hours: index (APSI, a measure of fluctuations 1293±1317hrs) were matched on around a 0 point along the sagittal axis gender, age (±5yrs), and total-flight of the force plate), time to peak force, hours (±500hrs) with pilots (aircrafts: and loading rate (PVGRF/time to AH64=8, UH60=11, CH47=3,

Journal of Athletic Training S-231 13165DONE

OH58=9) without LBP history (29 is warranted. Supported by Effects of Arthrogenic Muscle males/2 females, Age: 31.5±5.9years, USAMRMC #W81XWH-11-2-0097 Inhibition On Sagittal Plane HT: 176.9±8.8cm, WT: 82.9±14.6kg, Kinetics And Kinematics During total flight-hours: 1291±1312hrs). Stair Descent Interventions: An isokinetic Murray AM, Lepley AS, Bahhur dynamometer was used to evaluate NO, Thomas AC, Pietrosimone isometric hip abduction and isokinetic BG: University of Toledo, Toledo, concentric trunk flexion, extension, OH and rotation strength. A digital inclinometer was used to measure Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 passive hip internal/external rotation Context: Arthrogenic muscle and active lumbar spine flexion/ inhibition (AMI) is common extension, lateral flexion, and rotation following knee injury, resulting in flexibility. Paired t-tests or Wilcoxon decreased quadriceps activation and tests were used to compare between strength. As a result, performing two groups (p<0.05). Main Outcome activities that require increased demand Measures: Hip abduction and trunk on the quadriceps, such as stair descent, flexion, extension, and rotation in the presence of AMI may lead to average peak torque were normalized altered lower extremity joint loading and to body weight (%BW). The average chronic knee injury. The consequences of three measures was recorded for hip of AMI on joint loading and movement internal/external rotation and lumbar patterns during stair ambulation have not spine flexion/extension, lateral been investigated. Objective: flexion, and rotation (°). Results: The Investigate the effects of simulated AMI LBP group demonstrated significantly on knee biomechanics during stair weaker trunk extension strength (LBP: descent. Setting: Motion Analysis 345.5±78.1%BW, non-LBP: 404.5± Research Laboratory. Design: 66.0%BW, p=0.004). The LBP group Descriptive laboratory study. Patients had significantly less trunk lateral or Other Participants: Eighteen flexion right (LBP: 21.5±4.1°, non- healthy individuals (11M/7F; LBP: 26.4±4.6°, p<0.001) and left 22.3±2.4yrs; 174.1±6.8cm; 71.8± (LBP: 23.0±4.4°, non-LBP: 26.8± 8.1kg) participated. Interventions: 4.7°, p=0.005) and right rotation Participants were outfitted with 26 flexibility (LBP: 9.4±3.2°, non-LBP: retroreflective markers and performed 11.4±3.9°, p=0.043). Conclusions: three trials of stair descent at a self- The current investigation revealed selected pace on a custom built staircase musculoskeletal characteristics that instrumented with a force plate. are associated with pilots with a self- Following baseline testing, 60mL of reported history of LBP. For allied sterile saline was injected into the knee health professionals working with a joint capsule of each participant through military population, identifying an area supralateral to the patella. Ten modifiable musculoskeletal minutes following effusion, participants characteristics associated with performed posttest measurements. individuals with LBP is essential for Voluntary quadriceps activation was treatment and prevention of LBP. evaluated before and after effusion with Future studies are needed to confirm the central activation ratio (CAR) using if these characteristics are predictive the burst superimposition technique with of LBP and loss of duty days due to the knee in 90° of knee flexion to medical leave. Additionally, further confirm the presence of AMI. Main research on other modifiable Outcome Measures: Peak internal neuromuscular factors (e.g. trunk knee extension moments (KEM), proprioception, posture, and balance) vertical ground reaction force (vGRF) and knee flexion angle (KFA) were

S-232 Volume 48 • Number 3 (Supplement) May 2013 collected through 3-dimensional motion analysis and extracted from the first 50% of stance phase, which was initiated once vGRF exceeded 10N. All variables were averaged across trials with KEM normalized to participant body (mass*height) and vGRF normalized to participant body mass. Dependent t-tests were performed to

assess the effects of AMI on peak KEM, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 vGRF and KFA. Alpha level was set a priori at Pd”0.05. Results: The presence of AMI was confirmed with reduction in CAR following effusion (pre: 0.93± 0.07; post: 0.88±0.10; t(17)=2.29, P=0.035). KEM (pre: 0.46±0.17Nm/ kgm; post: 0.39±0.13Nm/kgm; t(17)= 2.78, P=0.013) and vGRF (pre: 12.16±1.67N/kg; post: 10.99 ± 1.42N/ kg; t(17)=3.62, P=0.002) were significantly lower following effusion while KFA did not change (pre: 24.7± 6.8°; post: 25.9±5.6°; t17=0.842, P=0.412). Conclusions: In the presence of AMI, quadriceps activation is decreased and subsequently KEM and vGRF are lower during stair descent. These kinetic changes may be indicative of participants attempting to decrease loading of the effused knee secondary to decreased quadriceps control. Though unexpected, it appears participants were able to overcome quadriceps AMI and avoid potentially hazardous loading of the knee joint. Future investigations may benefit from inclusion of hip and ankle biomechanics to better understand these compensatory strategies. Supported by funding through the Great Lakes Athletic Trainers’ Association.

Journal of Athletic Training S-233 Free Communications, Poster Presentations: Education 13433FOPE 13148FOPE

Variability In Clinical Integration completed the 12-item questionnaire, Effects Of Continuing Achieved By Athletic Training rating clinical integration for each of Professional Education On Students Across Different their previous clinical rotations. Main Entry-Level Competence Clinical Sport Assignments Outcome Measures: Descriptive Among Athletic Trainers Dodge TM, Mazerolle SM, statistics, including mean clinical Berry DC, Penny JM: Saginaw Bowman TG: Springfield College, integration scores (potential minimum Valley State University, University Springfield, MA; University of score of 12, maximum score of 72) Center, MI, and University Connecticut, Storrs, CT; Lynch- were calculated for each clinical Research Associates,

burg College, Lynchburg, VA placement. One-way analysis of Greensboro, NC Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 variance (ANOVA) was used to identify Context: Clinical integration, defined differences in clinical integration Context: To maintain the ATC® as assimilation into the clinical portion achieved across clinical placements. credential athletic trainers (AT) are of entry-level education, has been Results: One-way ANOVA revealed required to complete mandatory shown to impact athletic training differences in clinical integration continuing education (CE) within a students’ (ATSs) professional levels achieved across various clinical defined time period because CE is development, motivation and assignments F(19,415)=3.486, considered vital to insuring clinical persistence. However, research has p<0.001. Students completing a competence and preventing outdated yet to elucidate the manner in which rotation with NCAA division I football practice. Unfortunately, there is a different clinical placements can achieved the lowest levels of clinical paucity of evidence examining influence clinical integration. integration (46.9±9.1). Other division whether the accumulation of CEUs Objective: Examine differences in the I sports rated higher with averages maintains minimal professional levels of clinical integration achieved ranging from 51.6±10.1 (baseball) to competency as determined by the by ATSs across various clinical sport 57.8±4.5 (lacrosse) with less anxiety original Board of Certification (BOC) assignments. Design: Cross- and time wasting reported than certification process. Objective: To sectional design utilizing a football. The high school rotation determine whether mandatory CE questionnaire for data collection rated highly as well (54.7±6.4) with maintains entry-level competence purposes. Setting: Thirteen higher levels of learning reported and among certified athletic trainers. undergraduate Athletic Training fewer concerns about anxiety, Design: Prospective, cross-sectional, Education Programs (ATEPs) in the excessive hours and wasting time. observational study. Setting: AT southeastern United States located at Conclusions: There were clear practice settings. Participants: NCAA division I institutions. Patients differences in clinical integration Convenience sample of 1,025 ATs or Other Participants: Question- achieved among sites. In particular, from a solicitation of 9,789 who re- naires were administered to 169 ATSs ATSs completing clinical rotations certified in 2010 and 196 ATs whose engaged in clinical education with NCAA division I football reported certification lapsed (overall response experiences. 129 ATSs completed the the lowest levels of clinical rate was 10.3%). Participants were questionnaire for a response rate of integration. These low levels of predominantly female (61%) and 76.33%. The ATSs had completed an integration stemmed from feelings Caucasian (91%). Average years average of 4 ± 2 clinical rotations. of wasting time during clinical practicing as AT was 10.2 years (±7.4); Interventions: The 12-item clinical education, completing menial tasks, 72% held a masters degree or higher. integration scale was developed by the excessive hours and anxiety associated Interventions: An e-mail invitation researchers following a review of with the educational experience. As was sent to ATs recertifying in 2010 athletic training and other health clinical integration is related and those who allowed their professions education literature to student motivation and eventual certification to lapse. The invitation concerned with clinical education and persistence, matching students to explained the research project and student retention. The questionnaire appropriate clinical sites seems asked participants to complete an on- was reviewed by a panel of experienced as important as matching ATS and line recertification assessment athletic training educators and piloted on preceptor characteristics. Future administered by Castle Worldwide a group of 11 recent ATEP graduates. research should continue to focus (Raleigh, NC). The recertification The questionnaire was administered via on identifying clinical site specific assessment was a retired form of the a combination of in-person and on-line characteristics that not only BOC Certification Exam used during methods. Responses were scored on a hinder integration but also those 2010-2011 published by Castle 6-point Likert scale (1 strongly that facilitate integration. Worldwide under the BOC Role disagree-6 strongly agree). Participants S-234 Volume 48 • Number 3 (Supplement) May 2013 13243FOPE

Delineation Study 5th Edition. A The Relationship Between significantly correlate with locus of shortened version of the original 175- Candidate Psychological control (r= -.262, P = .001) and item exam, the assessment contained Factors And First-Attempt Pass academic worry scores (r= .307, P < 125 scored, multiple-choice items and Rate On The Board Of .001). Academic worry had a not the 50 field test items normally Certification Examination significant relationship with emotion included. Castle conducted a Breitbach AP, Downey DL, Frager focus coping scores (r= .307, P < recertification assessment standard A: Saint Louis University, St. .001) and locus of control (r= -.229, setting meeting where nine panelists Louis, MO, and Austin High P = .006). Locus of control correlated (ATs) set two passing levels (proficient, School, Austin, MO with emotion focus coping (r= -.262, P = .001) and academic worry (r=

advanced) for the recertification Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 assessment. One-way ANOVAs (˜= Context: Success on the Board of -.229, P = .006). The results of the 0.005 to control experiment-wise error) Certification (BOC) examination is logistic regression analysis suggests were performed to investigate between necessary for persons who wish to that the full model significantly group assessment scores. Main obtain the Certified Athletic Trainer predicted passing on the first attempt Outcome Measures: Inde-pendent (ATC) credential. BOC exam first (˜2 (4) =15.346, p=.004). The results variables included highest degree and attempt pass rates have historically of the t-tests indicate that compared role. Dependent variables included been an issue in athletic training (AT). to those who pass the test on the first recertification exam scores, individual Objective: The purpose of this study attempt, those who did not pass on the domain scores and items considered to is to examine the impact of coping, first attempt had significantly different be predominantly measuring recall, locus of control and academic worry scores on the Emotion-Focused application, and synthesis. Results: on first attempt passing rates of the Coping Scale (p= 0.024), locus of Recertification assessment scores BOC exam. Study strategies for the control (p= 0.002), and Academic ranged from 15-117; mean was 88.6 BOC exam were also addressed in the Worry (p= 0.026). Conclusions: Data (±12.7). Converted to percentage study. Design: Cross-sectional from this study suggests that correct, the average was 70.9% (range Survey-based Design. Setting: psychological factors such as high 12%-94%). Twenty-nine percent of ATs Subjects were recruited through emails academic worry, emotion focused completing the assessment passed at the sent to CAATE Accredited Entry-Level coping and an external locus of control proficient level, 4% at the advanced Program Directors, which were have a lower first attempt pass rate level. Significant differences forwarded to recent program on the BOC examination. These data also suggest that students who pass (F4,965=21.46, P<0.001) existed between graduates who accessed the survey ATs with a doctorate (94.92±9.59) and instrument on-line. Participants: The on the first attempt are more likely to ATs with a Masters in athletic training research sample consisted of 145 use multiple strategies to prepare for (92.48±11.28) versus all other newly graduated AT students, who the exam. Professional preparation educational levels: ATs with a non-AT reported they took the BOC should address psychological issues Masters (88.50±12.51), ATs with a examination from April to October, such as academic worry, locus of Bachelors-non-AT major (83.25± 2010. Interventions: The survey control and coping skills along with 14.33), and ATs with a Bachelors-AT instrument included three sections of multiple study strategies and major (83.77±11.76). Significant items used to measure the elements of structured preparation activities. differences (F2,568=18.40, P<0.001) locus of control, method of coping and existed between educators (97.75± academic worry. Analysis was 11.39), practicing ATs (88.62±11.47), and performed showing the relationships administrators (83.64±15.38). Conclu- between the scores on these factors sions: Results suggest that many ATs are and first attempt pass rate on the BOC not maintaining a “proficient” level of exam. Main Outcome Measures: competence as measured by this The dependent variable for this study assessment. A paradigm shift may be was the first-attempt pass rate on the warranted to address how CE is BOC exam. Participants were asked to delivered and measured. Shifting from self-report if they passed and how attendance (seat-time) based CE to many attempts they had on the BOC improved pre-defined learning exam. Independent variables in the outcomes with post-testing and/or study include coping, locus of control assessment of patient outcomes using and academic worry. Results: newly learned skills might be options. Emotion focus coping scores

Journal of Athletic Training S-235 13420FOPE 13429MOPE

Civic Professionalism: The interviews and individual pre, mid and Learning Styles Of Impact Of Service Learning On post-service reflective journals. We Undergraduate Athletic Training The Professional Development collected and analyzed data through Students In A CAATE-Accredited And Values Of First Year Athletic constant comparative analysis. We Athletic Training Education Training Students also used methodological Program Klossner J, Tarzon M, Docherty triangulation, member checks and peer Reyes AD, Swanik CB, Knight CA, CL, Grove KA: Indiana University, debriefing to ensure trustworthiness. Kaminski TW: The University of Bloomington, IN Results: Themes such as civic Delaware, Newark, DE professionalism and social awareness emerged as ATS interacted with Context: While research supports the Context: Assessing preferences and Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 value of service learning (SL) in higher patients of various socioeconomic perceptions about the athletic training education including health care backgrounds and recognized the role (AT) learning environment may assist professional preparation programs, they could play to help the community. program directors to enhance their research specific to the efficacy of SL Direct SL experiences also facilitated student’s educational experience and in athletic training education is professional socialization as overall retention of knowledge. lacking. Furthermore, the value of interactions with health care Objective: The purpose of this study civic professionalism is discussed in professionals reinforced student was to identify and evaluate learning nursing and medicine, yet there has values and professional behavior. In styles of undergraduate AT students and been no such discourse in athletic addition, authentic experiences determine if there is a learning style training. Objective: The purpose of facilitated self-efficacy in the ATS’ profile that translates into admission this study was to identify ways in which developing professional role. Role acceptance and success on the Board direct service learning influenced the confusion existed in some instances of Certification (BOC) examination professional development and values as roles and responsibilities in the for athletic trainers. Design: of first year athletic training students service setting were not consistent Prospective, cohort. Setting: (ATS) through a framework of civic with duties of the athletic trainer as Classroom. Participants: Three professionalism. Specifically, students understood them. hundred and fifteen (110M, 205F) research questions included: 1) In what Conclusions: Service learning is college students (18-25yrs.) between ways do ATS view civic responsibility beneficial to the development of ATS. 2004-2012 were tested. All students before and after a direct service Findings suggest Athletic Training were enrolled (or seeking enrollment) learning experience? 2) What specific Programs (ATP) should emphasize in a CAATE accredited athletic training interactions and/or experiences service learning and civic education program (ATEP) at a mid- influence the professional professionalism within their sized Division-I institution. development and values of ATS? 3) In curriculum. ATP may wish to explore Interventions: The Kolb Learning what ways do ATS develop a growing different service settings which Styles Inventory (LSI) is a 12 question sense of civic professionalism or other are more consistent with roles survey that describes the way we learn professional values? Design: Basic and responsibilities of athletic trainers and deal with day-to-day situations. qualitative content analysis based on and/or integrate the value of service Athletic training interest (ATI) Scholarship of Teaching and Learning learning throughout the ATP students are administered the LSI as methodological framework. Setting: curriculum so students more fully part of their orientation activities Undergraduate athletic training appreciate the value of civic annually. Students who are accepted classroom as well as service learning professionalism. Further research into the ATEP and matriculate through within a community-based free clinic. should also explore perceptions the program repeat the LSI during the Patients or Other Participants: of the community partner, different Fall semester of their final year. Pass/ Undergraduate ATS (sophomore level; service learning models, and the fail rates from the BOC exam were n=19) enrolled in A283 – General value the profession places derived as students completed the Medical Issues in Athletic Training on community service. ATEP. Main Outcome Measures: were purposively recruited. All of the Concrete experience (CE), active students, 9 male and 10 females, experimentation (AE), reflective volunteered to participate. Participant observation (RO), and abstract ages ranged from 20-25. Data conceptualization (AC) cycles of Collection and Analysis: Data learning were analyzed and used to collection included reflective group compute an overall learning style interviews, semi-structured cohort (accommodator, diverger, converger,

S-236 Volume 48 • Number 3 (Supplement) May 2013 13250DOIN assimilator). Learning styles from the Mental Health Issues in an audit trail. Results: Positive factors first year were compared to program Intercollegiate Athletes: Clinical impacting referral were performance admission status (yes/no), while And Educational Implications declines, personal experiences, learning styles from the final year were LaRue MJ: University of knowledge of comorbidity, compared to success on the BOC exam Wisconsin-Eau Claire, Eau convenience of Division I resources, (pass/fail) using chi-square analysis. Claire, WI cost and convenience of campus Results: To determine learning style, counseling centers, confidentiality and combined scores from the cycles of Context: Currently, limited statistics supportive coaches’ influence. learning are plotted on a grid. are available regarding the incidence, Negative factors which hindered Combined learning ability scores recognition and referral were lack of recognition and treatment of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 (means±SD) for the first year of psychiatric conditions in college confidence, coaches’ detrimental testing were, AE-RO (7.3±10.8) and student-athletes1. A University of influence, Division III resources, AC-CE (2.9±9.9); while those scores Minnesota study2 indicated that 25.1% campus counseling location, in the final year were AE-RO of college students had been diagnosed confidentiality and emotional impact. (8.8±10.0) and AC-CE (7.2±10.1). with a mental health condition in their Participants encountered mental The dominant learning style was an lifetime; therefore, it is probable that health issues in their student-athletes accommodator (31%) for the first student-athletes are experiencing these ranging from anxiety and depression year and a converger (39%) for the conditions at similar rates. This study to substance abuse and disordered final year. There was a significant explored what mental health issues eating. Referral resources ranged association between learning style and certified athletic trainers encountered from team physicians and acceptance into the program (X2(3, in student-athletes with whom they neuropsychologists to emergency n=281) =12.057, p=0.0072). The work and how the referral process was room physicians. Certified athletic odds of a converger being accepted managed. It also explored whether trainers felt their educational were 2.44 times higher than any other certified athletic trainers felt their background did very little to prepare learning style. There was not a educational background prepared them them to recognize and refer mental significant association between to manage these conditions. Design: health issues in their student-athletes, learning style type and success on the An interpretive phenomenological however practical experiences BOC exam (X2(3, n=92) =5.525, analysis was conducted. Setting: assisted them in gaining this p=0.137). Conclusions: A converger Participants were employed in the knowledge. Conclusions: Educational is defined as a learner who focuses on university setting and currently worked implications should include AE and AC cycles of learning and with intercollegiate athletes. incorporation of mental health therefore prefers practical Participants: Popcorn sampling of 18 intervention and referral discussions applications of knowledge. As AT certified athletic trainers with a throughout the curriculum. Speakers students progress in ATEPs, practical minimum of five years’ experience in such as student-athletes, psychiatrists, applications of their classroom the intercollegiate setting were psychologists and other mental health experiences become crucial for interviewed. Eight females and ten professionals should be utilized in achieving success. Enhancing ways to males representing all regions of the relevant courses. Clinically, athletic strengthen these students’ learning country and all NCAA divisions training staffs should develop contact experience in the clinical setting may participated. Data saturation guided the lists of area mental health prepare them more effectively for total number of participants chosen for professionals and facilities and success in the profession as entry- this study. Data collection and incorporate a psychosocial component level athletic trainers. Finally, BOC Analysis: Semi-structured interviews to pre-participation exams. Mental exam success does not appear to be were conducted and transcribed health professionals should be learning style dependent. verbatim. Interview guides were educated on the intricacies of utilized and additional probing intercollegiate student-athletes and questions were posed as concepts the role of athletic trainers. Staffs emerged. Analysis was conducted should also have in-service training on using NVivo software. Trustworthiness intervention and referral techniques, was established via credibility, as well as setting proper boundaries. transferability, dependability and confirmability through prolonged engagement, persistent observation, member-checking, peer debriefing and

Journal of Athletic Training S-237 13251MOEX 13369FOHE

Student Athletes Have Poorer Outcome Measures: Objective Post-Professional Graduate Sleep Compared To Students sleep measures were calculated from Students’ Perceptions At The Same University the raw actigraph data and subjective Concerning The Competencies Chicoine N, Onofrio MC, Dover sleep measures were recorded from Within The Commission On GC: Concordia University, the diary. Results: There was a Accreditation Of Athletic Montreal, QC significant difference between Training Education Programs groups for sleep efficiency (SE Van Lunen BL, McCarty CW, Context: Sleep is important for athletes= 79.3%± 5.9; students= Hankemeier DA, Bay RC: Old athletes and students and can affect 88.2% ± 3.0; p< .001) and WASO Dominion University, Norfolk, VA; (WASO athletes= 105.9 min ± 36.3; A.T. Still University, Mesa, AZ; Ball their performance while attending Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 university. However, there is a paucity students= 56.2 min ± 17.2; p< .001). State University, Muncie, IN of information on objective sleep There was no change in total sleep measures in athletes. Objective: To time between the athletes and Context: Post-Professional athletic compare subjective and objective students. In addition, there was a training (PPAT) programs will be sleep measures of student athletes and significant difference in bed time implementing six competencies students enrolled at the same variability between football players within their programming, which are university. Design: Two groups, and students (football players = 74 currently assessed within other repeated measures design. Setting: All min± 33min; students= 40min ± healthcare professions. Students’ level sleep measurements occurred at each 32min; p=.023). Moreover, there of ability in these competencies needs subject’s residence. Participants: was a significant difference in wake to be assessed. Objective: To Thirteen healthy students from the time between football players and determine PPAT students’ perceived university population (5 males and 8 students (football= 09:18:47 am± abilities, importance, and females, height = 171.9 ± 9.1 cm, mass 01:07:52; students= 08:00:00 am± preparedness to implement concepts = 69.5 ± 9.2 kg, age = 21.3 ± 1.9 years) 00:45:35; p< .001). In addition, of the six educational competencies and 36 healthy male athletes from the athletes had a higher ESS score within their clinical practice. Design: university population (12 hockey compared to students indicating they Cross-sectional design. Setting: Self- players, 24 football players, height have more daytime sleepiness reported paper survey. Participants: = 183.3 ± 5.8cm, mass = 95.2 ± 17.7 (athletes= 7.9±3.6; student= 202 of 258 PPAT students (78.29%) kg, age = 21.3 ± 1.9 years) 4.8±2.7; p= .029). Conclusions: completed the survey (74 males, 128 volunteered for this study. Athletes have poorer sleep com- females, age=23.32±2.10yrs). Interventions: All subjects pared to students at the same Participants included 95 first-year completed a self report evaluation on university. The variability in the students, 91 second-year students, and sleep including the: SF-12, athletes’ bed time suggests that 16 students from a one-year Pittsburgh Sleep Quality Index the full schedule of the student program.Interventions: Participants (PSQI), Epworth Sleepiness Scale athlete might compromise their completed the survey in the Fall of (ESS), and received the Pittsburgh ability to get the proper amount of 2012. The survey consisted of three sleep diary and Actiwatch Score sleep. Considering the amount of sections for each identified (AS). All athletes wore the Actiwatch resources spent on coaching and educational competency: quality Score during a 5-day period in the conditioning, more studies are improvement(QI), professionalism competitive season and students needed to address athletes sleep (PROF), healthcare informatics(HCI), wore the AS during the semester. since it could affect performance. interdisciplinary collaboration(IDC), Both groups completed the sleep evidence-based practice(EBP), and diary every night before going to bed patient-centered care(PCC). Three and every morning upon awakening scales were used for each recording bed and wake times and competency: 1) participants rated their subjective sleep information. One- ability to incorporate concepts of each way ANOVA’s and paired sample t- competency within clinical practice, tests were used to analyze sleep 2) participants identified how efficiency (SE), total sleep time important they perceived each concept (TST), wake after sleep onset to be for implementation within their (WASO), sleep quality, fatigue upon clinical practice, and 3) participants awakening, and alertness upon reported how well they perceived their awakening (˜=0.05). Main professional undergraduate athletic

S-238 Volume 48 • Number 3 (Supplement) May 2013 13133MOIN

training program (ATEP) had prepared regarding the PROF(M1styear=3.41/ Perceptions Of Athletic Trainers

them for each concept. Each concept 4.0±0.29, M2ndyear=3.53/4.0±0.27, And Athletic Directors described an ability that was related to U=3331, p=.007) and EBP Regarding UIL Anabolic Steroid

the definition of the competency. (M1styear=3.26/4.0±0.31, M2ndyear=3.40/ Testing Reliability for each scale was found to 4.0±0.37, U=3244, p=.006) Creinin K, Vela L, McDonald J,

be extremely high: ˜ability=.955, competencies than first-year students. Awoniyi S: Texas State University,

˜ importance=.967, ˜preparedness=.971. Main Conclusions: Although PPAT students San Marcos, TX, and Edgewater Outcomes Measures: The survey are implementing the six High School, Orlando, FL consisted of Likert-scale items(range competencies within their clinical 1-4) and the number of concept practice, improvement occurs while Context: Texas Senate Bill (SB) 8 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 statements ranged from 8-18 for each enrolled in PPAT programs. Further mandates random anabolic steroid competency. Composite ability, research is needed to determine which testing of high school athletes to importance, and preparedness Likert- factors affect changes in competency improve athlete health and safety while scale scores were achieved by improvement within professional and costing the state $500,000 to 1 tabulating all values and then averaging post-professional programming. million dollars a year. No known the scores back to the Likert scale. research has been conducted on the Higher scores indicated that perceptions of the program by key participants perceived themselves to personnel enforcing the policy. have greater ability, that the concepts Objective: To assess the perceptions were more important for of Texas athletic trainers (ATs) and implementation in clinical practice, athletic directors (ADs) regarding the and that they perceived themselves to purpose, effectiveness, and necessity be more prepared. Descriptive of the current program. Design: Cross statistics (means, standard deviations, sectional survey. Setting: An internet- percentages) were reported and based survey with a six-week window between-group differences were and a 2-week and 4-week invitation calculated using Mann-Whitney U reminder. Participants: We randomly tests (P<.05). Results: Overall, selected 900 ATs and 1,020 ADs to participants reported they “agree” they participate. ATs were all certified or were able to implement the concepts associate members of D6 employed in of the competencies into their daily high school or clinic outreach settings. practice (QI=3.28/4.0±0.32, PROF= ADs were identified from the 2011- 3.46/4.0±0.29, HCI=2.92/4.0±0.43, 2012 Texas Sports Guide of High IDC=3.15/4.0±0.44, EBP=3.32/ Schools and Colleges. Interventions: 4.0±0.35, and PCC=3.20/4.0±0.37), A survey with 24 Likert-style and 8 and perceived the concepts involved in demographic questions was developed the QI(3.66/4.0±0.29), PROF(3.75/ with 2 content-matter experts (an 4.0±0.28), HCI(3.41/4.0±0.44), expert in health legislation and a IDC(3.65/4.0±0.34), EBP(3.64/ researcher of anabolic steroid use 4.0±0.36), and PCC(3.61/4.0±0.36) among adolescents). Three ATs and competencies to be “moderately three ADs were interviewed to assess important” to “extremely important” face validity. The survey addressed for implementation. While they perceptions in four areas: 1.) purpose perceived their professional ATEPs of mandatory anabolic steroid testing, “moderately prepared” them for the 2.) effectiveness of mandatory QI(3.18/4.0±0.41), PROF(3.36/ anabolic steroid testing and anabolic 4.0±0.39), IDC(3.13/4.0±0.53), steroid education programs, 3.) EBP(3.18/4.0±0.49), and PCC(3.14/ necessity of state regulated mandatory 4.0±0.49) competencies, 57% of anabolic steroid testing, and 4.) participants reported they felt knowledge of Senate Bill 8. Main “minimally prepared” regarding HCI. Outcome Measures: Dependent Second-year students perceived variables were the endorsements for themselves to have greater ability the questions, which were classified as

Journal of Athletic Training S-239 endorsed when the participant selected a rating of “agree” or “strongly agree”. Results: 140 (15.6% response rate) ATs (87 males, 53 females) and 187 (18.3% response rate) ADs (178 males, 9 females) responded to the survey. ADs were fairly distributed throughout Texas geographic locations and school sizes. ATs were fairly distributed throughout Texas Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 geographic locations, however most respondents were employed at a 3A or larger school. A small number of ATs (21.5%) and ADs (31.6%) believe that anabolic steroid testing, in general, is effective. A smaller number of ATs (19.3%) and ADs (28.6%) believed that Texas mandated anabolic steroid testing prevents anabolic steroid use among high school athletes. A greater number of ATs (49.3%) and ADs (65.6%) believed adult led education programs were effective in deterring anabolic steroid use. Only a small number of ATs (3.6%) and ADs (2.7%) believe that the Texas Legislature should be responsible for regulating testing or education programs in high school athletics. Conclusions: ATs and ADs perceive that anabolic steroid education programs are a more effective deterrent than random anabolic steroid testing and recent research evidence concurs with their perceptions. Given recent research findings and ATs/ADs perceptions, SB 8 should be re-evaluated. Changes could increase the practicality and effectiveness of a steroid prevention program by redirecting funding to evidence- based steroid education programs.

S-240 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Poster Presentations: Therapeutic Intervention 13318FONE 13159UOMU

Graded Talocrural Joint talocrural joint manipulation (Grade V; Shoulder Kinematics In Elite Mobilization Does Not Alter maximum of 2 attempts), talocrural Volleyball Players Following A Cortical Motor Excitability Of joint anterior to posterior Full Season Of Play The Soleus In Individuals With mobilization (Grade IV; 3 sets, 60 Brewer ME, Tucker WS: Chronic Ankle Instability oscillations), and a sham intervention University of Central Arkansas, Grindstaff TL, Morton SK, Dolan (positioning similar to Grade IV). Conway, AR, and SMART Sports N, Pietrosimone BG: Creighton Cortical motor excitability of the Medicine Center, Cheyenne, WY University, Omaha, NE, and soleus was determined by measuring University of Toledo, Toledo, OH the amplitude of a motor evoked Context: Changes to the shoulder Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 potential (MEP) following transcranial complex, such as postural impairment, Context: Ankle joint mobilization can magnetic stimulation. The intensity muscle length and scapular dyskinesis, influence lower extremity spinal was set at 120% active motor have been associated with shoulder reflex excitability in individuals with threshold with five MEPs obtained. injuries in overhead athletes. It is Maximal muscle response (M ) was chronic ankle instability (CAI). It is max unknown if changes in scapular possible that changes in cortical motor determined by delivering a kinematics are normal as a result of excitability occur in conjunction with percutaneous electrical stimulus, with participating in a full season of an changes in spinal reflex excitability. It incremental increasing intensity, to the overhead sport regardless of the is unknown if a higher intensity joint tibial nerve and measuring the maximal presence of shoulder injury. manipulation (Grade V) has a more peak-to-peak amplitude of the muscle Objective: To compare pre-season profound effect at altering cortical response with three measures obtained. and post-season scapular upward motor excitability than a lower Main Outcome Measures: The rotation (SUR), anterior scapular intensity mobilizations (Grade IV). average peak-to-peak amplitude of the position (ASP), glenohumeral internal MEP normalized to M (MEP/M Objective: To determine the effects max max rotation (IR) and glenohumeral of talocrural joint manipulation or ratio) and expressed as a percentage external rotation (ER) in elite mobilization on cortical motor was used for data analysis. A two-way volleyball players. Design: Within excitability of the soleus in individuals mixed model ANOVA was used to subject. Setting: Controlled compare changes in soleus MEP/M with CAI. We hypothesize that the max laboratory. Patients or Other Grade V mobilization will result in a ratio between interventions over time Participants: Sixteen female greater increase in cortical motor (pre/post intervention). Results: collegiate volleyball athletes were excitability than the Grade IV There were no significant differences recruited. Fourteen (18.9±1.1 y, mobilization and there will be no between groups when examining 174.9±5.8 cm, 70.7±10.2 kg) changes in soleus MEP/M ratio change following a sham intervention. max completed a full volleyball season and (F =0.16, P= .86) (Grade V Pre= Design: Randomized crossover 2,58 were included in the study. design. Setting: University research 2.71±1.10%, Post= 2.64±1.34%; Interventions: Static SUR was laboratory. Patients or Other Grade IV Pre= 2.83±1.37%, Post= measured at rest, 60ˆ, 90 and 120 of Participants: Twenty-eight parti- 2.52±0.98%; Sham Pre= 2.65±1.19%, humeral elevation in the scapular plane cipants (age=22.7±2.9 y, height= Post= 2.44±0.94%). Conclusions: with an electrical inclinometer. 173.9±9.1 cm, mass= 72.6±14.0 kg) Talocrural joint mobilization (Grade V Anterior scapular position was volunteered for this study. All and IV) did not alter cortical motor measured using the pectoralis minor participants had CAI which was defined excitability of the soleus individuals length test. With the participant in a as repetitive episodes of instability with CAI. Although talocrural joint supine position, the distance in and quantified by scoring less than mobilization has previously been centimeters from the table to the 85% on the Foot and Ankle Mobility reported to improve outcomes posterior aspect of the acromion Measure Sport subscale or at least 3 associated with CAI, the mechanism of process was measured with a modified on the Ankle Instability Instrument. effectiveness may not involve changes triangle. For IR and ER, participants Participants also demonstrated at least in cortical motor excitability. laid in a supine position with the a 5° deficit in ankle dorsiflexion shoulder abducted to 90 and the elbow compared to the contralateral ankle. flexed to 90ˆ. Maximum passive IR Interventions: Participants received and ER were measured with a digital each of the following interventions, in protractor placed in-line with the a randomized order, with at least 48 olecranon process and ulnar styloid hours between testing sessions; process. For each kinematic assessment, three trials were

Journal of Athletic Training S-241 13123UOPR performed and averaged on the Effectiveness Of Three- were randomized and disinfected using serving dominant arm prior to the Sanitation Techniques On one of three treatments (dish start of the pre-season (pretest) and Bacterial Growth On Athletic detergent/cold water, Colgate Total® repeated within one week after the Mouthguards After Activity toothpaste, UVC-light). The final match (posttest). The order of McLeod RL, Katch RK, Reinbold disinfected devices were swabbed, kinematic assessments was KE, Taylor ST, Berry DC, Castillo planted (SBA), and incubated for 24 randomized. The independent KH: Saginaw Valley State hours. In phase-4, the two sets of 30 variable was time (pretest and University, University Center, MI plates were evaluated for colony posttest). Main Outcome counts and appearance. The Measures: The dependent variables independent variable was treatment

Context: Observations during sporting Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 were the mean measurements for events suggest that athletic group. Bacterial colony growth and SUR at rest, 60ˆ, 90 and 120ˆ, ASP, mouthguards (device) are commonly count were dependent variables. Main IR and ER. The influence of time for dropped in the dirt/mud, stored Outcome Measures: Colony growths each dependent variable was improperly in dark, warm too numerous to count (TNTC) were compared using paired samples t- environments, and placed in areas on defaulted to the minimal threshold tests with an adjusted alpha level the body and equipment that are level of 300. Data was analyzed with (p<0.007). Results: There were no unhygienic. These potentially “dirty” descriptive statistics, and a repeated significant differences for SUR at devices are then placed directly back measures ANOVA (group X time rest (t13=0.270; P=0.791) within the into the athlete’s mouth. Objective: [initial, post-24, post-disinfected pretest (3.1±3.9°) and posttest Determine the degree of swab]) set a priori at 0.05 using SPSS (2.9±3.9°), 60 (t 13=-1.326; P= contamination on athletic mouthguards 20.0 Results: A repeated measures 0.208) within the pretest (9.1±3.6°) after routine use, and to evaluate the ANOVA revealed a significant main and posttest (10.3±4.9°), 90 (t =- 13 efficacy of three different disinfecting effect for time (F2,54=23.8, P < 0.001) 1.426; P=0.177) within the pretest methods in reducing bacterial on normal mouth flora colony counts. (22.1±4.6°) and posttest (23.8±4.4°) exposure to collegiate athletes. All groups decreased bacterial growth and 120ˆ (t 13=-0.859; P=0.406) Design: Cross-sectional, repeated from initial swab (260.0±103.7), to within the pretest (36.7±6.8°) and measures. Setting: Football practice post-24 (168.3±139.2), to post- posttest (37.9±5.0°). There were no setting and microbiology laboratory. disinfected (100.8±110.4). Results significant differences for ASP Participants: A convenience sample revealed no significant interaction or (t 13=1.760; P=0.102) within the of 30 collegiate male football players group main effect. In post-disinfected pretest (5.8±1.1cm) and posttest (age=20.4±1.4; height =187.6 swabbings, 100% of toothpaste, 81.8% (5.5±1.3cm), IR (t 13=-1.117; cm±9.5cm; mass= 109.2kg±21.9) free dish detergent/cold water, and 77.8% P=0.284) within the pretest of recent history of oral/dental UVC-light had growth. Majority of (67.3±8.2°) and posttest trauma. Interventions: The study organisms were normal flora; however, (69.1±10.9°) and ER (t13=-1.921; consisted of four phases. Phase-1, opportunistic bacteria accounted for P=0.077) within the pretest participants fabricated a “boil and bite” 50%, 33.3%, and 18.2% of the growth (136.1±10.7°) and posttest mouthguard following manufacture in the toothpaste, UVC-light, and dish (139.7±9.1°). Conclusions: recommendations, and then wore the detergent/cold water treatment groups, Participation in a full volleyball device for one 2 1/2 hour practice. respectively. Conclusions: If un- season does not appear to change Phase-2, devices were collected post- sanitized, mouthguards may be a SUR, ASP, IR and ER in elite practice, placed in labeled, quart- possible vector for bacterial growth. volleyball players. Clinicians should plastic bags (preventing cross Of the three interventions, dish consider these results when contamination), and delivered to the detergent/cold water appeared to be comparing physical exam microbiology lab. The devices were the more effective in reducing the findings before, during and after a aseptically swabbed and planted on opportunistic bacterial growth. season. Future research should sheep blood agar (SBA) plates, and However, more research is warranted investigate the shoulder kinematics incubated at 37ˆC for 24 hours. on a larger sample size. of overhead athletes over the Devices were returned to the plastic course of multiple seasons. bag, placed in a “sports” bag, and stored at 23°C for 24 hours. After 24 hours, the devices were again swabbed, planted (SBA), and incubated for 24 hours to begin phase-3. The devices

S-242 Volume 48 • Number 3 (Supplement) May 2013 13443FOIN 13403FC

Prevalence Of Staphylococcus (7%), from the wood steps on 11 Using Implement Soft Tissue Aureus And MRSA In And days (73%), from the neoprene toe Mobilization Technique And Around A Therapeutic Whirlpool caps on 13 days (87%), from the Laser To Treat Lateral In College Athletic Training water on eight days (53%). We also Epicondylitis Room identified Staphylococcus aureus Demchak TJ, Steppe E: Indiana Kahanov L, Eberman LE, Young from drain and water on two of State University, Terre Haute, IN K: Indiana State University Terre the days (13%). A statistically Haute, IN significant difference existed between the number of athletes using Background: A 42 year old female

Context: Community-associated the whirlpool and the presence of surgical technology student Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 methicillin resistant Staphylococcus Staphylococcus aureus in and complained of pain in her elbow after aureus (CA-MRSA) has become a around the whirlpools (F2,238=2.445, completing surgical technology leading cause of skin and soft tissue p=0.007). However, Staphylococcus externship. Patient spent 6-10 hours infection in the non-hospitalized aureus was identified regardless per day gripping instruments for community. Care for the athletes in of the number of athletes using surgery. The patient reported pain over athletic training rooms (ATR) is the whirlpool. We did not identify left lateral epicondyle and no specifically designed with equipment a significant relationship between the neurological symptoms in the hand or tailored to the health care needs of the number of athletes whirlpool and forearm. Palpation over lateral athletes; yet recent studies indicate Staphylococcus aureus/MRSA epicondyle increased pain as well as that CA-MRSA is still prevalent in density (p=0.134). Conclusions: resisted wrist extension and ulnar athletic facilities and that cleaning The identification of Staphylococcus deviation. Grip strength was 20 pounds methods may not be optimal. aureus and MRSA throughout the for the left hand and 40 pounds for the Objective: To assess Staphy- day and 24 hours after closing right hand; pinch strength was 25 lococcus aureus and CA-MRSA cleaning procedures suggests pounds bilaterally. Differential prevalence in and around whirlpools whirlpools and related structures Diagnosis: Lateral epicondylitis, wrist in the ATR. Design: Observation. should be cleaned and disinfected extensor strain. Treatment: Physician Setting: Division I Midwestern regardless of number of athletes diagnosed patient with lateral University. Parti-cipants: Student- using a whirlpool and on a routine epicondylitis. During the initial athletes (n=109) consisting of 46 basis throughout the day. According treatment (8/7/2012) the patient‘s men (42%) and 63 women (58%) to CDC guidelines for environ- forearm and elbow were heated with from 6 sports, participated in the mental infection control in health an electric heating pad set at 126o F study. Main Outcome Measures: care facilities-hydrotherapy tanks for 10 minutes. After heating the The study assessed the presence of and pools, draining and cleaning of patient receive Implement Soft Tissue MRSA and Staphylococcus aureus the whirlpool after each patient’s use Mobilization Technique (IASTM) in and around the whirlpool with EPA-registered products are treatment using three instruments for structures relative to the sports and recommended. However, draining 10 minutes over the flexor and number of athletes using the and cleaning of whirlpools after each extensor muscle groups and tendons, whirlpools. Results: We identified patient did not occur during data pronator terres, and around the right Staphy-lococcus aureus in 22% collection, nor is it traditional elbow. Four strokes were used (n=52/240) of the samples and practice in a collegiate ATR. including sweeping and fanning the MRSA in 0.8% (n=2/240) samples. Transmission of the bacteria can be area to detect and treat fascial Thirteen (22%) samples tested reduced by following the Center for restrictions, framing around the boney positive for Staphylococcus aureus Disease Control and Prevention structures and light brushing was used in the opening shift, seven (11%) recommended cleaning and over the lateral epicondyle to decrease from the pre-practice shift, and 32 disinfecting protocols. Athletic pain. Fascial restrictions were mainly (28%) from the post-practice shift. Trainers should use registered found in the flexor muscle group and Two (1.7%) samples tested positive disinfectants to sanitize sanitation all pronator terres. After the treatment, for CA-MRSA in the post-practice whirlpools between uses. Key the patient completed wrist flexion and shift from the drain and water. Over Words: Cleaning, Center for extension stretches 3 x 30 seconds the course of 15 days, we identified Disease Control and Prevention with arm fully extended. The patient Staphylococcus aureus from drains Recommendations, Sanitizing, Infection was then treated with Laser-stimulation on two days (13%), from the agitator set at super pulsed 25 W laser (905 head and turbine switch on one day nm) 5-1000 Hz, 4 Infrared (660nm),

Journal of Athletic Training S-243 13154OOTE for 5 minutes over the lateral Clinical Outcomes Of Platelet outcome variable was the paired epicondyle and forearm and 50 Hz for Rich Plasma Injection In differences of IKDC scores (pre- 5 minutes over the cubital fossa to Patients With Patellar injection to post-injection) for each increase blood flow to the elbow. The Tendinopathy Following ACL patient assessed with the Wilcoxon patient was instructed to perform wrist Reconstruction Signed-Rank Test (pd”0.05) and flexion and extension stretches at Taggart KE, Wilson JJ, Baer GS, reported as the median (inter- home and ice as needed. During the McGuine TA: University of quartile ranges [IQR]: 25th and 75th). second visit, two weeks later (8/23/ Wisconsin-Madison, Madison, WI A difference of 12 points in an 2012), the patient reported pain had individual subject’s IKDC score decreased for 2 days after the first indicates a significant change.

Context: Anterior Cruciate Ligament Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 treatment, but had returned. The second (ACL) reconstruction utilizing a Results: IKDC pre-injection values treatment was the same as the first patellar tendon autograft can cause were (48.3 [44.3, 60.3) while post- heat, IASTM technique and stretching, Patellar Tendinopathy (PT) in patients, injection values were (74.7 [52.9, however, the Laser treatment was leading to decreased function, inability 82.8]). The post-injection scores changed. The Laser treatment utilized to return to prior levels of activity, and were significantly higher (13.8 [1.1, the LASER Shower consisting of six reduced patient satisfaction post- 33.0]) (p = 0.02). Seven (64%) 50W Laser diodes (905 nm) and four operatively. In situations where patients showed significant 25W Infrared diode (660nm)and the conservative treatment has not improvement in their IKDC scores, settings were 5-250 Hz ( anti- provided pain relief, platelet-rich while four (36%) patients showed no inflammatory effects ) for 5 minutes plasma (PRP) injection has been significant change. Conclusions: over the lateral epicondyle and 50 Hz proposed as an additional treatment to PRP injection may be a viable for 5 minutes over the cubital fossa. help augment patellar tendon healing treatment option for patients with PT The patient report her pain had to alleviate pain and improve function. following ACL reconstruction with decreased when she left the clinic. To date, little data exists that a patellar tendon autograft. Upon arriving at her third treatment (8/ documents changes in knee function 28/2012), the patient reported pain was following PRP injection for PT only a 3/10. The patient received the following ACL reconstruction. same treatment as last visit, and added Objective: Document changes in self- 50 repetitions of the following reported knee pain and function for exercises, wrist flexion and extension patients treated with single with 2 pounds and supination and intratendinous PRP injection for PT pronation with a green flex bar. An following ACL reconstruction. addition laser treatment to decrease pain Design: Prospective case series. was added (1000 Hz for 5 minutes over Setting: Sports medicine clinic. the C5-C6 nerve root). The patient was Patients or Other Participants: iced using a commercial ice pack for 10 Eleven patients (9 females, 2 males; minutes post exercise. The patient average age = 19 ± 2.19 years) with reported that she was pain free when she chronic PT recalcitrant to multiple left. The patient came to her last visit on conservative treatments (physical 8/30/2012 and reported her elbow was therapy, NSAIDS, rest, iontophoresis) pain free. She was treated with heat, wrist following an ACL reconstruction flexion and extension stretches, utilizing a patellar tendon autograft. exercises, and laser treatment as Interventions: Each patient was described for the previous visit. The diagnosed with PT and received an patient self discharged at the end of the intratendinous PRP injection of the visit, therefore final grip strength proximal patellar tendon. Injections measures were not obtained. were performed 34.8 ± 17.1 weeks Uniqueness: Patient was pain free after post-ACL reconstruction. Each patient only three treatments utilizing the completed the 2000 International combination of IASTM and laser Knee Documentation Committee treatments. Conclusions: The (IKDC) at pre-injection and at 29.5 ± combination of IASTM and Laser are 17.7 weeks post-PRP injection. Main effective in treating lateral epicondylitis. Outcome Measures: The primary

S-244 Volume 48 • Number 3 (Supplement) May 2013 13357UC 13335FOTH

Osteo Chondral Defect 5 minute treatment at 5-1000 Hz Deep And Superficial Successfully Treated With over the medial condyle and a 5 Quadriceps Heating Using LASER minute 50 Hz treatment over the Continuous Shortwave Steppe E, Demchak TJ: Indiana popliteal fossa to increase blood Diathermy At Two Different Duty State University. Terre Haute, IN flow to the knee. Treatment 1 (7- Cycles 10-12) Laser treatment plus Trowbridge CA: The University of Background: A forty year old commercial ice pack for 10’; Texas at Arlington, Arlington, TX female house wife presented to the Treatment 2 (7-17-12) Patient free rehabilitation clinic reported her knee felt better for 2- 3 days after initial laser treatment. complaining right anterior medial Context: Shortwave diathermy (SWD) Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 knee pain. The patient was unable to However, the patient reported she has traditionally been delivered via a determine mechanism of injury. Pain re-injured her knee closing a door drum and large machine; however, new started one month prior to evaluation on 7-16-12. Pain was great enough technology uses circumferential and increased with stair climbing and to have the knee buckle (9/10). The sleeves and portable units to deliver washing the floors. The patient wore patient reported a pain decreased energy. SWD is used for heating deep a compression wrap for 1 month immediately after laser treatment tissue for pain relief, spasm reduction, prior to appointment, but it did not (6/10). Treatment 3 (8-7-12) The and/or improvement in tissue help. Pain level was 7/10 during the patient reported she only had pain compliance; however, we still lack data initial evaluation. Palpation: in the knee when she was not regarding the relationship of intensity Tenderness was noted anterior and wearing the compression wrap, and duration to treatment outcomes. medial knee and thigh around the otherwise pain 0/10. Palpation of Objective: To investigate the heating VMO insertion and medial femoral medial condyle did not elicit pain. of two continuous SWD (50% and condyle. Observation: No swelling Treatment 4 (8-14-12) The patient 100%) settings on both superficial and in knee was observed. Knee Active reported knee Pain 0/10 even deep tissue heating. Design: Within Range Of Motion was within without knee wrap. She stated that repeated measure crossover design. normal limits. Resisted range there was a slight ache. Setting: Controlled laboratory motion – Right knee Flexion 4/5 Immediately after the laser setting. Participants: Twenty-five pain; Extension- 4/5 pain, Left treatment the patient reported no males (n=14) and females (n=11) (age knee Flexion 5/5, extension 5/5. pain or ache in the knee. The = 25±5 years, mass = 80±16 kg, height The following ligamentous tests patient reported she was able to = 174± 9cm, distal thigh skinfold = were negative: Lachman’s; perform all activities of daily 15.8±9mm) volunteered for study. All Posterior Drawer; and Varus/ living without knee wrapped. had no current injury involving their Valgus. Wilsons test for Wilson’s test was negative and thighs or knees. Interventions: osterchondral defects of the knee knee flexion and extension Thermocouples were inserted into was positive and Thessaly’s test strength was 5/5 bi-laterally. The both distal and proximal vastus lateralis for a meniscus tear was negative. patient discharged herself at this muscles using a 1.16 in and 1.88in 20g Differential Diagnosis: Osteo time. Uniqueness: Pain level catheter needle, respectively. The Chondral Defect; Subchondral decreased significantly after one proximal thermocouple was inserted Cyst. Treatment: X-Ray laser treatment and was completely to an absolute depth of ~4 cm from the impressions were a subchondral alleviated with just four laser skin surface (4.0±0.1cm) and the distal cyst versus osteochondral defect treatments over five weeks. Ice thermocouple was inserted 1.5 cm medial femoral condyle; physician was applied during the initial visit, below the subcutaneous adipose layer diagnosed as osteochondral but not thereafter. Conclusions: (~2.3±0.4cm depth). The thermo- defect. The patient was treated LASER is a viable non-invasive couple was interfaced through an four times with low level laser treatment to reduce pain and Isothermex®. Two counterbalanced over a 5 week period. The low level increase function in patients with conditions using theRebound™ laser used a LASER Shower an osteo chondral defect. continuous shortwave diathermy consisting of six 50W Laser (CSWD) unit were compared diodes (905 nm) and four 25W including (1) 50% duty cycle/35 Infrared diode (660nm). Each day minutes and (2) 100% duty cycle/35 the patient was seated on edge of minutes. The CSWD was delivered at treatment table with her knee bent 13.1 MHz using standard thigh sleeve. to 90o of flexion. She received a Main Outcome Measures: Baseline

Journal of Athletic Training S-245 13460FOTH

(TB), skin surface (TSKIN), Effects Of Applied Pressure On depth of 1.5 cm below the surface of superficial and deep intramuscular Intramuscular Temperature the skin. Main Outcome Measures: (SupTIM; DeepTIM) temperatures During Ultrasound Treatments Intramuscular temperature probes (°C). Two separate 2 x 11 (condition x Krasinski D, Thrasher A, Miller were used to measure triceps surae time) repeated measures ANOVAs with MG, Holcomb WR: Western temperature and the time required to eleven levels of time (Start, 5, 10, 15, Michigan University, Kalamazoo, increase temperature to the four 20, 25, 30, 35, post5, post10, post15 MI, and The University of Southern temperature intervals was determined. minutes) investigated changes in skin Mississippi, Hattiesburg, MS A two within repeated measures surface and both SupTIM and analysis of variance (RM-ANOVA) was DeepTIM. Alpha wasset apriori at 0.05. used to analyze the differences in time

Context: The magnitude of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Results: There was no difference intramuscular temperature increase for each pressure (200 g, 600 g, and (p>0.05) in TB at each temperature during therapeutic ultrasound is 800 g) that it took to reach critical site between conditions (Skin: dependent upon depth, frequency, and temperature points (baseline, 0.5oC, 32.1±0.2°C; Superficial: 35±0.1°C; intensity. These variables have been 1.0oC, 1.5oC and 2.0oC). Results: Deep:36.6 ±0.1°C). There was a studied widely. Another potential There was no significant interaction condition x time interaction for TSKIN variable that could affect the rate of between time and pressure (p<0.001) and SupTIM (p<0.001), but temperature elevation is the pressure (F(8,96)=1.494, P=.169). The time no interaction or main effect for that is applied to the transducer head required to raise temperature 2oC was DeepTIM. Both TSKIN and SupTIM during application. Added pressure 209.1± 104.3s with 200 g, 181.5± increased significantlyover treatment could compress the tissue affecting 123.7s with 600 g, and 194.9± 90.9s time. The 95% CIs were 38.3-38.9°C density and the transmission of with 800 g. Conclusions: Under the (Skin), 38.3-38.8°C (SupTIM), 37.2- ultrasound energy. Little research has conditions of this study, the amount of 37.8°C (Deep TIM) after 35 minutes been completed to determine the pressure applied with the ultrasound of treatment using 100% duty cycle. effects of the amount of pressure transducer head during an ultrasound The 95% CIswere 36.5-37.2°C (Skin), applied during therapeutic ultrasound. treatment does not ultimately affect 36.8-37.4°C (SupTIM), 36.9-37.3°C Objective: To determine the effects the rate of tissue heating. (Deep TIM) after 35 minutes of of different applied transducer treatment using 50% duty cycle. pressures on intramuscular Conclusions: Intensity of energy does temperature during an ultrasound determine amount of heat transfer and treatment within the left triceps surae. overall tissue heating when using Design: Crossover Clinical Trial. CSWD. Both 50% and 100% settings Setting: Human Performance were effective in heating skin and the Research Laboratory. Participants: superficial muscle above baseline Convenience sample of thirteen levels as early as 5 minutes after healthy, college-aged students (M=5, treatment began. Therapeutic levels of F=7, Height: 170.03±9.86 cm, Mass: heating wereachieved at both skin 71.96±16.2 kg, Skinfold: 12.79±5.5 surface and superficial muscle sites as mm, Calf circumference: 35.5±6.9 increases greater 1°Cwere seen at cm) free of lower leg injury for the these sites across both duty cycles. previous six months and no known contraindications to ultrasound volunteered to participate. Interventions: Three separate 3MHz, 1.0W/cm2 ultrasound treatments were administered to the triceps surae, using weights on the transducer head of: 200 g, 600 g and 800 g. Treatments were within subjects and order was counter-balanced. The independent variable was pressure applied by the transducer head. The dependent variable was time required to raise temperature 0.5, 1.0, 1.5 and 2oC at a

S-246 Volume 48 • Number 3 (Supplement) May 2013 13188MOTH 13324OONU

Effect of Lidocaine Monofilaments (SWM). Clinician 2 NCAA Division I Soccer Players’ Phonophoresis With Hydrogel administered the assigned intervention Use Of Over-The-Counter Pain Dressing On Cutaneous before clinician 1 returned to Relievers Anesthesia After Varying complete follow-up skin sensation Lins LAB, Plos JM, Polubinsky RL, Treatment Times measurements at 0-, 15-, and 30- Wigglesworth JK: Western Illinois Hix RI, Rupp KA, Saliba SA, Hertel minutes post-intervention. Main University, Macomb, IL J: University of Virginia, Outcome Measures: Skin Charlottesville, VA anaesthesia (grams) measured with Context: Athletes regularly use over- SWM (larger force values indicate the-counter (OTC) pain relievers in decreased skin sensation). SWM

Context: Phonophoresis is a addressing pain. The use of pain Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 therapeutic modality used to treat soft force is presented as mean ± standard relievers by professional soccer tissue injuries by combining deviation. Wilcoxon Signed Ranks players has been studied; however, the therapeutic ultrasound with a topically tests were used to compare skin prevalence, attitudes, and behaviors applied medication preparation. anesthesia by group and by time. related to the use of pain relievers by Application of a thin hydrogel dressing Results are presented as median collegiate soccer players are unknown. over the topical medication (interquartile range). Results: Pulsed Objective: To examine the attitudes preparation may allow for better phonophoresis caused significantly and behaviors of NCAA Division I medication absorption through the decreased sensation immediately collegiate soccer players regarding skin. Additionally, alterations in post-intervention [0.70 g (0.41, 1.19), their use of pain relievers. Design: intervention dosage may affect P=.007], 15-minutes post-inter- Cross-sectional study. Setting: intervention efficacy. Objective: To vention: [0.70 g (0.41, 1.19), P=.001], Emailed survey. Patients or Other determine changes in skin anesthesia and 30-minutes post-intervention: Participants: Fifty-one Division I on the anterior forearm after 3 [0.70 g (0.41, 0.70), P=.005] soccer players from 7 of 16 Summit different phonophoresis interventions compared to baseline [0.41 g (0.17, League Conference teams responded using 2% lidocaine hydrochloride 0.70)]. Continuous phonophoresis (29%). Interventions: Participants aqueous gel covered with a hydrogel caused significantly decreased skin completed a 24-item survey with dressing. Design: Randomized, sensation immediately post- multiple subsets of questions. The double-blind, crossover study. intervention [0.70 g (0.41, 1.19, survey was a modified version of the Setting: Laboratory. Patients or P=.011] and 30-minutes post- “Over-the-Counter Drug Screen for Other Participants: 15 healthy intervention [0.70 g (0.41, 1.19), Athletes Survey” (Wolf, 2006) and had subjects (9 females, 6 males; age: P=.027] compared to baseline [.0.41 a Cronbach’s Alpha of 0.699. Main 21.8±2.9 years; height: 170.8±7.2 cm; g (0.17, 0.70)]. Sham phonophoresis Outcome Measures: Frequencies mass: 72.7±18.2 kg) volunteered to caused significantly diminished skin and chi-square (X2) analyses were used participate. Interventions: All sensation 15-minutes post- to assess current attitudes, behaviors, subjects received 3 interventions over intervention [0.70 g (0.41, 1.19, and relationships between factors. The 3 sessions separated by at least 24 P=.003], and 30-minutes post- main outcome measures included hours. Interventions included intervention [0.70 g (0.41, 1.19), knowledge of drug classifications, continuous phonophoresis: 1 MHz, P=.005] compared to baseline [0.41 g knowledge of drug effects, label 1.0 W/cm2, 5 minutes, continuous duty (0.17, 0.41)]. Conclusions: While all reading, use of recommended dosage, cycle (100%); pulsed phonophoresis: 3 treatments reduced skin sensation origin of decision for use, reasons for 1 MHz, 1.0 W/cm2, 25 minutes, pulsed post-intervention, there were no use, and communication on proper duty cycle (20%); sham: 0 MHz, 0.0 significant differences between the use. Results: Drug classification W/cm2, 25 minutes. All 3 interventions 3 interventions at any time point. knowledge was minimal regarding used 2 cc of 2% lidocaine The continuous motion of the ibuprofen (41%), naproxen sodium hydrochloride gel covered with a transducer head simulating a massage (28%), aspirin (26%), and hydrogel dressing for the duration of may be responsible for the reduction acetaminophen (22%). Knowledge of intervention. Interventions were in skin sensation. When a clinical drug effects was moderate-high randomly assigned, and both the application for using phonophoresis regarding use of pain relievers with assessor and patient were blinded to is needed to decrease skin sensation, alcohol (80%), taking higher doses intervention order. Clinician 1 marked the continuous treatment is more than recommended (78%), and larger the treatment area, cleaned the skin, clinically applicable and as effective athletes requiring higher doses for and recorded pre-intervention skin as the pulsed and sham treatment. same effects (65%). Label reading sensation using Semmes-Weinstein was minimally practiced with 21%

Journal of Athletic Training S-247 13169MOTE reading labels every time pain The Use Of Biofeedback In muscle as the (contracted ratio – relievers were used, 28% reading Individuals With Low Back Pain resting rato )/resting ratio. Data were labels before the first use only, and Partner SL, Acocello S, Sutherlin not normally distributed therefore 15% never reading label directions. MA, Saliba SA, Hart JM: were used Mann-Whitney U tests to Use of recommended dosage University of Virginia, compare groups at baseline and after identified 64% using the Charlottesville VA exercise. Wilcoxon-signed ranked recommended dose or less, 32% tests were used to compare baseline taking more than the recommended Context: Patients with recurrent non- with post-exercise for each group. dose, and 4% being unaware of specific low back pain (NSLBP) often Results: There were no TrA PAR recommended doses. A significant differences between groups at baseline

have difficulty activating the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 2 correlation (X (4) =11.66, p=0.02) transversus abdominus (TrA) and (exercise only 0.02±0.07, exercise between reading label directions and multifidus (MF). Patients may benefit with biofeedback 0.06±0.05, p=0.29) taking more than the recommended from clinician-derived biofeedback or after exercise (exercise 0.08±0.17, dose was indicated. Origin of decision including verbal, visual, and tactile exercise with biofeedback 0.12±0.06, for use revealed self (77%), athletic cues while performing exercises. p=0.33). The TrA PAR increased pre trainer (11%), parents (9%), and Objective: To compare TrA and MF to post test following exercise with physician/pharmacist (4%) as the preferential activation ratio (PAR) in biofeedback (pre 0.06±0.05, post determining source. Reasons for use individuals with NSLBP before and 0.11±0.06, p=0.03), but not after indicated sports-related pain (81%), after directed exercises while exercise only (pre 0.02±0.07, post anticipation of pain (66%), and to providing visual, verbal and/or tactile 0.08±0.17, p=0.24) There were no MF avoid missing a practice/game (40%). biofeedback. Design: Controlled, PAR differences at baseline Communication on proper use was randomized study Setting: Laboratory (exercise 0.06±0.05, exercise with provided by the athletic trainer every Patients or Other Participants: biofeedback 0.10±0.09, p=0.36) or time (53%), sometimes (22%), first Twenty, asymptomatic subjects with after exercise (exercise 0.09±0.06, time only (19%) and never (6%) when history of recurrent NSLBP exercise with biofeedback providing the athlete a pain reliever. participated (11M/9F, age 23±4 years, 0.09±0.06, p=0.76). There were no Conclusions: There is evident misuse height 165.26±12.90 cm, mass changes from baseline to post and lack of knowledge regarding OTC 74.74±15.84 kg, current Oswestry low exercise with biofeedback (pre pain relievers and proper usage back pain scale=11.35±4.00). 0.08±0.07 post 0.09±0.06, p=0.46). amongst collegiate soccer players. Interventions: Subjects were Conclusions: TrA PAR increased Based on these results, the health of randomly allocated to one session of after a session of directed exercises athletes must be addressed as it directed exercises with verbal with verbal cueing. The addition pertains to use of OTC pain relievers. instructions (exercise only: n=10) or of tactile and visual biofeedback It is recommended that educational verbal instructions while patients techniques did not have an additive opportunities be established to inform observed muscle thickness changes effect. MF activation did not athletes about the effects and proper using real-time ultrasound (US) and improve after a session of directed usage of OTC pain relievers. pressure cuff biofeedback (exercise exercises. Verbal biofeedback with biofeedback: n=10). Verbal may improve TrA contractions in instructions included cueing to individuals with NSLBP. perform a supine abdominal drawing- in maneuver for TrA and lifting the tailbone to the ceiling while prone for a MF contraction. Main Outcome Measures: We calculated as the thickness ratio for the TrA relative to the abdominal wall (TrA+external and internal obliques) in the rested and contracted states using real-time ultrasound. We also calculated the thickness ratio of the deep portion of the MF relative to the entire MF in both the contracted and rested states. The PAR was calculated for each

S-248 Volume 48 • Number 3 (Supplement) May 2013 13303FOIN 13455OOHE

Athletes’ Attitudes On intercoder agreement as described by Athletic Trainer’s Perspectives Treatment Seeking, Injury Mason (2002). Results: No On Health Care Access Barriers Reporting, And Severity Of And statistically significant differences Of Injured/Ill Adolescent Athletes Playing With Injuries were found between men and women Hardy A, Vela LI: Texas State Granquist MD: University of La on quantitative items. 1) Do you University, San Marcos, TX, and Verne, La Verne, CA always seek treatment for your sport Channelview ISD, Channelview, injuries? [yes = 103 (72.5%), no = 39 TX Context: Athletes’ reporting and (27.5%)]; themes: optimal seeking treatment for injuries performance, injury healing, advice/ Context: The health care access clearance from medical staff, playing influences the care athletic trainers barriers (HCAB) model has been used Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 can provide. Sport ethic and the culture time, injury severity. 2) When injured, to identify community factors of risk associated with sports may do you report the injury to medical affecting individual’s health care influence these behaviors (Nixon, staff? [(yes = 125 (88%), no = 17 access (financial, structural and 1994). Objective: The objective of (12%)]; themes: pain/injury severity, cognitive), but little research has been this study was to explore athletes’ optimal performance. 3) Does the documented on ways to modify health attitudes related to reporting of and severity of the injury determine if you care access barriers and their impacts seeking treatment for injuries, on report it to medical staff? [(yes = 117 in adolescent athletes. Objective: To determination of severity of injuries, (82.4%), no = 23 (16.2%), no report understand possible HCABs and their and on decisions to cease play due to = 2]; themes: pain, optimal impacts on injured/ill adolescent injury. To meet this objective, performance, previous injury athletes from the perspectives of participants were asked questions in experience. 4) The following themes athletic trainers. Design: Qualitative four categories: 1) treatment seeking, emerged related to being too injured methodology. Semi-structured focus 2) injury reporting, 3) injury severity to play: pain, optimal performance, group interviews were conducted to determination, 4) ceasing play. advice/clearance from medical staff. identify athletic trainer’s perspectives Design: Cross-sectional, mixed- Conclusions: Participants were and personal experiences with methods. Setting: NCAA DIII generally comfortable reporting and adolescent athletes with HCABs to University. Patients or Other seeking treatment for injuries, create a descriptive model. Setting: Participants: Student-athletes in fall/ specifically to athletic trainers. The first focus group took place in a winter sports were recruited as Participants who were reluctant confidential meeting room at the PIs participants; 142 student-athletes (90 to report or seek treatment institution while the second and third men, 52 women; mean age 19.7 years) identified factors related to playing occurred at a regional athletic training from soccer, basketball, volleyball, time. Interestingly, participants conference. Patients or Other and football provided responses. based their reporting and their Participants: Twenty-two licensed Thirteen participants reported no seeking treatment on lack of optimal and/or certified Texas athletic trainers previous injury, 79 reported sustaining performance. Based on these (12 males, 10 females; experience = a minor injury, 56 a moderate injury, findings, athletic trainers should 12.9±9.8 years; range, 3-32 years) and 21 a severe injury (participants continue to build positive rapport with full-time positions employed as may have reported multiple injuries). with their athletes, and should an athletic trainer in a middle school Data Collection and Analysis: take care to educate athletes about or high school and at least 3 years of Following IRB approval and informed pain and injury related to athletic administrative work experience were consent, participants provided written performance. Future investigations purposively sampled to participate in responses in a classroom setting should explore psychosocial one of three focus group interviews. during pre-season. Descriptive and factors related to injury reporting Focus groups were completed until inferential statistics were calculated and treatment seeking, so that data saturation occurred. Five athletic for quantitative items; hierarchical strategies can be implemented trainers (4 males, 1 female; experience content analyses were conducted for to enhance athlete care. = 19±13.1 years; range, 3-32 years) qualitative items. Hierarchical content participated in the member-check analyses proceeded through the use of individual interviews to establish inductive and deductive techniques in trustworthiness. Data Collection and order to group meaningful text Analysis: Focus group interviews segments (i.e., quotes) into raw were conducted by the principal themes, and more general abstract (i.e., investigator face-to-face and were higher order) themes through audio-taped and transcribed verbatim. The HCAB model was used to derive

Journal of Athletic Training S-249 13F19DOCE the interview guide questions and we M1 Macrophages Are Active As per 0.60mm2 and 5.25± 1.25 per (AH & LV) individually analyzed Early As Six Hours Following 0.60mm2 respectively). General interviews using a framework analysis. Eccentric Exercise: A Pilot cellular infiltration measured by Trustworthiness was established using Study H&E was significantly higher in the member checks and analyst Waters-Banker C, Swann W, 6hr compared to the 24hr group triangulation. Results: We confirmed Butterfield TA: University of (43.0±6.0 and 16.13±2.88 the presence and impacts of the 3 Kentucky, Lexington, KY respectively, p=0.04). Conclusions: barriers, financial, cognitive, and Traditional models of muscle structural, in the HCAB model. Context: Recent studies have exposed regeneration utilize supra- Financial barriers were represented by physiologic means of muscle injury

potential influences of massage at the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 limitations with general insurance, cellular level however, a lack of sound (e.g. freeze injury or cardiotoxin issues with uninsured athletes, and scientific data to support the efficacy injection). These models have restrictions specific to state/ of massage remains. Objective: predominantly shaped our view of government/school funded insurance. Assess the effects of massage on the the time course associated with the Structural barriers were problems with temporal inflammatory response inflammatory response. The influx transportation, parent availability and following damaging eccentric exercise of M1 macrophages has largely been communication problems, and (EEX). Design: Cross-over control reported to take place at 12hrs post healthcare infrastructure constraints. study. Setting: Performed in a injury, however our pilot data show Cognitive barriers related to problems controlled laboratory environment. selective fiber infiltration/ with understanding insurance policies, Subjects: Four maleWistar rats, damagemediated by M1ˆs as early knowledge about condition/injury and divided into two groups: 6-hour as 6hrs. Macrophages are incredibly prevention, and language barriers and (n=2) and 24-hour (n=2). Inter- plastic cells, influenced by the local literacy. A new barrier, sociocultural ventions:Nerve cuff electrodes micro-environment, and have the beliefs and expectations, was were surgically implanted on the ability to transition phenotypes discovered from the interviews when peroneal nerve of each limb. Animals between anti- and pro-inflammatory problems with obligation beliefs, fear were provided one-week of recovery mediators. Our unique in vivo model of deportation, and health care system time to reduce any confounding most closely resembles muscle beliefs were noted. All barriers were inflammatory effects of the surgery. injury, and allows for the careful associated with negative impacts: Each limb underwent a single bout of temporal analysis of the immune changes in source of care, time of eccentric exercise. Immediately response inregards to various presentation, quality of care, and following exercise, the right limb of immuno-modulatory treatments like prevention. A new modified model, the each animal received a 30- min bout massage. Although small group HCAB-AT model was generated from of massage using a customized numbers prevented inferences the findings. Conclusions: Our results cyclic compressive loading device based on statistical analysis at this will help athletic trainers and other (massage memetic). Rats were time, this observationin genetically health care providers find possible sacrificed based on respective group identical animals is likely accurate. solutions for barriers to minimize the time point (i.e. 6hrs or 24hrs). Therefore, M1 macrophage effects of the barriers on athletes and/ Tibialis Anterior muscles were activation as early as 6hrs or families. Future researchers can harvested and cryogenically following injury, is an important examine health care outcomes preserved for tissue analysis. Cells finding that may shape the disparities of adolescent athletes and/ counted using random stereological current dogma associated with or families and experimentally point counting. Main Out- macrophage action, the understand how the impacts can comeMeasures: Identify cellular inflammatory response, and growth deleteriously affect them. infiltration of neutrophils, M1, and and regeneration of skeletal muscle. M2 macrophages utilizing immunohistochemistry techniques. Quantify general cellular infiltration utilizing H&Estaining. Results: The most notable result from this pilot investigation was theidentification of M1 macro-phages at 6hrs following EEX and EEX+Massage in all limbs the 6hr group (0.75±0.75

S-250 Volume 48 • Number 3 (Supplement) May 2013 13391FOTE 13397MOHE

Acute Response Of High- and were evaluated using one-way Feasibility Of Conducting A Intensity And Traditional ANOVA with repeated measures (i.e., Web-Based Survey Of Patient Resistance Exercise On baseline, post-HIT, and post- Reported Outcomes And Anaerobic Power traditional RT bouts). Results: Rehabilitation Progress Pettitt RW, Austad MA, Gay CR, Neither HIT (269.2 ± 51.3 W) nor Meade AR, Mattacola CG, Murray SR, Sexton PJ: Minnesota traditional RT (275.1 ± 51.3 W) Toonstra JL, Howard JS: State University, Mankato, MN, and evoked depreciations (P > 0.05) in Cedarville University, Cedarville,

Mayo Clinic Health System- P150 s from the baseline (275.1 ± 45.4 OH, and University of Kentucky, Mankato, Mankato, MN W). Moreover, estimates of W’ at the Lexington, KY baseline (8.3 ± 3.2 kJ) were Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Quantifying the maximal unaffected (P > 0.05) either by the Context: Patient reported work capacity (W’) above the aerobic HIT (7.6 ± 2.3 kJ) or the traditional outcomes(PROs) have become the critical power (CP) has emerged as a RT (8.3 ± 1.3 kJ) bouts. Measures of standard for collecting Health Related method for estimating anaerobic work CP were similar pre to post- Quality of Life data(HRQOL). PROs capacity. Slower cadence, lower-load intervention for HIT (TE = 8.7 W, CV provide clinicians insight into patients’ resistance training (RT), colloquially = 4.1%, ICC = 0.96) and traditional experiences during treatment. There is referred to as high-intensity training RT (TE = 7.2 W, CV = 3.7%, ICC = currently a need to develop more (HIT). HIT consists of slower 0.98), respectively. Anaerobic work efficient means to incorporate cadence, lower-load resistance, as capacity, as estimated by W’, was HRQOL assessments into clinical commonly used in rehabilitation and more variable for the traditional practice. Collecting surveys on reconditioning, and is purported as a RT trial (TE = 1.87 kJ, CV = 36.0%, multiple occasions throughout better metabolic stressor than faster ICC = 0.45) in comparison to the treatment or rehabilitation captures cadence, higher-load RT. To date this HIT trial (TE = 1.72 kJ, CV = 34.3%, patient perceptions and behaviors belief has not been substantiated by ICC = 0.62). Conclusions: These throughout the entire treatment research. Objective: We compared data indicate that the 4:2 cadence process. Web-based surveys provide the acute effects of HIT and traditional is insufficient to exhaust a person’s a means to track data over time more RT bouts on average power within a capacity for high-intensity work. efficiently as they do not rely on the Longer RT durations, either 150-second time period (P150 s), CP patient returning to the clinic or the and W’, as measured from a 3-minute by slower cadences or by multiple use of clinician time for the all-out exercise test using cycling sets, are necessary to evoke completion of additional paperwork. ergometry (3 MT). Design: A substantive declines on W’, and Objective: Our purpose was to crossover design was used. Setting: should be investigated. determine the feasibility of utilizing Data were collected in a research web-based surveys to longitudinally laboratory. Patients or Other capture compliance and self-reported Participants: Eight recreationally outcomes among postoperative active males (mean ± SD: age 22 ± 2 orthopedic patients. Setting: y, body mass 85 kg ± 14 kg, and height Orthopedic clinic Design: 183 cm ± 9 cm) volunteered. Prospective longitudinal cohort. Interventions: Baseline 3 MT, 10 Patients: Surgical knee patients were repetition maximum testing on leg- recruited for study participation during press and leg-extension machines, and their first post-operative clinic visit post-bout 3 MTs following a HIT (4:2 (n=34, 17 males, 16 females; 34±11.7 second cadence) or traditional RT bout years of age). Interventions: (1:1 second cadence) were collected. Following intake questionnaire, Previous reported reliability of the 3 patients with internet access, an MT for CP is TE = 15 W, CV = 7%, available email address and willingness ICC = 0.93 and for W’ is TE = 2.8 kJ, to participate in web-based surveys CV = 28%, ICC = 0.76, where TE is were counter-balanced into groups to typical error, CV is coefficient of receive surveys either every 2 or 4 variation, and ICC is intraclass weeks for 24 weeks post-surgery. correlation coefficient. Main Patients were sent a web-link and log-

Outcome Measures: P150 s, CP, and in for each survey via recurring emails. W’ served as the dependent variables Reminders via email or phone were

Journal of Athletic Training S-251 13F21MOTE provided at regular intervals if surveys Hip Kinematics, Strength, And body weight * height. Four intervention were not completed. The surveys Pain, In Female Runners With sessions consisted of performing three included questions related to Patellofemoral Pain Before And specific gluteal muscle exercises for rehabilitation compliance and After A Short-Term Intervention no more than 20 repetitions with 3 attendance and also incorporated Quinlevan, ME, Norberg JD, minutes of treadmill running questions from the Lysholm Knee Phegley A, Fleming A, Mahaffey immediately following each exercise Scale, IKDC, and modified Cincinnati S, Mattacola CG, Uhl TL, Noehren with verbal feedback. This exercise- Knee Scale. Main Outcome B: University of Kentucky, run intervention was repeated 3 times Measures: Outcome measures Lexington, KY, and University of at each training session. Recovery included recruitment rate (number of Toledo, Toledo, OH after each session was 48-72 hours. participants consented/number of The final two sessions were identical Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 patients approached for study Context: Patellofemoral Pain (PFP) to the initial session, with the final participation), eligibility (participants is associated with abnormal hip session occurring approximately two with available email//participants kinematics and decreased strength. weeks following the post-training consented), willingness (participants Nevertheless, few interventions have session. Main Outcome Measures: willing to receive web-based surveys/ been developed to simultaneously Independent variable was Time (Pre, participants eligible), and response improve both kinematics and strength. Post, 2wks Post), and the dependent rate (percentage of surveys completed Objective: To evaluate the variables were peak HADD and peak by willing participants). Variables were effectiveness of a short-term HIR during stance phase, VAS analyzed using frequencies and intervention that focused on muscle maximum pain level during running and percentages. Independent t-tests were awareness exercises and verbal maximum hip external rotation peak used to compare response rates feedback during running to improve hip torque. Separate Freidman’s tests were between the 2 and 4 week groups. kinematics, strength, and pain in utilized for each dependent variable, Results: Overall 35 patients were female runners with PFP. Design: A with Wilcoxon signed-rank test for approached regarding participation. single group, longitudinal study. post hoc analysis. Results: We Recruitment rate was 97%(n=33). Setting: Laboratory setting. observed a significant reduction in Eligibility was 91%(n=30); one Participants: Five female runners pain from Pre (4.2±1.1) to 2wks Post patient did not have internet access with PFP (25.67±6.68 yrs, 1.64±.06 (1.6±1.8) (p=.042) time points. Hip and 2 did not have email address. Two m, 59±11.89 kg) participated. All external rotation strength increased patients were not willing to subjects met inclusion criteria and from Pre (4.1±1%) to Post testing participatein surveys (willingness were used for analysis. Participants had (4.8±.7%) (p=.03). There were no =93%, n=28). The average response no other injury affecting the lower significant changes across time in rate was 45±36% among all extremity, nor any previous knee average peak HADD (Pre 19.4±5.3°, participants. There was no difference surgeries. PFP was diagnosed by a Post 20.5.3±5.8°, 2wks Post in response rates between the 2 licensed medical professional using 18.7±3.7°) (p=.513) and HIR (Pre week(49±35%) and 4 week previously established criterion. 9.5±4.3°, Post 13.3±9.1°, 2wks Post groups(42±39%; p=.651). Of all 34 Intervention: Subjects participated in 16.4±8.3°) (p=.846). Conclusions: patients that were approached to an initial pre-intervention session Following a two week short-term participate in the study, 47%(16/34) (Pre), 4 treatment sessions and two intervention utilizing awareness had at least good compliance(>50% post intervention sessions exercises targeting gluteal response rate) in the surveys. (immediately Post, and 2wks Post). musculature, and verbal feedback Conclusions: This is one of the first During the initial data collection during running, there was a studies to examine the feasibility of session, the subjects ran for thirty significant decrease in pain and web-based surveys in an orthopedic minutes on an instrumented treadmill. increase in strength in female population. Our results demonstrate Average peak hip internal rotation runners with PFP. A longer response rates that are at or above (HIR) and hip adduction (HADD) intervention, traditionally 6-8 weeks, accepted standards for survey during stance phase were then may be necessary to see kinematic research; however, response rates calculated. During the run, pain was changes. Acknowledgement: This with the current methodology were recorded every minute using a 1 to10 project was supported by a 2010 well below the minimum follow-up pain verbal analog scale (VAS). Hip NATAREF Osternig Masters Grant. rate of 85% recommended for strength was measured with a hand held clinical outcomes research. dynamometer and recorded as a percentage of torque normalized to

S-252 Volume 48 • Number 3 (Supplement) May 2013 13392DOPR

Dosage Effects of 5)NMT duration and frequency were higher NMT volume, precisely more Neuromuscular Training documented. Data Extraction: Study than 30 minutes per week, to Interventions To Reduce quality was assessed with the PEDro demonstrate greater prophylactic Anterior Cruciate Ligament scale. Extracted data included the effect of NMT to reduce ACL Injury In Female Athletes: number of ACL injuries and the injuries in female athletes. Meta-And Sub-Group Analyses number of subjects in the NMT Sugimoto D, Myer GD, Barber intervention and control groups. The Foss KD, Hewett TE: Cincinnati extracted data were further classified Children’s Hospital Medical by NMT duration (Short=Less than 20 Center, Cincinnati, OH; University minutes per session vs. Long=More Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 of Kentucky, Lexington, KY; Ohio than 20 minutes per session), State University, Sports Health & frequency (Single=One NMT session Performance Institute, Columbus, per week vs. Multi=At least two NMT OH session per week) and volume (Low=Up to 15 minutes per week Context: Consistent increases in during in-season vs. Moderate=15-30 number of anterior cruciate minutes per week during in-season, vs. ligament(ACL) injuries and their High=More than 30 minutes per week associated long-term physical impact during in-season). Odds ratios(OR) have resulted in the development and were used to compare a ratio of ACL use of neuromuscular training(NMT) injuries between intervention and as a prophylactic intervention. Recent control groups among the meta-analysis reports demonstrate the dichotomized and tertile analyses. effectiveness of NMT to reduce ACL The quality of evidence was assessed injury in female athletic population. using the Strength of However, among reviewed studies Recommendation Taxonomy (SORT) disparity of ACL injury reduction was – Levels of Evidence. Data observed, which may stem from Synthesis: Fourteen studies met differences in NMT duration and inclusion and yielded average PEDro frequency. Thus, a series of sub-group score of 4.8/10(range: 2 to 7). analyses was performed to delineate Results are presented as OR the potential effects of training volume [95%Confidence Intervals]. Fewer relative to the prophylactic ACL injuries were documented in effectiveness of NMT on ACL injury. Long(OR 0.35: [0.23,0.53]) than Objective: To systematically review Short(OR 0.61: [0.41,0.90]) and synthesize previously published duration. Also, fewer ACL injuries studies to evaluate dosage effects of were recorded in Multi(OR 0.35: NMT on reduction of ACL injury in [0.23,0.53]) compared to Single(OR young female athletes. Data Sources: 0.62: [0.41,0.94]) frequency. The A computerized search was performed tertiary analysis indicated using PubMed, CINHAL, Medline, statistically fewer ACL injuries in SPORT Discus, (1995-2012) in May, High(OR 0.32: [0.19, 0.52]) 2012. Key words were “anterior compared to Moderate(OR 0.46: cruciate ligament”, “ACL”, [0.21,1.03]) and Low(OR 0.66: “prospective”, “neuromuscular”, [0.43,0.99]) volume. The SORT “training”, “female”, and “prevention”. reached evidence level A. Abstracts and unpublished data were Conclusions: Results of the excluded. Study Selection: Criteria dichotomized analyses revealed for inclusion required that 1)number dosage effects in NMT duration and of ACL injuries were reported, 2)NMT frequency on ACL injury. The inverse program was utilized, 3)females were dose-response relationship observed included as participants, 4)studies used in the tertile analysis recommend prospective, controlled trials, and

Journal of Athletic Training S-253 13288FOBI 13F16FOTE

Combined Landing, Core, And differences before and after training. Strength Changes Following Jump Training Modifies Lower If a significant interaction was Quadriceps Or Hip Focused Extremity Energetics During observed, a paired sample t-test was Rehabilitation In Patients With Single-Leg Landing In College used to determine the difference in PFP: An Outcome-Based RCT Handball Players: Implications work for each joint. Results: The Study For Anterior Cruciate Ligament ANOVA revealed a significant increase Earl-Boehm J, Bolgla L, Emery Injury Prevention in the negative work performed by each CA, Hamstra-Wright KL, Ferber Shimokochi Y, Igawa T, Watanabe joint (pre-training vs post-training: R: Department of Kinesiology, Y, Uota S, Kusumoto S: Osaka NTOL=-60.2±54.0 vs.-68.2±33.5, University of Wisconsin- University of Health and Sport p<0.05; TOL=-62.4±39.6 vs. Milwaukee, Milwaukee, WI; Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Sciences, Osaka, Japan -72.3±24.9, p<0.01) and interactions Department of Physical Therapy, for both legs(p < 0.01). The paired Georgia Health Sciences Context: Non-contact anterior sample t-test revealed a significant University, Augusta, GA; cruciate ligament (ACL) injuries are increase in HW(NTOL=-3.4±16.5 vs. Department of Kinesiology & known to be more common in female -52.4±28.1, p<0.01; TOL=-23.1±21.0 Nutrition, University of Illinois at than in male athletes, such as handball vs.-67.8±24.8, p < 0.01)and a Chicago, Chicago, IL; Faculty of players who frequently perform reduction in KW(NTOL=-123.2±29.1 Kinesiology, University of Calgary, sudden deceleration–acceleration vs.-103.6±20.4, p=0.01; TOL= Calgary, Canada motions; these athletes are at high risk -101.8±23.1 vs.-86.0±20.2, p<0.05) for such injuries. Objectives: To for both legs. No significant changes Context: Patellofemoral pain examine the effects of combined in AW were observed (NTOL= syndrome (PFPS) is the most common landing, core, and jump training on -54.0±17.4 vs.-48.5±17.0; TOL= injury experienced by running- and lower extremity energy absorption -66.7±20.6 vs.-62.0±19.3, both jumping-based athletes. Traditionally, during single-leg landing and to p>0.05) Conclusions: HW was the gold standard for PFPS determine the risk of non-contact ACL lowest and KW greatest during single- rehabilitation has been strengthening injury in female handball players. leg landing before training. However, the knee musculature. More recently, Design: Intervention Settings: a significant increase in HW and the etiology of PFPS has been Training facilities and laboratories. decrease in KW were observed after suggested to be related to reduced hip Patients or Other Participants: training. Thus, combined training may and core strength. However, no large- Twenty-three Japanese female division decrease the possibility of excessive scale randomized controlled trials I college handball players(age, 20.0 ± quadriceps muscle activations without (RCT) have been conducted to 0.8years;height, 162.4 ± 4.9cm, and hamstring muscle co-activations determine the optimal rehabilitation weight, 59.1 ± 5.7kg). Intervention: during decelerating moves such as for PFPS. Objective: To compare The subjects participated in a 5-month single-leg landing, which have been strength changes in knee extension training program of core and jump- suggested to reduce knee stability and (KEXT), hip abduction (HABD), hip landing training for 1 month and high- increase ACL strain and injury risk. external rotation (HER), and hip intensity core, jump-landing, and jump extension (HEX) before and after a 6- training for 4 months. Before and after week treatment protocol focused on the training period, 3-dimensional the knee (KNEE) or hip/core (HIP) biomechanical data were collected musculature in physically active PFPS using electromagnetic motion tracking patients . Comparing strength changes system and a force plate while subjects in those who had a successful performed single-leg landings from a treatment outcome was a secondary 30-cm box. Main Outcome objective. Design: Single-blind RCT Measures: Biomechanical data were multi-centered study. Setting: Four collected from non-takeoff (NTOL) clinical research laboratories across and takeoff legs (TOL) when shooting North America. Patients or Other a handball. The negative work (J) of the Participants: 202 PFPS patients, sagittal plane hip(HW), knee(KW), and assessed by an AT and meeting ankle joint(AW)during the descending inclusion criteria based on Boling et phase of single-leg landings were al. (2006), volunteered to participate, calculated. A two-way (joint × training) 135 patients had complete strength repeated measures ANOVA examined measure data (43 males, 92 females:

S-254 Volume 48 • Number 3 (Supplement) May 2013 13F04FOTE age= 20.0±7.1 years; mass= effective for producing strength gains, Pain, Function, And Strength 67.6±13.5; height=170.4±9.4cm). and should be prescribed based on Outcomes For Males And Interventions: PFPS patients were individual patient impairments. Funded Females With Patellofemoral randomly assigned to a treatment by the NATA REF: 808OUT003R and Pain Who Participate In Either protocol: KNEE vs. HIP. Each subject Alberta Innovates: Health Solutions. A Hip- Or Knee-Based visited an AT 3 times per week over a Rehabilitation Program 6-week period for rehabilitation Bolgla LA, Earl-Boehm J, Emery progression. Main Outcome CA, Hamstra-Wright KL, Ferber R: Measures: Isometric peak strength Department of Physical Therapy, was recorded using a force Georgia Health Sciences Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 dynamometer for KEXT, HABD, University, Augusta, GA; HER, and HEX. Peak force was Department of Human Movement normalized to body weight (N/Kg) and Sciences, University of used as the dependent variables. Wisconsin-Milwaukee, Milwaukee, Treatment success was a priori defined WI; Faculty of Kinesiology, as a decrease in VAS by 3cm and/or an University of Calgary, Calgary, increase in AKPS of 8 points (SUC vs Canada Department of UNSUC). Data were analyzed using Kinesiology & Nutrition, University an intent-to-treat basis. We performed of Illinois at Chicago, Chicago, IL; a 2x2x2 ANOVA (rehab group x time x success; P<0.05) on the dependent Context: Patellofemoral pain (PFP) variables. Results: Multivariate is a common pathology experienced by analyses indicated no significant individuals who participate in running interactions among rehab group, time, and jumping-based sports. While and success (F=.96-1.7; P=.14-.726). quadriceps exercise is the gold There was a significant multivariate standard intervention, evidence exists effect for TIME (F=6.28, P<.005). regarding the importance of hip/core Regardless of rehab group or treatment (HIP) strength. Moreover, researchers success, HABD(F=12.38,p=.001), have shown that, unlike males, females HER(F=12.66, P=.001), HEXT exhibit altered landing and running (F=.6.6, P=.011), and KEXT(F=8.3, mechanics, possibly from reduced HIP P=.005) strength significantly strength, that contribute to PFP. Thus, increased following the 6-week females with PFP may respond more intervention HABD(Pre:3.38±1.17, favorably to a HIP rehabilitation Post:3.63±1.19), HER(Pre:1.19±.43, protocol than a knee-focused (KNEE) Post:1.32±.42), HEXT (Pre:2.44 program. However, no study to date ±1.05, Post:2.76±1.22), KEXT has investigated this hypothesis. (Pre:3.95±1.54, Post:4.40±1.48). Identification of these differences There were no other significant main could help clinicians implement sex- effects for rehab group or treatment specific interventions for patients with success. Conclusions: Both the PFP. Objective: To compare KNEE- and HIP-focused rehabilitation improvements in pain, function, and programs resulted in significant strength between males and females strength gains in all of the muscle with PFP who participated in a HIP or groups. It is possible that the exercises KNEE rehabilitation program. We performed, regardless of group, hypothesized that no sex differences caused enough muscle activation to would exist in visual analog scale produce strength gains, even if the (VAS), Anterior Knee Pain Scale exercises were not thought to target (AKPS), or hip and knee strength one particular muscle. The clinical measures. Design: Single-blind application of these findings are that randomized controlled trial multi- both quadriceps and hip focused centered study. Setting: Four clinical strengthening seem to be equally research laboratories across North

Journal of Athletic Training S-255 13207FONE

America. Patients or Other P=.210) in HER strength. Whole Body Vibration Reduces Participants: 185 patients with PFP, Conclusions: Regardless of sex, Quadriceps Arthrogenic Muscle who met inclusion criteria (Boling et subjects with PFP benefitted from a Inhibition Induced By al., 2006), participated (60 males: HIP- or KNEE-based rehabilitation Experimental Knee Joint age=29.9±7.5 years, mass= program. The fact that males and Effusion 79.6.8±11.4 kg, height=178.6±6.6 females had relatively similar Blackburn T, Pamukoff DN, Sakr cm; 125 females: age=29.1±7.4 years; improvements in HABD and KE M, Vaughan AJ, Berkoff DJ: mass=63.6±11.7 kg; height= 166.6 strength supports the importance of Neuromuscular Research ±7.7 cm). Interventions: Patients were exercises targeting these muscles Laboratory, University of North randomly assigned to a HIP or KNEE for all patients with PFP. However, Carolina at Chapel Hill, Chapel Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 rehabilitation program. Each subject clinicians should consider Hill, NC visited an AT up to 3 times per week prescribing exercises that over the 6-week period for specifically target the HEXT for Context: Quadriceps arthrogenic rehabilitation progression. Main females and HER for males.Funded muscle inhibition (QAMI) is a Outcome Measures: VAS and AKPS by the NATA REF: 808OUT003R. common symptom following knee scores as well as hip abductor injury which impedes rehabilitation (HABD), hip external rotator (HER), and may increase the risk of hip extensor (HEXT), and knee subsequent injury and osteoarthritis. extensor (KE) isometric strength Whole body vibration (WBV) measures were collected before and facilitates quadriceps function and after subjects participated in a 6- may minimize QAMI. However, the week rehabilitation program. Data effects of WBV on QAMI are were analyzed using an intent-to- unknown. Objective: To evaluate the treat basis. Separate mixed-model effects of WBV on QAMI following 2X2X2 ANOVAs (sex x group x experimental knee effusion. Design: time; P<0.05) with repeated Randomized controlled trial. Setting: measures were used to determine Research laboratory. Patients or differences in all dependent Other Participants: Seventeen measures. Results: Regardless of healthy volunteers were randomly sex or rehabilitation group, a assigned to WBV (n = 9; Mass = 71.5 significant reduction in VAS (mean ± 13.9kg; Height = 1.7 ± 0.1m Age = difference=-2.6+0.2 cm; F1,181= 21.0 ± 1.2 years) or Control (n = 8; 201.1; P<.0001) and improvement in Mass = 71.2 ± 19.5kg; Height = 1.7 ± AKPS (mean difference=11.0+0.9 0.1m Age = 22.0 ± 3.5 years) groups. points; F1,181=155.0; P<.0001) Interventions: QAMI was induced by scores occurred. Similar improve- ultrasound-guided injection of 60mL ments existed for HABD (mean of saline into the knee joint space. difference=0.17+0.1 N/kg; F1,181= Both groups performed the same 8.4; P=.004), HER (mean difference intervention on a WBV device (6 one-

=0.10+0.0 N/kg; F1,181=15.1; minute repetitions of an isometric P<.0001), HEXT (mean difference squat), but only the WBV group

=0.23+0.1 N/kg; F1,181=15.9; received the vibratory stimulus (30Hz, P<.0001), and KE (mean difference 2.6g). Quadriceps function was

=0.30+0.1 N/kg; F1,181=12.4; assessed at baseline, post-effusion, and P=.001) strength. Although not post-intervention. Main Outcome significant, females demonstrated Measures: Quadriceps function was modest improvements in HABD (5.4 evaluated via peak torque (PT), rate of vs. 4.5%; P=.617), HEXT (11.3 vs. torque development (RTD), and 7.4%; P=.825), and KE (8.0 vs. Central Activation Ratio (CAR, 6.8%; P=.998) strength than males resulting from a superimposed while males exhibited greater electrical stimulus) during maximal improvement (10.5 vs. 5.8%; voluntary isometric knee extension. PT and RTD were normalized to body

S-256 Volume 48 • Number 3 (Supplement) May 2013 13129FOBI

mass. These variables were evaluated Acceleration Through The Body epicondyle of the femur, the anterior via 2(Group) x 3(Test) mixed-model During Whole-Body Vibration Is superior iliac crest, and the spinous repeated-measures ANOVA, and Affected By Vibration process of the seventh cervical significant interaction effects were Parameters vertebrae. Main Outcome Measures: evaluated post hoc via Bonferroni’s DeMont RG, Rakeja S, Saade N: Acceleration (g) in the vertical plane procedure. Results: The interaction Department of Exercise Science at the four locations was collected. A effect for PT was significant (p = and Department of Mechanical repeated measures ANOVA was used 0.048). PT decreased similarly in the Engineering, Concordia to compare the four body points across WBV ( = -22.2 ± 16.6%; p = 0.003) University, Montreal, QC variables. Results: In the vertical and Control ( = -15.0 ± 15.0%; p = plane, acceleration measured at the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 0.004) groups following effusion. Context: Whole-body vibration foot and knee were affected by the However, WBV increased PT ( = 28.6 (WBV) platforms have been used interaction of displacement and ± 21.4%; p = 0.002), but the Control widely under various parameters most frequency. At the foot the variables had group did not change ( = 0.0 ± 11.8%; of which indicate benefits to a variety a significant effect (F=62.17, p = 0.263). The interaction effect for of physiological measures. However, p<0.001), such that the 2mm15hz CAR approached significance (p = studies using WBV do not follow (0.8904±0.44) < 4mm15hz < 0.077; Power = 0.65). Exploratory specific protocols for determining 2mm30hz < 4mm30hz (3.11±0.44). post hoc analyses indicated that while what parameters are used, and few have At the knee the 2mm30hz effusion decreased CAR similarly in measured the transmission of vibration ((1.39±0.44)< 2mm15hz < 4mm30hz both groups (WBV = -10.2 ± 11.9%, thought the body. Analyzing the effects < 4mm15hz (2.90±0.55) (F=35.75, p = 0.017; Control = -9.4 ± 5.6%, p of WBV throughout the body could be p<0.001). However, there were no = 0.001), WBV increased CAR ( = useful information in determining interactions of main effects across 12.5 ± 13.0%; p = 0.010), but the effective dosage parameters in training variables at the hip (F=0.89, P =0.372) Control group did not change ( = 0.9 with this modality. Objective: To or cervical vertebrae (F=0.313, ± 13.0%; p = 0.417). Though determine the vertical plane p=0.578). Main effects were seen at effusion decreased RTD in both acceleration transmission through the the ankle with an effect of frequency groups (-51.2% vs. -46.7%), this body as measured at the foot, knee, hip, (30Hz > 15Hz, (F=315.42 , p<0.001)) decrement and the associated and cervical vertebra. Our hypothesis and at the knee with an effect of improvements post-intervention was that attenuation of the vibration displacement 4mm > 2mm (F=56.02, (54.8% vs. 60.4%) were similar would occur from the foot through to P<0.001)). Conclusions: The between groups (interaction effect p the cervical vertebrae. Design: transmission of vibration does = 0.898). Conclusions: WBV Counterbalanced control trial. attenuate through the body as appears to be an effective Setting: Engineering and measured by acceleration at different mechanism for minimizing QAMI. biomechanics research laboratory. anatomical points in this study. The Quadriceps strengthening following Patients or Other Participants: 30 level of attenuation is not even knee pathology is often limited due healthy young females (age = 21.7 ± throughout the body as the to QAMI. As such, WBV may be 3.1 years, height = 65.7 ± 3.1 inches, acceleration at the hip and cervical used to facilitate quadriceps function weight = 137.3 ± 19.8 pounds) volun- areas are negligible. As well, the and enhance quadriceps teered. Interventions: Participants effects of displacement and frequency strengthening, thus enhancing the performed 4 one-legged squat at 40 on acceleration at the ankle and knee efficacy of rehabilitation and degrees of knee flexion on an should lead practitioners to consider potentially mediating the risk of oscillating WBV platform (VibraFlex both the frequency and displacement subsequent injury and osteoarthritis. 600). Trials were separated by 5 when establishing WBV protocols. minutes of rest and repeated within subjects. Participants were exposed to four 15-second bouts of vibration consisting of two displacements (2mm and 4mm) and two vibration frequencies (15Hz and 30Hz). Trials were presented in a counterbalanced order. Three-axis accelerometers (Sparkfun electronics) were placed at the medial malleolus, the medial

Journal of Athletic Training S-257 13130MOBI 13038FOPR

Acceleration Through The Ankle conditions. Results: Vibration at the Pre- And Post-Activity During Whole-Body Vibration ankle was lower in SW compared to Stretching Practices Of Affected By Footwear Condition BF in the vertical-axis at all settings Collegiate Athletic Trainers In Females [2mm15hz (SW= 0.742±0.225, BF Popp JK, Judge LW: Ball State Saade N, Rakheja S, DeMont RG: 1.039±0.317, F1, 56 = 17.445, P = University, Muncie, IN Department of Exercise Science 0.001), 2mm30hz (SW= 2.355 and Department of Mechanical ±0.619, BF 3.160±0.564, F1, 56 = Context: Current research suggests Engineering, Concordia 27.751, P < 0.001), 4mm15hz (SW= the benefits of pre-activity dynamic University, Montreal, QC 1.788±0.371, BF 2.040±0.256, F1, 56 stretching include an increase in sport- = 9.409, P = 0.003), 4mm30hz (SW=

specific flexibility, strength, power, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

Context: No guidelines exist for 2.911±0.522, BF 3.299±0.227, F1, 56 agility, and sprint performance. On the selecting between shoe wearing (SW) = 13.865, P < 0.001)].Vibration at the other hand, recent evidence and being barefoot (BF) while using ankle was higher in SW then BF in the demonstrates that pre-activity static whole-body vibration (WBV) coronal-axis [2mm15hz (SW= stretching may actually decrease machines. Understanding the 1.674±0.316, BF 1.329±0.339, F1, 56 athletic performance, and is alternately transmission patterns of vibration = 16.663, P < 0.001), 2mm30hz (SW= recommended as a component of a through the foot in SW or BF 3.079±0.501, BF 2.199±0.706, F1, 56 post-activity cool-down routine. conditions may play a role for = 30.988 , P < 0.001), 4mm15hz Objective: To investigate the appropriate selection of footwear (SW= 2.299±0.335, BF 2.029±0.312, knowledge and practices of collegiate during the use of WBV. Objective To F1, 56 = 10.425, P = 0.002)] but was not certified athletic trainers (ATs) to determine whether acceleration of significant at 4mm30hz. Vibration at determine if stretching practices WBV is significantly reduced through the ankle in the sagittal-axis was not utilized are in line with the current the ankle in the vertical, coronal and significant between groups and research. Design: Cross-sectional sagittal planes by being barefoot or inconsistently varied in response to study. Setting: A population-based wearing a shoe. Design: Counter- SW or BF conditions. Conclusions: questionnaire administered via email balanced controlled trial. Setting: The SW condition influences the with a hyperlink to the survey was used Engineering and biomechanics medial/lateral ankle displacement to conduct the data collection. research laboratory. Patients or more than BF and should be Participants: A total of 2839 ATs, who Other Participants: 30 healthy considered when using WBV on are members of the National Athletic young females (age = 21.7 ± 3.1 years, individuals with ankle pathology. Trainers’ Association and indicated the height = 65.7 ± 3.1 inches, weight = Further work is needed to determine collegiate setting as the primary place 137.3 ± 19.8 pounds) volunteered. the interest of using WBV during rehab of employment were emailed and Interventions: Participants per- exercises for ankle sprains. The BF invited to participate. A total of 500 formed a one legged squat at 40 condition increases vertical loading at participants (17.6%; 252 male, 248 degrees of knee flexion on an the ankle compared to SW which is female) completed the survey. oscillating WBV platform (VibraFlex important when using WBV to Interventions: The “Pre- and Post- 600). The SW and BF trials were increase bone density. Activity Practices in Athletic Training separated by 5 minutes of rest and Questionnaire” was administered repeated within subjects. Participants electronically as each subject was were exposed to four settings contacted via email, with a brief (2mm15hz, 2mm30hz, 4mm15hz, description of the survey purpose and 4mm30hz) for 15 seconds each in a the hyperlink to the web-based survey. counterbalanced order. Acceleration at The survey consisted of demographic the medial malleolus was recorded characteristics and multiple choice using a 3-axis accelerometer items related to athletic trainers’ (SparkFun Electronics). Main knowledge and use of pre-activity Outcome Measures: Acceleration (g) warm-up, pre-activity stretching, post- was recorded in the vertical, coronal activity cool-down, and post-activity and sagittal axes at the medial stretching. In previous studies, the malleolus for SW and BF conditions. survey demonstrated construct The means were compared using validity, ˜ = .722. Main Outcome repeated measure ANOVA to Measures: Descriptive statistics were determine differences between computed for all items. Pearson chi-

S-258 Volume 48 • Number 3 (Supplement) May 2013 13010FOEX square test was used to evaluate Acute Static Stretching Does contraction EMG activity. While goodness of fit, and kappa was Not Affect Golgi Tendon Organ contracting, the Achilles tendon was calculated to measure agreement Reflex Inhibition stimulated 50 times (rectangular between the subjects. Results: 32.2% Miller KC, Burne JA: North Dakota pulses, 75 mA, 100 μs duration, 2-s of collegiate ATs recommended State University, Fargo, ND, and interpulse interval). Pre, during, and dynamic stretching pre-activity, School of Medical Sciences, post-stimulus EMG activity for the 50 whereas 42.2% recommended a Sydney Medical School, University trials at each measurement time were combination of static and dynamic of Sydney, New South Wales, filtered, full-wave rectified, and stretching. However, post-activity, Australia averaged. An algorithm (implemented 60.6% of collegiate ATs recommended using MatLab software) identified static stretching, while only 27.9% Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Context: Golgi tendon organ (GTO) inhibitory points and calculated the recommended a combination of static disinhibition is thought to contribute main outcome measures. Main and dynamic stretching. There was a to exercise-associated muscle cramp Outcome Measures: Inhibition area moderate level of agreement that of -1 (EAMC) genesis. Despite limited (mV*ms ), inhibition maximum (mV), the collegiate ATs who recommend evidence of efficacy, acute static and inhibition duration (ms). Outcome dynamic stretching pre-activity, 21% stretching is often prescribed to measures were normalized using 100 of athletes are actually performing prevent EAMC based on the belief that ms of pre-stimulus EMG activity. dynamic stretching (K=.582, P<.001). stretching activates GTOs. Repeated measures ANOVAs with Post-activity, there was a substantial Gastrocnemius GTO inhibition is Geisser-Greenhouse corrections were agreement that of the ATs who highest when the gastrocnemius is in used to analyze data (˜=0.05, NCSS recommend static stretching, 61.0% a lengthened position, but no research v.2007). Data are reported as means ± of athletes are actually performing has examined the effect of acute SD. Results: Inhibition area was static stretching (K=.761, P<.001). stretching on GTO inhibition. unaffected by stretching at any time Conclusions: Collegiate ATs are (F =1.5, P=0.25; pre-stretch Objectives: We asked: Does a single 1,14 employing practices that are not in line -1 bout of acute static stretching increase =0.07±0.09 mV*ms , immediately with current research, which -1 gastrocnemius GTO inhibition? If so, post-stretching= 0.07±0.10 mV*ms , recommends dynamic stretching be how long does GTO inhibition stay 5 min post-stretching=0.06±0.08 incorporated pre-activity as a means -1 elevated post-stretching? We mV*ms , 10 min post-stretching to prepare the musculoskeletal -1 hypothesized GTO inhibition would =0.05±0.04 mV*ms , 15 minutes system for sports activity. There is a -1 increase post-stretching but would post-stretching=0.05±0.04 mV*ms , low percentage of collegiate ATs who return to pre-stretching levels within 30 minutes post-stretching are recommending, as well as -1 5 minutes. Design: Repeated =0.05±0.05 mV*ms ). Inhibition athletes who are performing, measures, cross-sectional. Setting: maximum was also unaffected by dynamic stretching pre-activity. In stretching over time (F =0.2, Laboratory. Patients or Other 1,14 addition, there is a great deal of Participants: Six men (age=26±3 y; P=0.72; pre-stretch= 0.0008±0.0009 collegiate ATs who are ht=179.5±4.1 cm; mass=81.8±13.4 mV, immediately post-stretching = recommending a combination kg) and six women (age=27±7 y; 0.0008 ±0.0008 mV, 5 min post- of pre-activity static and dynamic ht=163.4±4.9 cm; mass=64.4±9.6 stretching= 0.0008 ±0.0007 mV, 10 stretching. However, collegiate kg). Interventions: Subjects’ min post-stretching=0.0008±0.0007 athletic trainers are emphasizing dominant limb medial gastrocnemius mV, 15 minutes post-stretching= static stretching post-activity, and GTO inhibition was tested before, 0.0008± 0.0007 mV, 30 minutes post- athletes are performing it immediately after, and 5, 10, 15, and stretching=0.0008±0.0008 mV). post-activity, which is in line 30 minutes post-stretching. With Stretching also did not affect inhibition with the current research. duration over time (F =1.5, P=0.24; subjects long sitting, the investigators 1,14 applied three, 1-minute bouts (1 pre-stretch=3.5±2.8 ms, immediately minute of rest separating each bout) post-stretching=3.3±2.8 ms, 5 min of static stretching to the post-stretching=3.3±2.5 ms, 10 min gastrocnemius by placing the ankle into post-stretching=2.8±1.6 ms, 15 maximum dorsiflexion. To measure minutes post-stretching=2.7±1.7 ms, inhibition at each selected time 30 minutes post-stretching=2.7±1.8 interval, subjects maintained medial ms). Conclusions: A single bout of gastrocnemius contraction intensity at static stretching had no impact on GTO 5% of their maximum voluntary inhibition. Single bouts of static

Journal of Athletic Training S-259 stretching are unlikely to prevent EAMC assuming the theory that GTO disinhibition contributes to EAMC genesis. The effect of chronic stretching programs on GTO inhibition warrants future examination. Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021

S-260 Volume 48 • Number 3 (Supplement) May 2013 Free Communications, Poster Presentations: Case Studies 13236UC

Rehabilitation Program To program was implemented to increase reconstruction. By discontinuing Increase Knee ROM And Muscle both the patients’ knee ROM and girth rehabilitation after 3 months, this Girth Following A 1-Year before considering surgical patient demonstrated the pitfalls of not Absence From ACL Post- intervention. Knee extension was completing a properly designed and Operative Rehabilitation deemed most important and a supervised program. Our protocol Snyder B, Smith S, Fricker D, rehabilitation protocol of moist-heat demonstrates that improvements in Tomchuk D, Ross K: Missouri (20 minutes) and thermal ultrasound knee ROM and muscle girth are Valley College, Marshall, MO, and (7 minutes, 1 Mhz at 1.5 intensity) possible after a 1-year absence and Marshall Orthopedics and Sports while the athlete remained in an surgical intervention is not always Medicine, Marshall, MO† extended knee position began on the necessary. Conclusion: Delayed ACL Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 distal hamstring. This was followed by rehabilitation can create significant Background: An 18 year old male deep tissue massage on the hamstring scar tissue buildup resulting in collegiate soccer signee reports and patella, stretching, and ice with decreased knee ROM, strength, having difficulty playing soccer for external compression in an extended athletic performance, and quality of extended periods of time to the knee position for 20 minutes. life. Completing a properly designed athletic trainer. The athlete could Hamstring curls, balance/ and supervised rehabilitation program perform activities of daily living; proprioception exercises, hip prevents deficits in knee ROM and however, his left thigh and knee extensions, TKE’s, straight-leg raises, muscle girth. Athletic trainers should become tight and painful during and calf raises were implemented 1 educate their patients on the prolonged soccer drills and week later. After 6 weeks, the athletes’ importance of adhering to and scrimmages. The athlete is 14 months knee extension and flexion improved completing their rehabilitation post-ACL reconstruction (cadaver by 3° and 4° respectively resulting in program to prevent complications. graft) with medial and lateral meniscus squat-oriented exercises such as: wall repairs on his left knee. Rehabilitation sits, wall squats, lunges, and slide board was initiated day 1 post-surgery. being introduced. Heat, ultrasound, Rehabilitation consisted of knee range massage, and stretching on the athletes’ of motion (ROM) and strengthening quadriceps was introduced at this time. exercises, moist heat, cryotherapy, and At week 10, quadriceps extensions, muscle stimulation 3 times a week for stool scoots, general running/cutting 3 months until he was able to walk drills, and team soccer practice were without discomfort. At that time the added as the athletes’ ROM and girth athlete discontinued all rehabilitation. continued to improve. Twelve weeks The injury, surgery, and initial into rehabilitation, ROM was rehabilitation were performed before reevaluated revealing 117° of flexion the athlete signed with his college and 2° of extension in his injured knee. team. Differential Diagnosis: Post- Girth measurements for the thigh operative arthrofibrosis, infrapatellar (47.5cm and 63cm) and calf (40.5 and contraction syndrome, patella 38.5) also improved. The ROM and entrapment syndrome, cyclops lesion, girth measurements on the uninjured and myositis ossificans. Treatment: leg remained constant. The athlete was Goniometer measurements revealed instructed to continue exercises and 110° of flexion and 7° of extension in play soccer during summer vacation. his injured knee vs. 125° flexion and - Upon reporting for fall camp the 1° in his uninjured knee. Thigh and calf athletes’ ROM and muscle girth girth measurements on both limbs 5cm measurements were identical as when and 15cm superior and inferior to the he departed. The athlete was able to patella revealed a deficit on his injured practice and compete during the fall side (thigh - 45.5cm and 61cm vs. at a higher level with decreased 48cm and 64cm; calf - 40.5cm and discomfort compared to the spring. 38cm vs. 38.5 and 40cm). Upon Uniqueness: Completing a consultation with an orthopedic rehabilitation program is vital for a surgeon an aggressive rehabilitation successful outcome following ACL

Journal of Athletic Training S-261 13312MC

Case Study Report: Pectoralis (ER) at 0 degrees to 90 degrees, However, having a highly motivated Tendon Repair In A Collegiate PROM abduction to 60 degrees, as athlete and athletic training staff Football Player well as putty exercises to strengthen factored heavily into an optimal Williams EM: Mississippi State his hand and forearm musculature. Two outcome for this patient to return to University, Starkville, MS weeks post-operative he was cleared play as quickly and safely as possible. to begin PROM abduction to 90 Background: The patient is a 20- degrees, PROM forward flexion to year-old male Division-I Football 120 degrees, and light forearm weights Player. He was involved in a motorized to increase grip strength. Four weeks post-operative, he was cleared to begin vehicle accident one weekend during Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 the summer. Two days later, he some ER and internal rotation (IR) reported to the Athletic Training Room, Thera-Band exercises, underwater complaining of pain in the right treadmill jogging, and leg workouts in pectoralis major. He informed the the weight room as long as they did not Athletic Trainer about the accident, but involve his arms. The goal of this he could not remember an exact phase was to achieve all full range of mechanism of injury. He only motion but the last 10 degrees of remembered being expelled from the abduction external rotation at the 90- vehicle onto the ground. Immediately 90 position. Five weeks post- following the accident he did not feel operative, the patient was cleared to any pain. However, later that day he begin biceps and triceps strengthening started to experience extreme pain and via dumbbells (high repetitions and low was unable to use his right arm to weight) as long as the pectoralis major perform any activities of daily living. was not stressed. He was also cleared Physical examination by the Athletic to begin lateral raises and running Trainer revealed a lack of muscle outside in a straight line. Eight weeks function and contraction in the right post-operative, he was cleared to begin chest/shoulder as well as pain with all pectoralis major strengthening shoulder abduction and external exercises with high repetitions and low rotation. Differential Diagnosis: weight. Progression was as tolerated. Possible diagnoses included pectoralis He also began catching balls at minor strain and labrum tear. practice. Nine weeks post-operative, Treatment: The patient was seen by a the patient was cleared to begin light physician that day and a Magnetic plyometric exercise. He also began Resonance Image (MRI) was ordered running some routes and catching and conducted that afternoon. Physical more balls at practice. Ten weeks post- findings included pectoralis major operative, he was cleared to begin weakness and a palpable knot in the more strenuous plyometric exercise. medial portion of the muscle. The He also began limited non-contact MRI revealed a complete tear of the practicing. Twelve weeks post- right pectoralis major tendon from its operative, he began full non-contact humeral attachment. Surgery to repair practicing. Thirteen weeks post- the muscle was scheduled for two days operative, the patient was cleared for later. Cryotherapy alone was the full-contact practicing and to play in treatment course for about the first the football game that week. week. The patient was also instructed Uniqueness: This case is unique to wear a sling with a pillow at all because most pectoralis major times. Nine days post-operative, the rehabilitations take about 6 months for patient had a follow-up with the non-athletes to return to full activities. operating physician. His staples and It is rare for an athlete to return to a the pillow were removed. He was high-contact sport in just 13 weeks. cleared to begin passive range of Conclusions: This injury typically motion (PROM) external rotation requires a long-term recovery.

S-262 Volume 48 • Number 3 (Supplement) May 2013 13F22MC

Use Of Exos Splints In A Middle splint to decrease irritation, but locked series studies that examine the use School Population in due to the patient’s previous of Exos technology. Given the Gravelin EM, Brownell EH, noncompliance. On 10/8/12, the advertised benefits, it is important Butterfield TA: University of patient returned to the clinic that Exos splints are recognized as Kentucky, Lexington, KY complaining of skin irritation, and was an option for upper extremity advised to remove the splint at night fractures, but situationally used. Background: A 14 year-old middle and apply an anti-fungal cream. A cast school volleyball athlete with no past was applied after no decrease in skin medical history of hand injuries was irritation on 10/10/12, with instructions to follow up as necessary participating in a “punch for punch” Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 game with a football athlete on 8/30/ until her next scheduled appointment. 12 when she punched his occiput, No problems were reported after feeling a pop in her right hand. application of the cast, and following Evaluation by the athletic trainer its removal, she successfully revealed pain and swelling over the completed a home exercise program. head of the fifth metacarpal, with Uniqueness: New to the healthcare limited active and passive range of field, Exos splints are the world’s motion (ROM). The patient was given first modifiable, waterproof, ice and instructed to follow-up with a antimicrobial bracing system. When physician the next morning. heated, the foam brace is molded and Differential Diagnosis: Boxer’s customized to the patient. The fracture, hand contusion. Treatment: optional locking feature safeguards Physician’s exam of the right hand against unwarranted removal with its revealed pain and swelling at the dorsal lock and key feature. Exos splints aspect of the hand over the fifth ensure a sawless removal and no need metacarpal. ROM was limited at the for removal during radiographs, due fifth metacarpalphalengeal joint, but to radiolucent properties. Prior to normal at the proximal phalangeal and skin irritation, this patient’s boxer’s distal phalangeal joints, with no fracture was successfully treated rotational abnormalities. Upon with an Exos ulnar gutter splint, reviewing the radiographs, attending allowing her to shower, as well as fellow and physician agreed on the perform gentle ROM exercises to final diagnosis of a right boxer’s and decrease risk of hypomobility fifth metacarpal neck fracture. She was following fracture healing. It is placed in an Exos ulnar gutter splint unknown if this patient’s skin with instructions to remove the splint irritation is correlated to use of the daily only to wash her hand. On 9/18/ Exos splint. Conclusion: Exos 12, subsequent exam and follow-up splints can be used to stabilize a radiographs revealed the fracture to be variety of upper extremity injuries. mildly healed. The patient was placed The splints allow for basic human in the Exos for an additional two necessities and rehabilitation, and weeks, with instructions to wash her guarantee against removal in hand daily and work on gentle ROM noncompliant and adolescent when out of the splint. On 10/2/12, patients. However, the locking four weeks from fracture, follow-up feature is only successful if radiographs still revealed mild interval enforced. In this case study, the lack healing of the fracture. Examination of parental enforcement led to revealed pain and swelling over the insufficient healing and the eventual fifth metacarpal, ecchymosis over the application of a cast. There is also dorsum of the hand, but normal ROM currently no literature to support or at the wrist, PIP and DIP joints. The confute Exos use. This gap in the patient was fitted for a larger size Exos literature can be closed through case

Journal of Athletic Training S-263 13285MC

Functional Postoperative intact, scar tissue was removed from swimmer post shoulder arthroscopy Rehabilitation Of A Division 1 the joint, and the synovial lining of the and a 20 year old swimmer post repair Swimmer joint was surgically excised. The first of a compound femur fracture. Francis C, Johnston T, Poole D: four days post surgery he used cold Clemson University, Clemson, SC modalities, and completed ROM exercises. Five days post, Background: Athlete is a 21 year old strengthening exercises began. As soon male swimmer. He is a breaststroke as he was cleared to enter the water, specialist. After 33 days of practice he began rehab in the therapy pool. Freestyle was the only stroke used the the athlete began complaining of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 bilateral anterior medial knee pain. He first week in the pool. He then began was tender to palpate on the patella progressing into breaststroke. He used tendons of both knees. No joint line a kick board to isolate the kick. Jet pain. No previous history of knee pain. speed was adjusted to slow down his Limited ROM due to pain in all knee kick and focus on a pain free functional motions. Manual Muscle Test 4/5 with range of motion. Once achieved, the pain in all knee motions. Differential jet speed was increased and a Diagnosis: Meniscal and ligamentous resistance cord was added to help pathology were originally suspected as strengthen. Focus was then placed on was patella tendinitis. This was the deep knee flexion associated with reinforced by the relief of pain when pushing off the wall. Athlete returned using a patella strap. Also considered to competition the following season subpatellar bursitis, that was ruled out with personal best times in his first as well due to area of pain. Treatment: meet back. Uniqueness: A nonsurgical MRI and Xray were both negative. treatment was taken during the season Athlete was diagnosed by the team in order to keep him competing. The physician with bilateral knee synovitis. unique aspect is the functional He was treated conservatively during rehabilitation that was performed using the season without surgery. He was an underwater treadmill and treated daily with the focus on underwater jet resistance training. To increasing strength without pain and isolate each phase of the stroke in a decreasing the swelling within the knee controlled tank was a unique joint. He was immediately limited opportunity to make sure that the during team strength training, and swimmer was rehabilitating without breaststroke during practice. A patellar affecting his stroke mechanics. The strap was used on the patella tendon size of the pool used also provides the because it decreased pain. A daily clinician a unique chance to change maintenance rehab plan was put in specific aspects of the rehabilitation place. 3 days a week he completed a to advance the treatment and make the warm up on the stationary bike, table rehabilitation as functional as possible. slides, prone quad sets, 4 way straight Video recordings were taking in order leg raises, step ups, terminal knee to give the athlete appropriate extensions, mini-squats, weighted knee feedback on his progress. extension and flexion, calf raises, and Conclusions: Although most sports proprioception exercises. During off have a generally accepted method for days the rehabilitation was focused on functional rehabilitation, swimming pain management through the use of does not. The inclusion of an isolated cold and electric stimulation tank with resistance jets into the rehab modalities. After the season was adds to the functional application of completed he had arthroscopic the exercises and hopefully a hastened surgery on both knees. During the return to play. This method was also procedure, the meniscus appeared used to rehabilitate a 21 yr old

S-264 Volume 48 • Number 3 (Supplement) May 2013 13050UC

Upper Extremity Paresthesia In osteoarthritis, spinal stenosis, cervical Most common clinical symptoms of A Collegiate Swimmer disk herniation, clinical cervical polyradiculopathy are neck pain and Ayotte J, Rothbard M, Morin G: instability, facet joint dysfunction, unilateral arm pain accompanied by Southern Connecticut State degenerated facet joint, and cervical motor and sensory deficits. The University, New Haven, CT radiculopathy. Treatment: The patient prevalence of polyradiculopathy was referred to the team orthopedist secondary to spinal stenosis increases Background: A 20 year-old male and removed from athletic with age and most commonly occurs individual medley and backstroker participation. Following initial at C6-C7 and in adults over 30-40. presented with idiopathic persistent consultation he was referred to a Furthermore, the patient is a post- neurologist who ordered blood tests pubescent athlete who developed early cervical spine pain and paresthesia in Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 the upper extremities and jaw. and an MRI of the brain and cervical onset cervical spinal stenosis. Finally, Reported symptoms started four years spine. Blood tests were normal. The only 2% of all cervical radiculopathies ago bilaterally, but recently became MRI of the cervical spine revealed occur at C4-C5 or above. more prevalent on the right side. He mild asymmetric right-sided Conclusions:. Polyradiculopathy reported being able to perform sport uncovertebral hypertrophy at C2-C3 refers to compression or damage of activities on a self-limiting basis. and C3-C4 with mild-to-moderate more than one spinal nerve root that Symptoms increased throughout the neuroforaminal stenosis. A mild mass produces pain and neurologic deficits. day and decreased with lying down. The effect on the left axillary sleeve at the This occurs when the spinal column patient’s medical history was not C3-C4 segment was noted. A small narrows and places pressure on significant for traumatic injuries to the subannular fissure and left central/ multiple nerve roots. The lower spine or surrounding area. Visual subarticular disc protrusion cervical nerve roots (C5-C8) are most observation revealed increased encroaching on the left axillary sleeve commonly involved. Various cervical lordosis with forward carriage and neural foramen at C5-C6 was etiologies can result in pressure on one of the head and chin protraction along observed. The neurologist diagnosed or more cervical nerve roots. In this with thoracic kyphosis and associated the patient with polyradiculopathy case, the pathology was caused by rounded shoulders. Physical secondary to C2-C6 neuroforaminal neuroforaminal spinal stenosis examination elicited bilateral diffuse spinal stenosis and was prescribed secondary to overactivity. cervical spine tenderness, upper Carbamazepine ER for abnormal nerve cervical extensor muscular spasms, sensations, Voltaren for inflammation, and normal skin temperature. AROM and rehabilitation to facilitate recovery testing revealed lower cervical and and function. The rehabilitation upper thoracic spine hypomobility and program involved an integrated induced symptomatic increases with approach and was designed to control bilateral cervical extension, lateral inflammation, provide symptomatic flexion, and rotation. PROM testing relief for radicular pain and muscular revealed sternocleidoid, trapezius, spasms, and to decrease cervical nerve levator scapulae, and pectoralis major root compressive forces. It consisted and minor tightness. MMT elicited of physical agents, postural retraining, deep anterior cervical, serratus manual therapy, kinesiotaping to anterior, and scapular retractor encourage correct posture, and weakness. Cervical compression, therapeutic exercises to release tight cervical distraction, Spurling’s, Roos, structures and strengthen postural and military brace tests were positive; muscles. Status post four months his however, valsalva maneuver and symptoms improved, but did not Adson’s and Allen tests were negative. completely resolve. Participation was Neurologic testing revealed self-regulated and related to pain levels significant bilateral sensory and motor and neurologic deficits. Status-post deficits over the entire right upper six months his symptoms completely quarter. Differential Diagnosis: resolved. He was cleared for Rheumatoid arthritis, multiple unrestricted activity. His return to sclerosis, tumor, cervical swimming did not elicit any pain or spondylolysis, degenerative neurologic deficits. Uniqueness:

Journal of Athletic Training S-265 13127FC

Chronic Upper Extremity scapular dyskinesis. Specific thorough biomechanical evaluation Neurological Symptoms In A scapular stabilization exercises were to identify all impairments/ High School Football Athlete focused on re-education and dysfunctions. These discoveries Henderson K, Frymyer JL, Felton promoting proper scapula humeral allowed a detailed rehabilitation SD, Bloom KL: Florida Gulf Coast rhythm utilizing PNF patterns for the program to address and change University, Fort Myers, FL, and scapula. Hypomobility of the first athlete’s biomechanics allowing Naples Community Hospital, rib, upper thoracic and lower cervical better positioning and Naples, FL vertebrae were addressed with arthrokinematics, which when graded joint mobilizations to restore treated eliminated his chronic normal arthrokinematic movement. stingers. Conclusions: This case Background: Athlete is a 17 year-old Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 male high school football linebacker. Soft tissue mobilization and highlights the treatment of chronic The athlete presented to Certified myofascial techniques were bi-lateral transient brachial Athletic Trainer (ATC) during his administered to the soft tissue plexopathy. The athlete responded junior football season after prolonged impairments including the SCM, well to treatment and was able to history of chronic bilateral stingers. upper trapezius and pectoralis major/ return to full football competition Athlete noted he had been examined minor. Athlete was an active and had had no episodes of stingers by orthopedic physician as well as participant in his treatment process during his final season. treated by other allied healthcare making ergogenic changes at home Furthermore, this case highlights the professionals including ATCs and PTs. and school for completing importance of conducting a thorough The ATC conducted orthopedic schoolwork and sleeping postures. biomechanical examination involving examination and a full bio- Athlete responded well to treatment the entire kinetic chain and mechanical upper extremity as evidenced by decreased scapular developing a rehabilitation plan that examination. Biomechanical dyskinesis and improved forward addresses tissue specific examination revealed athlete was head posture and was able to return impairments. No current research experiencing bilateral scapular to participation. However, during explores the FHP/rounded shoulder dyskinesis. Specifically bio- the post-season, athlete was posture in association with chronic mechanical examination revealed participating in physical education stingers. This case demonstrates forward head posture (FHP), course and experienced a subsequent suggestion of a connection with the increased kyphosis, and hypertonic stinger resulting from non-traumatic inflamed brachial plexus in the upper trapezius and sterno- mechanism of injury. Athlete decreased space anteriorly with FHP. cleidomastoid musculature (SCM). reported to ATC and in consultation Increasing this space through He also presented with hypomobile with Team Physician elected to refer addressing postural impair- first rib as well hypomobile lower athlete to a Neurologist for further ments assisted in relieving future cervical and upper thoracic evaluation. Neurologist conducted brachial plexus injury. It also vertebrae. Athlete continued to EMG. EMG revealed normal testing. demonstrates that the use of demonstrate full range of motion Athlete, with prescribed diagnostic imaging is important, but (ROM) which revealed decreased rehabilitation program, has been able ATCs need to continue to conduct a rotator cuff strength; bilateral to complete senior year of football thorough clinical examination. sensation, reflexes, and shoulder competition absolved from ROM WNL. ATC presented current reoccurring stingers. Uniqueness: findings to Team Physician where Stingers are a frequent pathology MRI was ordered to rule out any diagnosed and treated by ATCs with cervical neck pathologies. MRI up to 65% of college football revealed uncovertebral joint athletes having experienced a spurring, and no other significant brachial plexus injury during their findings. Differential Diagnosis: athletic careers. Most stingers Soft Tissue Contusion, Subluxation, resolve with conservative treatment Cervical Neck Pathology, AC Sprain, of symptoms and general Transient Brachial Plexopathy strengthening exercises with low (Stinger) Treatment: The athlete incidence of re-occurrence. There is was treated conservatively with the currently limited research on the ATC initiating a detailed rehabilitation for brachial rehabilitation plan addressing the plexopathy. This case highlights a

S-266 Volume 48 • Number 3 (Supplement) May 2013 13F02MC

Upper Extremity Deep Vein Compartment Syndrome although he cause this condition. Early detection Thrombosis In A College reported arm tightness, swelling, and and treatment of patients with UEDVT Baseball Player: A Case Study some paresthesia of the fingers. A is important to successful treatment Patton TS, Peer KS: Kent State gross protrusion of a small artery in and progression to return to play. As University, Kent, OH his right arm was noticed during a athletic trainers, we are the first line physician visit that warranted further of detection and referral of UEDVT in immediate investigation. Treatment: our upper extremity athletes. Background: A twenty-year old The physician determined the patient Caucasian, male, height 6’2, weight had a possible Deep Vein Thrombosis (DVT). The patient was immediately 185lbs, varsity athlete who is a right- Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 handed pitcher on a division 1 baseball sent to a local Emergency Room for a team reports with shoulder and arm Doppler Ultrasound to rule out DVT. pain. The athlete has been playing Upon receiving a Doppler Ultrasound baseball since he was six year old and at the local ER, the patient was has no documented history of prior determined to have a Deep Vein shoulder injuries or upper arm Thrombosis. The recommended conditions, until two months prior to treatment was a right para-clavicular the manifestation of this condition thoracic outlet decompression when he strained his right pectoral. He including anterior and middle has no known medical history of scalenectomy, brachial plexus illness or acute injuries and patient’s neurolysis, and complete resection of family history reflects no genetic, the first rib; external venolysis of the terminal or chronic illnesses. The subclavian vein; and an intraoperative patient’s injury occurred during the upper extremity venography. Post- preseason of his sophomore year. The operatively, the patient was placed on patient’s parents became concerned anticoagulants and was allowed to start about their son after they noticed an rehabilitation exercises. The patient obvious hypertrophy in his right arm had a full recovery and has completed only. When asked, the patient his return to play program within seven mentioned having shoulder fatigue, months post-operatively. Uniqueness: tightness and “weird” sensations at UEDVT occurs in 2 out of every times. During inspection the patient 100,000 people per year after presented with noticeable tautness of strenuous activity like wrestling, the skin and edema in the right bicep rowing or pitching and is usually in and triceps region and slight edema and their dominant arm. Incidence rates tautness in the forearm. The patient had show that males are at a much greater full range of motion in the shoulder risk for developing DVT than their and elbow, as well as full strength based female counterparts and their risk on manual muscle tests and active increases with their age. This patient range of motion tests. The patient had no predisposing factors for tested negative for Thoracic outlet UEDVT other than gender and this syndrome and was referred to a condition manifested over time rather physician the next day. Differential than acutely. Conclusion: Upper Diagnoses: Thoracic Outlet extremity deep vein thrombosis is a Syndrome (TOS) and Chronic condition that usually affects the Exertional Upper Arm Compartment dominant arm of overhead athletes. Syndrome (CECS) were considered as This disorder should be suspected in differential diagnoses. Both of these athletes and patients performing conditions mimic signs and symptoms repetitive overhead activities who exhibited by the patient. The patient develop acute-onset swelling. tested negative for Thoracic Outlet Treatment of this condition varies as Syndrome yet was never tested for does the underlying etiologies that Chronic Exertional Upper Arm

Journal of Athletic Training S-267 13363UC 13293SC

Bilateral Neural Foraminal with physical therapy. This consisted Incidence Of Autoimmune Stenosis Associated With primarily of Williams flexion exercises Neuromuscular Hyper- Schmorl’s Nodes In An and core strengthening. Uniqueness: excitability In A Division I Adolescent Football Athlete Lumbar spinal stenosis is commonly Collegiate Athlete Orapello NS, Gildard M, diagnosed after middle age and Trotter N, Benson A: The Powers ME: Marist College, secondary to years of degeneration, University of Arkansas, Poughkeepsie, NY however those with a congenitally narrow Fayetteville, AR, and Troy central canal are more likely to develop University, Troy, AL Background: We present the case of symptoms at an earlier age. Our patient’s symptoms began at age fourteen, which an otherwise healthy sixteen year-old Background: A 19 year old female Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 high school football athlete who had is considered extremely early for this freshman Division I collegiate been experiencing intermittent lower condition. Foraminal stenosis is often basketball player with a history of bi- back pain for approximately two years. associated with severe and radicular leg lateral shoulder multi-directional Although he could not identify a single pain because the decreased space in the instability presented to the athletic traumatic episode during football or neural foramin causing impingement of training room in March her freshman any other sport activity, he did suffer a the dorsal root ganglion. Our patient year complaining of spasms in her neck fall while riding an all-terrain vehicle failed to report this, as his only symptom and trapezius. The patient had recently (ATV) just prior to symptomatic onset. was intermittent localized lumbar pain. returned to activity following her third He reported landing directly on the Conclusions: The diagnosis of SLAP repair and thermal sacral area after falling off of the foraminal stenosis is heavily dependent capsulorrhaphy. Increase in activity moving ATV, however he did not seek on both an in-depth patient history and resulted in more spasm. The Athletic medical care at that time. Physical body positioning during assessment. Trainer (ATC) referred the patient to examination revealed normal lumber Symptomatic relief during rest and the team physician, and she began lordosis and minimal tightness of the provocation during activities indicate the taking Zanaflex. One month later the lower lumbar paraspinals. Weight- dynamic component of foraminal athlete complained of a tight right bearing lumbar extension exacerbated stenosis. Narrowing of this area can trapezius. The ATC performed a light pain while seated positions and lumbar even occur with normal lateral flexion stretch of the trapezius, and then flexion relieved symptoms. All tests and extension motions in asymptomatic applied electrical stimulation and ice. were negative for radicular pain. Deep patients. Typically, patients presenting After five minutes the patient tendon reflexes, muscle strength and with lumbar stenosis will complain of complained of discomfort and the ATC range of motion were all found to be localized back pain as well as radicular noted that the patients forearm and within normal limits, while all sensory pain in the lower extremity upon wrist were visibly contracted. The tests were negative. Differential standing. Symptoms are normally electrical stimulation was Diagnosis: Zygapophyseal joint exacerbated by walking and other immediately discontinued. The syndrome, spondylolysis, spondylo- activity. While surgery is not uncommon, patient’s scapula was visibly listhesis, lumbar degenerative disc conservative treatment can provide depressed, her face appeared to have disease, disc herniation, spina bifida successful outcomes. In the current partial paralysis and she had slurred occulta. Treatment: Upon referral case, the patient’s symptoms have speech. The athlete was taken to the radiographs were negative for vertebral followed the desired course of urgent care then transferred to the malalignment, bone and joint regression following diagnosis and emergency room where blood work abnormalities, and spina bifida occulta. conservative treatment and he continues and a CT scan were performed. The Magnetic resonance imaging (MRI) to participate in recreational sports results were normal and the athlete revealed a Schmorl’s node at the T12- without limitation. While cases of was diagnosed with Bell’s palsy and an L1 level. The MRI also revealed a lumbar foraminal stenosis are rare in an infection of the radial nerve. During bilateral neural foraminal stenosis from athletic population, the symptoms of may the fall of her sophomore year, the L3 to L5. A congenitally narrow central present similar to lumbar pathologies patient was running sprints when she spinal canal with mild annular disk seen more commonly in athletic lost all motor control resulting in a bulging was observed at the L3 through populations. This emphasizes the need collapse. Initial evaluation by the ATC L5 levels and a decreased disc space for a very thorough clinical examination. noted nystagmus, abdominal rigidity height with mild annular disc bulging was and the athlete complained of not being observed at the L5 and S1 level. Due to able to move her legs or breathe. Upon the patient’s age and severity of relaxation, the symptoms resolved and symptoms, he was treated conservatively she was referred to the team physician

S-268 Volume 48 • Number 3 (Supplement) May 2013 13411MC

and then a neurologist. Both of the and frequency. Conclusions: ATCs Cervical Spine Anomaly In A doctors’ findings were inconclusive need to continue to broaden their Collegiate Football Player and she was released. Later in the scope of knowledge related to various Jacobs MM, Hoch JM, Bradley season the patient experienced similar medical conditions. Symptoms can MH: Old Dominion University, issues in her left shoulder including often be misleading however the ATC Norfolk, VA dislocations and spasm. An episode of needs to continue to be an advocate for syncope and spasms occurred during the patient and gather as much data as Background: A 21 year old male a game and the athlete was taken to the possible in order to ensure that a Division I-AA wide receiver sustained emergency room. Altitude and elevated proper diagnosis can be made. Even a neck injury during a football game. gallbladder enzymes were credited to though patients appear young and

The collision was helmet to helmet Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 the patient’s episode. The patient was healthy, the possibility of unique with a tucked chin, resulting in an axial then referred to a second neurologist. diseases should never be ignored. load with subsequent hyperextension. Differential Diagnosis: Pinched He walked off the field and reported cervical nerve, Viral infection of the to the athletic training staff with radial nerve, Bell’s Palsy, partial complaints of neck pain in the left seizures, cervical dystonia, early onset suboccipital neck region. Upon torsion dystonia, Autoimmune examination the athletic training staff neuromuscular hyper-excitability noted no radiculopathy, no UE disease (Stiff persons syndrome), weakness, no cracking sounds/ Neuromyotonia, Paroxysmal non sensations with movement, and no Kinesigenic Dyskinesia, and swelling or deformity. Pain increased Rheumatologic disease with CNS with PROM: contralateral flexion, manifestations. Treatment: Upon bilateral rotation, and extension. Any referral to the second neurologist, attempt of AROM could not be diagnostic imaging was performed performed due to pain. The patient had including an MRI, MRI Arthrogram, previous history of neck pain on right and a CT scan. Blood work screened side after being tackled in a game the her thyroid levels and ceruloplasmin previous season. Differential antibodies. Screenings were Diagnoses: Neck fracture, muscle performed to rule out: Wilson’s strain, ligament sprain. Treatment: Disease and Neuromyotonia. In The orthopedic physician ordered x- addition, an EMG/NCV, EEG, and rays to rule out any bony pathology. spinal tap were performed. The ATC Radiographs were taken at the game also provided video footage to the using a portable device. The orthopedic neurologist to illustrate the severity of physician deemed the x-rays abnormal the spasms when they occurred. The and requested they be reviewed by a video and results of the test confirmed radiologist. The radiologist reported that the patient suffered from the x-rays to be negative. The patient autoimmune neuromuscular hyper- was placed in a c-spine collar and excitability disease. The patient was underwent conservative modality treated with Baclefen and allowed to treatment. During this time, the patient return to full activity with follow-up was monitored to determine if further care as needed. Uniqueness: This is testing was necessary. Two days after considered a rare disease and its exact the initial injury, neck stiffness and cause is unknown; however the cause pain persisted with manual axial load. is thought to be acquired, Therefore, it was determined that paraneoplastic or heredity. It can often further diagnostic testing was be mistaken for ALS therefore necessary and a CT scan was scheduled. instances within the athletic population The results of the CT scan revealed a are unheard of. This is a treatable congenital C1 anterior and posterior disease with proper diagnosis and the neural arch defect. An appointment symptoms may fluctuate in severity with the team spine specialist was made for the following week to discuss

Journal of Athletic Training S-269 13132UC prognosis. The patient continued diagnosis. Athletic trainers need to be Delayed Onset Compartment treatment with modalities and the use cautious when dealing with suspected Syndrome Secondary To A of a c-spine collar until his c-spine injuries and continue to Thigh Contusion In A Division 1 appointment with the spine specialist. monitor associated symptoms. Spine Men’s Hockey Athlete: A Case During the appointment, the patient’s anomalies are often difficult to Study CT scan was examined and x-rays in identify on x-rays therefore a CT scan Castrejana TC, Lago MJ, Krawiec neck flexion and extension were taken and/or MRI may be necessary. CJ, Thomas AC: Northeastern to determine if there was any University, Boston, MA, and movement of the C1 vertebrae. No Harvard University, Cambridge, movement of the C1 vertebrae was MA noted. The spine specialist confirmed Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 that the non-union of the anterior and Background: The patient was a posterior neural arch of C1 was a twenty-year-old collegiate Division1 congenital anomaly. The initial men’s ice hockey athlete, 75 inches in recommendation by the spine height and weighing 205 pounds. The specialist was to discontinue patient’s significant medical history participation in football. However, involved a Total Anomalous Pulmonary further consideration was given Venous Return at 11 months old, regarding the lack of C1 movement and however this did not give suspicion to the physician cleared the athlete to his injury. After he was hit with an return to football activities. However, opponent’s knee and received a the patient and his family chose to contusion to the left anterolateral discontinue participation in football. thigh, this athlete had a severe increase Uniqueness: The literature reports in pain and edema, three days post- that C1 anomalies occur in only 2% injury. Treatments applied to the of patients, with combined anterior athlete, during that time, included ice, and posterior non-unions being the compression wrap, stretching, deep rarest. Most congenital C1 anomalies oscillation therapy and pneumatic are asymptomatic, but can be sequential compression. The athlete symptomatic following trauma, such also took Non-Steroidal Anti- as the direct blow sustained in this Inflammatory Drugs (NSAIDs), against case. It has been reported that the medical advice. The athletic trainer symptoms and appearance of a C1 measured his left thigh girth at 56 cm anomaly can be similar to those at 6 cm above the patella while the exhibited with an acute fracture. right was at 54 cm. The athlete’s thigh Correctly diagnosing the C1 injury is was elevated 45° and his distal important because the treatment of a sensation and circulation was C1 anomaly versus acute fracture is monitored with no noticeable change different. Furthermore, excess in either. Differential Diagnosis: movement must be measured in these While the initial concern was individuals via flexion and extension compartment syndrome, differential x-rays in order to determine the diagnoses considered were deep vein stability of the non-union arches. In thrombosis, hematoma, acute this case, no movement was detected ischemia, rhabdomyolysis, quadriceps in the patient’s flexion and extension contusion, femoral nerve injury, and x-rays. Conclusions: This patient myositis ossificans. Treatment: The sustained an axial load and physician, on site, noted the increase hyperextension to his cervical spine in swelling, severe pain, and inability resulting in the discovery of a C1 to flex the left knee. The physician, anomaly. His mechanism of injury concerned about compartment suggested a cervical spine fracture but syndrome, took the patient for his ability to walk off the field and his measurement of compartment lack of radiculopathy clouded the pressures. His quadriceps

S-270 Volume 48 • Number 3 (Supplement) May 2013 13116MC compartment pressure was measured Two days post-operation, it was Anterior Fibular Dislocation In at 23 mmHg and he was kept overnight extended due to resurgence in A Collegiate Baseball Player: A for observation. The following day symptoms. This case goes to show Case Study the patient had a sharp increase in that delayed onset compartment Chelette CJ, Greis PE, Petron symptoms and was taken to an urban syndrome can occur from a DJ,Yochem EM, Hicks-Little CA: level 1 trauma center. The pressure contusion to the thigh, therefore University of Utah, Salt Lake City, in the patient’s quadriceps read clinicians need to possess a high UT between 55-60 mmHg with a index of suspicion for this injury diastolic blood pressure of 70 when blunt trauma is involved. Background: A 23 year old healthy mmHg. The athlete was diagnosed Furthermore, the effects of male division one baseball athlete with Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 with delayed onset compartment pneumatic sequential compression no previous history of lower leg syndrome of his left thigh and an and NSAIDs on the vascular system pathology sustained an injury to his urgent fasciotomy was ordered to need to be taken into consideration left knee during a practice session on decrease the compartmental when treating contusions. More the turf in the indoor practice facility. pressure. The fascia was released studies are also needed on the The athlete was running to home base through an incision proximally and effects of these treatments and stepped on the plate. Since this distally, significantly decreasing in relation to compartment was in the indoor facility the plate was pressure throughout the thigh. Two syndrome. Further research is not secured to the ground and therefore days post-operation, due to an needed on the factors that influence slid causing the athlete’s knee to additional increase in pain and clinical outcomes to determine hyperextend upon contact with the swelling, the fasciotomy was proper treatment protocols. plate. The Athletic Trainer immediate- extended roughly 10 cm proximally ly evaluated the injury and found the and distally. The vastus lateralis was athlete was complaining of split along the femur and a large anterolateral knee pain. Upon hematoma was completely removed. palpation it was noted that the fibular 97 days after the patient’s initial head was not in its correct anatomical injury, with rehabilitation from the position. The Athletic Trainer sports medicine staff, he was able to carefully raised the pant leg to further return to Division 1 hockey. examine the athlete’s knee. This Uniqueness: The mechanism of revealed a large protrusion on the injury and the development of anterior aspect of the athlete’s knee symptoms are intriguing factors in just lateral to the tibial tuberosity. It this case. Although contusions are was suspected that the athlete’s fibular common in sports, delayed onset head had dislocated anteriorly. The thigh compartment syndrome athlete was rushed to the University secondary to a contusion is rare. Orthopaedic Center for further Compartment syndrome in the evaluation by the team physician. anterolateral compartment of the Differential Diagnosis: Fibular head thigh is usually the result of blunt dislocation, Lateral collateral trauma in the form of femoral ligament sprain, Fractured Fibula, fractures and car accidents, rather Posterior tibiofibular ligament sprain, than from a contusion. This patient Anterior tibiofibular ligament sprain. also had a reduction of edema and Treatment: The athlete was seen pain after the initial injury, and then immediately by an Orthopedic a sudden resurgence of both aspects Specialist. X-rays and a MRI revealed three days post injury. Conclusions: a dislocated fibular head. The Three days after receiving a physician tried but was unsuccessful contusion to the left anterolateral at reducing the dislocation. The athlete thigh, the patient had a spontaneous was therefore scheduled to be reduced increase in pain and swelling. The under anesthesia the next morning. next day, when the compartment The athlete was placed in an pressure reached 55-60 mmHg, a immobilizer, provided crutches and thigh fasciotomy was performed. transported home. That evening the

Journal of Athletic Training S-271 13356SC athlete accidently slipped on his before returning to play. This case Compartment Syndrome staircase and unknown to himself is important because it provides Following Anterior Cruciate reduced his fibular head. X-rays were a base for rehabilitation for Ligament Reconstruction taken the following morning prior to dislocated fibular heads. Further, it MacDonald A, Johnson D, Coates his scheduled reduction which showed highlights the importance for A, Lattermann C: University of normal fibular alignment. The athlete athletic trainers to look beyond the Kentucky Orthopaedic Surgery & was again placed in a straight leg mechanism of injury in their Sports Medicine, Lexington, KY immobilizer and provided crutches. evaluation and differential diagnosis. The day after self-reduction, the Background: An eighteen year old athlete was point tender over the male high school senior presented Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 fibular head as well was the biceps clinically with a left knee Anterior femoris tendon. For the first week Cruciate Ligament (ACL) tear, the of rehabilitation the athlete mechanism of which was reportedly completed quad sets, ankle pumps, unknown by the patient. The patient’s and received Gameready treatment. medical history included a previous The second week of rehabilitation left knee ACL tear which had been consisted of a light resistance bike surgically repaired approximately 9 program and basic uniplanar lower months previous to this current extremity exercises. Further, the incident. The initial tear was during athlete discontinued the use of the club soccer season in the summer. The crutches and began to fully bare patient’s initial surgery and rehab were weight. During week three the considered a success as he was able to athlete was cleared to return to play return for the final half of his senior as tolerated. The athlete began to hit soccer season. Two weeks after the balls off the tee, and field ground initial visit the patient underwent ACL balls delivered straight towards him. revision surgery. Post operatively the During week four the athlete worked patient was given an electric cooling on ground balls directed away from device and instructions for usage and him, started hitting live pitches and a prescription for narcotics to use PRN performing the following functional during the initial post-operative activities; running, sliding, and recovery process. The patient was cutting. The athlete returned to play instructed to begin therapy four days with no restrictions 35 days after the post-operatively. Two weeks post- initial injury and finished the season surgery the patient presented in our with no complications. Unique- clinic for his second post-operative ness: Anterior fibular head visit. The patient presented with a mild dislocations are the most common knee effusion as well as calf swelling. type of fibular head dislocations He complained of intense pain in his however, the uniqueness of this case knee and lower leg. He was was in the mechanism of injury. immediately transferred to a local Commonly, the fibular head is emergency department for further dislocated when falling on a flexed evaluation. Differential diagnosis: knee. In this case, the athlete deep vein thrombosis (DVT), described a hyperextension of his compartment syndrome. Treatment: knee before the fibular head An ultrasound was performed at a local dislocated and relocated the fibular emergency department for a suspected head by falling on a flexed knee. DVT. The ultrasound was negative for Conclusion: A 23 year old healthy DVT. Intracompartmental pressure was male baseball athlete dislocated his taken which showed an increase in fibula while running bases during pressure consistent with compartment practice. The athlete self-reduced by syndrome in a single compartment. A falling on a set of stairs. The athlete lateral release was performed. The underwent rehabilitation for 35 day patient was admitted to the hospital for

S-272 Volume 48 • Number 3 (Supplement) May 2013 13124FC continued care and monitoring. He Traumatic Eye Injury In A High Eye Orbit Contusion, Retinal remained in the hospital for 3 days post School Female Soccer Athlete Detachment Treatment: The lateral release with no recurrence of Felton SD, Frymyer JL, Andrews Ophthalmologist completed symptoms. Prior to hospital discharge CA: Florida Gulf Coast University, comprehensive eye examination and the wound was closed and the patient Fort Myers, FL, and Naples diagnosed athlete with an atrophic hole was instructed to follow up with his Community Hospital, Naples, FL within the left retina and commotio surgeon in 3 weeks for both lateral retinae. Athlete was withheld from all release and ACL care. It was later Background: Athlete is an 18-year- sport participation to limit increases revealed to orthopeadic staff that the old Hispanic female soccer goalie. in vitreous pressure which could leak patient had used the electric cooling to cause retinal detachment and was Athlete had no previous history of Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 device on a constant basis for 24 plus concussion, eye injuries, or other scheduled for Ophthalmologist hours. We believe that this constant significant medical history; however, follow-up appoint-ment in 5 weeks. At usages lead to a rebound phenomenon athlete does wear corrective contact 5-week follow-up, athlete’s signs and in the patient, leading directly to the lenses while participating. The athlete, symptoms persisted, and as result compartment syndrome. Uniqueness: competing at an away competition, was underwent in-office Panretinal Laser To our knowledge there are no other defending the goal when she was struck Surgery (PRP). The PRP surgery cases similar to this in the literature. in the left eye from an opponent’s shot produces scar formations to decrease There are no cases of rebound on goal from a distance of the likelihood of the atrophic hole phenomenon in orthopeadic journals. approximately 7 yards. Certified progressing to a retinal detachment. There are cases that appear to be Athletic Trainer (ATC) was summoned The PRP surgery ultimately corrected similar but the causes of compartment onto the field for on-the-field the athlete’s symptoms. Athlete did not syndrome were attributed to either assessment. Athlete presented with an participate in spring sports or activity improper tourniquet usage during epistaxis, but no cervical tenderness or and had follow-up with st surgery or 1 degree frostbite caused pathology and was alert and oriented ophthalmologist for spring pre- by direct-to-skin contact of a cooling times 3. Further side-line examination participation physical clearance. At device. Conclusion: This case, while revealed athlete complaining of that time, ophthal-mologist cleared increidibly unique, illustrates the transient oculus sinister vision that athlete with no restrictions. importance of following the resolved by the completion of the Uniqueness: Acute traumatic atrophic manufacturer’s recommendations examination. Concussion assessment retinal holes are extremely when using an electronic cooling including vitals, cranial nerve uncommon. Through an extensive device. Electric cooling devices are assessment, Standardized Assessment literature review, most atrophic retinal becoming more and more common in of Concussion (SAC) test, and Balance holes are a result of chronic athletic training rooms as well as use Error Scoring System (BESS) WNL. degeneration seen commonly in for in home for post-operative Host ATC educated athlete and patients with diabetes and peripheral swelling and pain reduction. It also guardian on potential signs and vascular disease. The atrophic holes demonstrates the importance of symptoms that would constitute the occur in patients due to the vitreous communication following surgery and need for immediate referral and humorous changing consistency giving explicit instructions for post- instructed the athlete to follow up with causing a traction force which results operative treatment. After a lengthy the ATC at her school the next day. in thinning of the retinal tissue. The physical therapy process in which the During the follow-up exam completed athlete did experience commotio patient was relatively non-compliant, the next day by ATC, the athlete retinae, a common sign associated with the patient regained full use of his foot presented with no signs or symptoms countercoup eye injuries. Although and is now walking with a normal gait. of a concussion, normal visual commotio retinae does not directly tracking, and PEARLA normal. Athlete produce inner eye swelling, it is a complained of intermittent gray spots contributing factor for periretinal and blurry vision while looking down. swelling which may have created the ATC, in consultation with guardian traction force required for the referred athlete to an Optometrist formation of the atrophic hole. which was further referred to an Conclusions: This case highlights the Ophthalmologist. Differential diagnosis of an athlete with a traumatic Diagnosis: Concussion, Cranial atrophic retinal hole resulting from a Nerve Pathology, Corneal Abrasion, blow to the ipsilateral side of the head.

Journal of Athletic Training S-273 13290OC

The case is extremely unique since Exertional Rhabdomyolysis In the hospital for intravenous fluids (IV) atrophic retinal holes are typically a A High School Athlete for hydration and IV fluid with result of age or diseases which Michelini KJ, Plos JM, Martin bicarbonate for urine alkalization. contributes to thinning of the retina. GM: Western Illinois University, After 3 days, the athlete was This case highlights the need for the Macomb, IL, and LaSalle Peru discharged with an acid-free fluid ATC to complete a thorough clinical High School, LaSalle, IL treatment plan and disqualified from examination. In this case, a head injury all activities for the next 48 hours. was able to be ruled out because of the Background: A 17-year-old, male, high Seven days post-injury, the athlete was comprehensive concussion evaluation school athlete reported to the athletic allowed to participate in restricted being negative, but the ATC needed to basketball practice, but was

trainer (AT) two days after Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 continue to examine to explore causes participating in a Physical Education disqualified from the PE class. After for the visual disturbances that were (PE) class in which maximum weights 14 days, the athlete was allowed to presented. Case also highlights the and repetitions were completed. The return to full practice with daily prompt referral and management of a athlete complained of severe bilateral progressive 30 minute time condition with unexplained clinical arm pain, generalized body soreness, allotments, but was still restricted presentation. The athlete has made a inability to sleep or fully extend his from weight training. Three weeks full recovery and has not had any arms, and dark urine. The athlete was post-injury, the athlete returned to full further problems or complaints. well-conditioned, had no previous participation and was released for history of injuries, surgeries, or other unrestricted weight training. No medical illnesses and denied use of physical complications resulted from power drinks, caffeine, stimulants, the exertional rhabdomyolysis. steroids, or supplements. The AT’s Uniqueness: Cases of exertional examination indicated tenderness on rhabdomyolysis in college athletes the biceps brachii and forearms with have been frequently reported over the limited elbow motion in both flexion last decade and continue to make the (~90 degrees) and extension (~160- headlines as larger numbers of team 170 degrees). All other tests were members fall victim to this negative; therefore the AT attempted preventable condition. Cases of massage, which did not diminish the exertional rhabdomyolysis in high pain or increase motion. Differential school athletes have just begun to be Dx: Delayed-onset muscle soreness, reported and have resulted from dehydration, exertional rhabdo- punishment drills or extreme training myolysis, muscle strain. Treatment: sessions. This case is unique given that Suspecting exertional rhabdo- the athlete was participating in a PE myolysis, the AT contacted the class that incorporated regular weight athlete’s physician for consultation and training sessions prior to this incident. exam. Physical findings noted: limited In addition, the athlete’s two younger elbow extension (160-165 degrees at brothers were in the same class and right elbow; 170 degrees at left elbow) participated in the maximum weights and flexion (<90 degrees at right and repetitions activity, but did not elbow; 80 degrees at left elbow); experience exertional rhabdo- severe point tenderness on the anterior myolysis. Conclusions: Exertional and lower portion of the biceps and the rhabdomyolysis is the breakdown of volar surface of the forearms muscle caused by excessive strenuous bilaterally; normal grip strength; exercise. Exertional rhabdomyolysis normal pulses at the wrist; intact can occur in individuals of any age, any sensation, normal strength; and no fitness level, and while participating in swelling or discoloration. Blood tests any maximal exercise activity. The revealed creatine kinase (CK) levels condition can mimic the muscle pain >4500 u/L (normal range 33-145 u/L), and limited range of motion associated confirming exertional rhabdo- with delayed-onset muscle soreness, myolysis. The athlete was admitted to making it easy to overlook. Exertional

S-274 Volume 48 • Number 3 (Supplement) May 2013 13053UC rhabdomyolysis can be fatal if the Facial Pain In A Collegiate appear dislocated. Status-post three symptoms are not reported by the Football Player days, the patient underwent athlete or if missed by the AT. The Travers E, Rothbard M, Nelson C: maxillomandibular fixation with wire key signs and symptoms for early Southern Connecticut State osteosynthesis and braces to keep his recognition and referral are dark University, New Haven, CT teeth from shifting. He was placed on colored urine and severe muscle a strict liquid diet for two weeks, then pain a day or two after exercise. Background: An 18 year-old male permitted to progress to soft foods, Elevated CK levels assist in football player with no previous related and finally advanced to solid foods as the diagnosis. With this condition on history presented to the athletic trainer tolerated. Two months post- the rise, the AT must continue to maxillomandibular fixation, the with acute, severe, sharp mandibular Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 educate athletes, coaches, and pain accompanied by loss of function, patient was cleared for non-contact physical educators about exertional malocclusion, and mild headache activity and resumed conditioning. rhabdomyolysis, exercise protocols secondary to a direct blow. The patient Three months status-post, the patient and other factors that tend was running while holding a 45lb made a full recovery and was expected to contribute to the condition, rubberized weight during a spring to be medically cleared for the associated signs and symptoms, season workout when he tripped and unrestricted participation; however, he proper immediate care, and fell forward, dropping the weight which was ruled ineligible and is no longer the potential complications. bounced off the floor and made direct participating in intercollegiate mandibular contact. Pain quotient was athletics. Uniqueness: Common described as a 9/10 with most of the etiologies of mandibular fractures discomfort being felt inside the mouth. include motor vehicle accidents and Visual inspection revealed immediate assaults, rather than sports, which severe swelling, moderate bleeding account for less than 4% of reported from a lip laceration, and gross cases. Mandibular fractures occur with deformity to the TMJ and mandible an average of 1.5 to 1.8 fracture sites which appeared to be shifted to the depending upon the mechanism; right. Physical inspection elicited however, the incidence of four or more moderate point tenderness and fracture sites is reported in less than deformity over the left TMJ and along .01% of cases. In addition to the the mandibular body without crepitus. number of fracture sites, the The patient was unable to perform TMJ mechanism and location of the fracture elevation, depression, or lateral sites make this case unique. The speed deviation due to pain. No cervical pain and angle of force with which the 45lb or ROM limitations were reported. plate made contact with the mandible Differential Diagnosis: TMJ caused unique and multiple dislocation, closed head injury, tooth combination fractures along both the fracture, trismus, and mandibular body and the condyles. Common fracture. Treatment: Direct pressure fracture combinations include the was applied to the laceration to control angle and the body or condyle and the bleeding, a rigid cervical collar was condyles and the symphysis. A final applied for immobilization, and his unique aspect of this case is that none airway was stabilized by the athletic of the fractures sustained were located training staff. EMS was summoned for under the third molar, which is the transport to the emergency most common site. Conclusion: department. After initial consultation Mandible fractures occur as a result with the emergency medicine of the prominent position, distinctive physician, he was referred to a shape, and lack of support of the bone. maxillofacial surgeon. Maxillofacial Patients suffering from mandibular radiographs revealed five fracture sites fractures require airway stabilization and the patient was subsequently and examination to rule out pathologies definitively diagnosed with multiple to the spine, brain, face, and teeth prior unstable mandibular fractures on the to maxillomandibular fixation and are body and condyles causing the TMJ to

Journal of Athletic Training S-275 13262UC normally permitted to return to activity Second Toe Swan Neck second toe. No notated signs of a PIP six to eight weeks post injury. Patients Deformity In NCAA Mens dislocation and a phalangeal fracture. placed on liquid diets should be Basketball Player The subject was diagnosed with a closely supervised and offered Clack SF, Christie SR, Erwin ruptured flexor digitorum tendon of commercial meal replacements to JR: Georgia Southern University, the second toe. A phalangeal pinning ensure proper nutritional balance and Statesboro, GA procedure was proposed and executed sufficient caloric intake. In this case, by the foot specialist. Under the maxillomandibular fixation fleuroscopic guidance, a 0.045 K wire hindered the patient’s nutritional status Background: The subject was a 20 pin was surgically implanted across the and oxygen consumption required by DIP and PIP joints of the second toe

year old male NCAA Division I Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 athletic participation which slightly basketball player. The subject had an extending down into the base of the delayed his anticipated return. unremarkable history of a lower proximal second phalanx in attempt to extremity phalangeal pathology. The promote bone healing at the plantar 6’10” power forward reported to the plate. The pin was secured and the right Certified Athletic Trainer (ATC) toe and ankle were immobilized using complaining of severe pain over the a custom toe splint and walking boot. ventral aspect of his right second toe The subject was non weight bearing for during a basketball game. Initial three weeks. The subject began lower evaluation revealed that during the push extremity range of motion exercises off phase of an attempt to “dunk” the and strengthening as part of a basketball, the subject stepped on the rehabilitation program three days post- posterior portion of a teammate’s heel, surgery. In order to control and reduce hyperextending his right toes as he the amount of muscular atrophy due to forced himself vertically. The subject immobilization, the subject was placed felt an initial “pop” accompanied with on a maintenance based rehabilitation sharp, severe pain in the involved toe. program focusing on right ankle, knee, Initial observation revealed an obvious and hip strengthening. The pin was proximal interphalangeal (PIP) removed three weeks following hyperextension deformity in the right surgery. The subject’s shoe was fitted second toe accompanied with slight with a custom orthotic featuring a rigid distal interphalangeal (DIP) joint toe box to limit range of motion of the flexion. The subject was incapable of phalanges. The custom orthotic was active flexion at the PIP joint (0 worn throughout the remainder of the degrees). The subject was tender to rehabilitation program and during palpation over the plantar aspect of the return to play. Uniqueness: second toe. The ATC attempted to Traditionally, a flexor tendon rupture, reduce an assumed PIP joint known as a swan neck deformity is seen dislocation, which resulted in the in the upper extremity phalanges reposition of the toe in the original rather than in the lower extremity deformed “swan neck” position. The phalanges. A swan neck deformity of subject was splinted and referred to an the lower extremity phalanges is a orthopedic surgeon. The orthopedic rarity. To date, there are no case surgeon evaluated the subject, placed reports of a swan neck deformity to in a walking book and referred the phalanges of the lower extremity. This subject to foot specialist for further extremely unusual toe hyperextension inspection and imaging. Differential injury may be attributed to the Diagnosis: Right second toe PIP uncommon forceful mechanism of dislocation; Right second toe injury. Conclusion: This case has phalangeal fracture; Right second toe demonstrated that a flexor digitorum flexor digitorum longus tendon tendon rupture can occur to the lower rupture. Treatment: The x-rays extremity phalanges, which may be displayed a swan neck deformity of the overlooked in athletics because ATC’s

S-276 Volume 48 • Number 3 (Supplement) May 2013 13175SC and physicians are not familiar with Ruptured Soleus Tendon In strength and range of motion of the this injury occurring to the lower Middle-aged Runner ankle and knee. She was instructed to extremity phalanges. It should not be Ridgeway J, Jagger J: University start physical therapy for her assume that a swan neck deformity can of Kentucky Orthopaedic Surgery nonoperative treatment, but did not only occur to the upper extremity and Sports Medicine, Lexington, return to clinic after this visit. She phalanges. The injury can be KY was contacted and verified that all her successfully treated and allow the pain and edema had resolved, and was subject to return to play. Background: The athlete is a 48 year back to running again. Uniqueness: old female who runs on a frequent With only an incident rate of 0.7% of all gasctroc-soleus myotendinous

schedule for half marathons. She Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 stated that she felt a pop in her junction injuries, an isolated soleus posterior lateral right calf with an tendon rupture is a rare occurrence immediate onset of pain while running that could be easily misdiagnosed 2 weeks prior. The athlete stated that and ultimately mistreated. the muscle balled up with additional Conclusion: As seen with this swelling, but no bruising. She said her runner, an out of the ordinary pop current pain level is a 2 out of 10, can lead to an uncommon injury, which is gradually improving daily, and such as her soleus tendon rupture. only takes naproxen as needed. She has With the help of advanced imagining, had no previous injury or surgery to this injury can be correctly that area. Differential Diagnosis: diagnosed, so that the correct Grastroc-soleus myotendinous strain, corresponding treatment can gastroc-soleus myotendinous rupture, be enacted. In her case, nonoperative mid-shaft fibula stress fracture, physical therapy was the optimum peroneal strain, peroneal rupture course of action. Ultimately, with Treatment: The athlete was examined any athletic injury, anatomical to have full strength and range of and functional assessments with motion at the ankle and knee. She was a thorough history allow an athletic tender along the lateral border of the trainer to confidently evaluate and gastroc-soleus musculotendinous treat an injury, even if the injury junction. Upon palpation, the right calf is uncommon and mimics other has a fuller mass effect in comparison more common injuries. to the left. X-rays of the tibia and fibula revealed no fractures or joint dislocations with the soft tissue being within normal limits. The athlete was diagnosed with a possible tear of the gastroc-soleus musculotendionous junction. A MRI was ordered to confirm the diagnosis at her follow up appointment. In the interim, she was allowed to continue activities as tolerated due to the age of the injury. At her one week follow up, the results of the MRI confirmed a full thickness tear of her soleus at the myotendinous junction of the fibular sided tendon with surrounding edema and a mild strain of the medial head of the gastrocnemius. Upon examination, a lump can still be palpable at the injury site. Her edema and pain have both been reduced while retaining full

Journal of Athletic Training S-277 13025SC 13387SC

Non-Contact Fibular Head those being fractures. Most Rupture Of The Peroneal Fracture In A Division III documentation and research has Retinaculum In A Collegiate Collegiate Men’s Basketball revolved around stress fractures Hurdler Player to the fibula rather than occult Webster KJ, McNulty MB, Harris AM: Endicott College fractures. The more common of Lawrence SJ, Uhl TL: University Beverly, MA fibular fractures reported are of Kentucky, Lexington, KY those of an avulsive type injury due Background: A twenty year old NCAA to an outside varus force acting at Background: A 20 year old male track division III men’s basketball player the knee with or without a fibular and field athlete, who competes in 60m head subluxation. There is no reports with a non-contact fibular head sprint, and 60m hurdle events, with no Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 fracture and associated LCL injury available literature on a fibular history of ankle injury reported to the while attempting a break-away layup in head fracture associated with a athletic training room after landing a game; jumping from two feet with a non-contact type mechanism that has inverted of his left ankle when jumping deceleration, varus, and slight twisting only mild complications with a hurdle during practice. He had minor motion to the knee. The athlete fell to the LCL. Conclusions: While a non- swelling around the posterior aspect the floor in immediate pain. Athlete contact fibular head fracture is of his lateral malleolus. He was able was assisted off the court via 1 person not common, it is possible that this to walk into the athletic training room carry and was evaluated. The athlete can occur. Practitioners can use with a significant antalgic gait. He presented with immediate swelling and this case as a guideline if ever complained of a sharp popping extreme tenderness to palpation over coming across a situation as unique sensation when landing after clearing lateral aspect of knee extending to the in their clinical practice. the hurdle. Upon observation he had fibular head. Patient was braced and minimal swelling but significant pain sent to team orthopedic MD. The over his distal lateral fibula. He had athlete denied history of knee injuries. significant subluxation of his peroneal Athlete also denied inversion tendons with dorsiflexion and mechanism at the ankle consistent with plantarflexion, and described a popping Maisonneuve type injury. Differential sensation with these movements. Diagnosis: Possible diagnosis based Strength, and range of motion were fair on location of pain included fibular for all directions both being limited by head fracture, fibular head subluxation, pain, Differential Diagnosis: Lateral LCL tear, lateral meniscus tear. ankle sprain, peroneal muscle strain, Possible diagnosis based on and subluxation of peroneal tendons. mechanism of injury included ACL Treatment: The team Orthopedist was tear, PCL tear, acute meniscal tear, on campus and evaluated him within LCL tear. Assessment given prior to thirty minutes and diagnosed him with imaging was LCL tear with fibular head a ruptured peroneal retinaculum. The subluxation. Treatment: Orthopedic athlete insisted on trying to compete assessment along with radiographic in the conference championship meet imaging showed non-displaced fibular in two weeks. The Physician was head fracture of the left leg. Patient willing to allow him to try and was placed in CAM walking boot while compete, knowing he could do no performing low impact cross training further damage. He was placed in a for six weeks as well as treatment with high tide walking boot on crutches non non-thermal ultrasound and ice per weight bearing for 10 days at all times MD protocol. Imaging received six and prescribed a Medrol dose pack to weeks post injury revealed full healing control inflammation. Treatments of bony structure. Patient was then consisted of cryotherapy, able to return to activity, progressing compression, and interferential to full participation with no additional current electrical stimulation, to complications. Uniqueness: Fibular control swelling and pain. No head fractures represent a small part strengthening or range of motion of reported injuries sustained to the exercises were implemented. For the leg, with an even smaller percent of functional test and meet the athletic

S-278 Volume 48 • Number 3 (Supplement) May 2013 13412MC training staff and Physician developed Navicular Avulsion Fracture In A cryotherapy, a compression wrap was a way to stabilize the peroneal tendons Division I Field Hockey Player: A applied to the foot and ankle and the in the retromalleolar groove. The Case Report patient was placed NWB on crutches athlete was taped using theraband Thornton AL, Hoch JM: Old and instructed to ice and elevate. One tubing placed along the lateral fibula, Dominion University, Norfolk, VA day post-injury the patient reported to act as a bumper to prevent decreased pain but the PE remained subluxation. Next we tape the distal Background: A 20-year old female unchanged. Rehabilitation was third of the tibiofibular joint using a Division-I field hockey player, who initiated with mild AROM and circular pattern with leukotape, which was undergoing treatment for tibialis intrinsic foot strengthening was applied with as much force as the exercises. Two days post-injury the

anterior tendonopathy, suffered an Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 athlete could tolerate. Lastly the ankle acute foot injury while performing a patient was evaluated by the team was taped in a standard way to provide cutting maneuver during practice. physician who ordered x-rays which support. He performed and passed a The patient finished the drill and revealed a small navicular avulsion functional test two days before the walked off with severely antalgic fracture. The patient was placed in a meet consisting of hurdle-take offs and gait. The patient reported feeling a long leg cast and instructed to be starting block take offs. He reported “pop” in her foot and immediate, NWB. Following one week of pain some pain but no subluxation or severe pain over the entire foot and free NWB the patient was given a popping and was determined to try to ankle region. Initial physical cast-shoe to begin walking in the run in the meet. The athlete ran in the examination (PE) revealed no gross cast. After two weeks additional x- preliminaries, and had a recurrent deformity, no edema, no ecchymosis, rays were obtained and a bone growth subluxation, but qualified for finals. normal neurovascular screen, and stimulator was provided to wear During the final race he felt a sharp pop generalized tenderness to palpation while sleeping. The six weeks post- again, but was able to finish the race and (TTP) over the foot and ankle region injury x-ray examination revealed placed 7th in the conference. Two weeks with moderate-to-severe TTP over full fracture healing and the cast was after the meet he under went a Peroneal the first tarsometatarsal joint. ROM removed. The patient was given a retinaculoplasty surgery to repair the tests revealed painful passive short walking boot for 4-7 days while ruptured retinaculum. After 5 weeks in a dorsiflexion and plantar flexion regaining strength. The patient posterior splint, athlete began ROM. AROM was painful and limited progressed through a rehabilitation rehabilitation, focusing on range of in all directions, especially program to restore mobility, motion and strength. He started jogging dorsiflexion. RROM was not strength, neuromuscular control and at eight weeks, and hurdling at thirteen assessed due to pain. The patient was power. Two weeks into the weeks and was cleared for full iced for the remainder of practice. rehabilitation program, the patient participation at 20 weeks post-op. Following ice removal the patient experienced abnormal pain along the Uniqueness: This is a unique case was unable to WB without severe first ray. An x-ray revealed intact because there is limited literature to pain. Repeat PE revealed mild edema bone and a walking boot was describe a conservative treatment over the anteromedial foot region, prescribed until the pain subsided. technique that allows an athlete to continued TTP over the first After two days the patient was participate for a short period of time tarsometatarsal joint, moderate TTP progressed out of the boot and re- prior to surgery. Using the three pillars over the navicular tuberosity, first initiated rehabilitation. The patient of evaluation, anatomy, physiology, and metatarsal, medial talar dome, and progressed to the functional phase of biomechanics, along with patient values tibialis anterior tendon. ROM tests rehabilitation with no major and our clinical expertise, we were able and neurovascular screen remained complications, but has continued to to make up for the lack of literature and unchanged. Long bone compression report intermittent pain of varying we were able to develop an intervention test of first and second ray were severity. No specific cause of the that allowed our athlete to accomplish negative, transverse arch squeeze test pain can be identified. The patient is his goal of competing in the meet. was negative, intermetatarsal set to follow-up with an orthopedic Conclusions: This case demonstrated distraction caused pain and torsion foot specialist to explore the cause that this innovative taping technique test was positive for pain, of her continued pain. Uniqueness: could allow an athlete to achieve their specifically combined pronation and Navicular avulsion fractures are goal of competing without adversely eversion. Differential Diagnosis: relatively rare injuries. This case affecting the long-term outcome. Midfoot sprain, navicular fracture, involves a small avulsion of the metatarsal fracture, tibialis anterior dorsal portion from the dorsal strain, intrinsic foot muscle strain. talonavicular ligament that was Treatment: After 20minutes of treated conservatively. Con-

Journal of Athletic Training S-279 13414MC clusions: Mid-foot injuries can Non-Contact Patellar Fracture showed evidence of a transverse lead to long-term activity limitations In A Collegiate Football Player fracture along the equator of the and participation restrictions Following ACL Reconstruction patellar. The fracture was at the level if not diagnosed and treated properly. Wasylyk NT, Antinarelli MK, Hoch of the bony defect resultant from the Conservative treatment is usually JM, Shall LM: Old Dominion ACL reconstruction. One day sufficient for full recovery but University, Norfolk VA; Norfolk following initial injury, the patient operative treatment may be State University, Norfolk, VA; underwent an open reduction internal necessary for optimal outcomes Atlantic Orthopaedic Specialists, fixation procedure to repair the in certain cases. In this case, Virginia Beach, VA fracture. Four pins were inserted conservative management and parallel to one another from the Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 a graduated rehabilitation program fracture distally and reinforcement produced satisfactory results and Background: A 22-year-old collegiate wires were placed around the pins in a the patient is currently progress- offensive lineman sustained a non- crisscross fashion. The initial post- ing to full participation. contact knee injury during a preseason operative treatment consisted of football practice. The patient reported wound management and the patient was that he stepped backwards, braced in full extension and allowed experienced a pop, and that it felt like to weight-bear as tolerated with someone kicked him in the knee. Upon crutches. One week post-operative, a initial evaluation by the athletic therapeutic exercise program was training staff diffuse swelling was initiated to decrease pain, edema, and present along with loss of active knee restore ROM. Active quadriceps extension. The patient reported an 8/ contractions were not permitted 10 pain. Palpation findings indicated during post-operative weeks 2-4, point tenderness over the anterior however assisted hip strengthening and aspect of the knee and two separate ROM exercises were performed. Two bony prominences at the level of the weeks post-operative the staples were patella. No knee special tests were removed and exercises to decrease performed due to the diffuse swelling, pain, edema, and restore ROM were extreme tenderness, and deformity continued. Following two weeks of over the anterior knee. The patient was immobilization in full knee extension, braced in full extension and with crutch use, the patient was immediately referred to the team progressed out of the brace and physician for further evaluation. The crutches over the next six weeks. Four patient’s medical history was weeks post-operative a repeat significant for an ACL injury radiograph showed no evidence of approximately 9 months previously in distraction of the patella and at this which he was able to complete the time quadriceps strengthening and season. Once the football season was knee ROM exercises were initiated. complete he underwent ACL Eight weeks post-operative the patient reconstruction utilizing a quadriceps was out of the brace and began active tendon autograft. Following a ROM exercises. Ten weeks post- structured rehabilitation program and operative treatment focused on functional return to football related quadriceps muscle strengthening. The activities the athlete was cleared to patient is currently fourteen weeks out return to full activity approximately 7 and is continuing to improve; current months post-ACL reconstruction. treatment focuses on lower extremity Differential Diagnosis: Patellar strengthening and increasing function. tendon rupture, quadriceps tendon It is expected the patient will have the rupture, patellar fracture, tibial hardware removed once the fracture tubercle avulsion. Treatment: site has healed, and return to full Following physician evaluation, x-rays activities of daily living six months were ordered. Results of the x-rays postoperatively. Uniqueness:

S-280 Volume 48 • Number 3 (Supplement) May 2013 13364UC According to the literature, patella Isolated Grade II Posterolateral collateral ligament and popliteofibular fractures are rare but not uncommon Corner Injury In A High School ligament, as well as a bone contusion following ACL reconstruction Football Player within the posteromedial tibial plateau. utilizing quadriceps tendon graft. Creedon D, Gildard M, Powers The orthopedic surgeon recommended This case is unique because the ME: Marist College, conservative treatment which included fracture occurred as a result of a Poughkeepsie, NY partial weight bearing for four weeks tensile force at the knee and not in a DonJoy T-ROM brace allowing for direct contact, which is a common Background: We present the case of 30°-70° of knee flexion followed by mechanism for acute patellar a conservatively treated isolated grade a five week course of physical therapy fracture in an athletic population. with the goal of regaining normal range

II posterolateral corner (PLC) injury Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Additionally, the fracture was at the in a high school football player. A of motion, strength, and level of the bony defect resultant previously healthy sixteen year old neuromuscular control. Uniqueness: from the ACL reconstruction. varsity running back with no prior PLC injuries are relatively rare when Conclusions: In this case the history of lower extremity injury was compared to the other capsulo- individual sustained a noncontact tackled during a preseason scrimmage. ligamentous structures of the knee. patellar fracture approximately 7 When the tackle occurred, his right These injuries are also rarely isolated months post-ACL reconstruction foot was planted on the ground, (1.6%), and often occur with using quadriceps tendon autograft. In resulting in an external rotation and concomitant tibial plateau fractures addition to integrity of the graft, the valgus force at the right knee. The (Segond fracture), avulsion fractures patient’s strength, ROM and athlete was able to limp off the field of the fibular head (arcuate sign), function; graft site healing should be under his own power, however he anterior and posterior cruciate taken into consideration when presented to the certified athletic ligament tears, peroneal nerve injuries, returning patients to full activity. trainer with complaints of deep and distal tears of the biceps femoris aching pain (6/10) over the tendon, tears to the lateral head of the posterolateral aspect of his right knee. gastrocnemius, IT-Band tears, and knee Physical examination revealed a mild dislocations. Injuries to the PLC are joint effusion, decreased knee flexion, also commonly missed upon both and point tenderness over the lateral physical examination and imaging, tibial plateau, fibular head, and lateral especially in the presence of collateral ligament. The patient’s pain concomitant injuries. Furthermore, increased with flexion, varus stress, although conservative treatment is and weight bearing. Moderate (2+) often recommended for grade II PLC laxity was noted with the varus stress injuries, there is little published test at 30° of knee flexion, and information on the long-term natural increased external rotation was noted history, and there are no known reports with the Dial test at 30° of knee flexion. on the natural history of isolated injury Differential Diagnosis: Lateral of individual components of the collateral ligament sprain, PLC injury, posterolateral complex. Conclusions: lateral meniscus tear, anterior/ It is crucial that clinicians proceed posterior cruciate ligament sprain, with a high degree of suspicion when avulsion fracture of the fibular head, dealing with possible PLC injuries, tibial plateau fracture. Treatment: The especially in the case of grade III patient was managed on site with ice injuries. After 2-3 weeks the tissue and compression. He was placed in a becomes necrotic, and a primary acute straight leg immobilizer and was given repair is no longer possible. crutches for non-weight bearing Additionally, unrecognized injuries to ambulation. The patient was evaluated the PLC have been associated with a by an orthopedic surgeon two days high incidence of ACL and PCL graft after the initial injury. Radiographs failures, and chronic injury can result were negative for fracture, while in a high degree of disability. In this magnetic resonance imaging (MRI) case the patient was cleared to return revealed a grade II sprain of the lateral to full participation approximately

Journal of Athletic Training S-281 13437SC three months after the initial injury. Median Arcuate Ligament electrocardiograph, which revealed a He progressed through the start of Syndrome In A Collegiate benign mitral valve prolapse. At a basketball season without Female Rower follow-up visit with the GI specialist recurrence and only minimal Stubblefield ZS, Mooney CH: in July 2011, a duplex scan of the symptoms. However, he still ex- Nova Southeastern University, celiac and mesenteric arteries was hibits mild residual laxity with Ft. Lauderdale, FL unremarkable. An upper endoscopy, tibial external rotation. Although with biopsy, was also negative for H. long term follow up is needed to Pylori. A magnetic resonance fully assess the outcome, it appears Background: We present a case of a angiogram (MRA) of the abdomen that in this case, conservative revealed moderate narrowing of celiac

median arcuate ligament syndrome Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 treatment was successful in treating (MALS) in a 20-year-old collegiate artery, most likely related to an isolated grade II PLC injury. female rower. The purpose of this case compression by the arcuate ligament report was to emphasize the diagnosis of the diaphragm. When the athlete and treatment of this rare vascular reported for August physical exams, disorder, in which the celiac artery was the team physician cleared her to compressed by the median arcuate participate as tolerated, but referred ligament as it passes through the her to a vascular surgeon for a diaphragm. The initial athletic training consultation. In December 2011, after examination, after a race in March reviewing her records and performing 2011, revealed severe lower an examination, the vascular surgeon abdominal pain and cramping, deemed the athlete a candidate for a accompanied by nausea and laparoscopic release of the median lightheadedness. The athlete had no arcuate ligament. In January 2012, the history of abdominal pain and her vital procedure was performed and the signs recovered normally following patient was released from the hospital the race. At first, her symptoms were the following day. The team only triggered by racing, but after nutritionist, athletic trainer, and several months, even submaximal surgeon educated the athlete on exercise provoked the symptoms. Due optimal food choices before, during to the incapacitating severity of the and after exercise. During the four symptoms, the athletic trainer referred weeks post-operative, the athletic her to the team physician. trainer guided her through a gradual Differential Diagnosis: The athletic return to rowing. For the first 2 weeks trainer’s differential diagnoses post-operative, she was restricted to included hypoglycemia, exertional submaximal, low-impact cardio- heat illness, illiopsoas spasm, and vascular exercise. For the next two possible ovarian cysts. Treatment: In weeks, she performed higher-impact April of 2011, within a week of the cardiovascular exercise and began onset of her symptoms, the athlete was submaximal weight-lifting. After 4 examined by her team physician. A weeks, she began gradual progression comprehensive blood panel and on the rowing ergometer, increasing urinalysis yielded normal results. Two exercise duration before increasing weeks later, a CT angiograph revealed intensity. The athlete returned to only a small ovarian cyst. The athlete racing 8 weeks after the surgery. Our was referred to a GI specialist who athlete has had to withhold herself prescribed omeprazole and ordered an from several races since the surgery, ultrasound of the liver and gall bladder. but is currently able to race without The ultrasound was unremarkable so he recurrence of symptoms. referred the athlete for a cardiac Uniqueness: In 10-24% of people, evaluation to rule out vasovagal the median arcuate ligament can syncope. The cardiac evaluation compress the celiac artery. CT included an electrocardiogram, angiography and MRA is able to echocardiogram, and stress diagnose the compression of the

S-282 Volume 48 • Number 3 (Supplement) May 2013 13278OC celiac artery. The significance of this Recurrent Anterior Cruciate radiographic imaging including AP/ compression is a source of Ligament Deficiency In The Lateral/Sunrise views revealed good controversy in the literature, Varus Aligned Knee Of A Multi- joint space and alignment and evidence especially given the high incidence of Sport Athlete of two previous ACL reconstructions this finding in otherwise asymptomatic Stanislawski VM, Hackett TR, with tunnels and screws. Outside individuals. Conclusions: Athletic Ashton J: The Steadman Clinic, magnetic resonance imaging(MRI) trainers often evaluate abdominal pain, Vail, CO dated February 2011 revealed ACL nausea and lightheadedness. We repair with graft failure, probable post- should be aware that MALS can be a Background: A 33 year old male meniscectomy without tearing of the source of these symptoms. Athletic root of the medial meniscus,

recreational athlete presented with left Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 trainers are qualified to guide an knee instability in February 2011. degenerative joint disease of medial athlete through a gradual return to play Patient’s history involved multiple and patellofemoral compartments, and following laparoscopic release of the anterior cruciate ligament (ACL) small flap tear of central trochlear median arcuate ligament. injuries initially from a snowboarding groove. Initial surgical intervention accident approximately twelve years involved revision ACL reconstruction prior. In 2001 he underwent primary with Achilles tendon allograft, tunnel ACL reconstruction with patellar bone grafting and removal of hardware. tendon autograft and partial medial Following re-injury, longstanding meniscectomy. A revision ACL radiographs demonstrated varus reconstruction with patellar tendon alignment of left lower extremity. allograft was performed 4years later. Diagnosis included failed ACL Both procedures were performed at reconstruction secondary to varus outside facilities. In February 2011, alignment of the left lower extremity he presented with a chief complaint of warranting additional surgical popping, catching, and instability intervention. A staged procedure following a work-related injury. The involving chondroplasty, hardware patient ambulated with antalgic gait removal, allograft bone grafting, and assisted by a custom hinged knee opening wedge high tibial brace. Focal exam revealed no osteotomy(HTO) was performed to deformity, lesions, erythema or correct alignment, to be followed by ecchymosis. Patient was non-tender revision ACL reconstruction with to palpation and presented with equal allograft approximately 6months later. patellar mobility and range of motion Uniqueness: A direct relationship has of 0/0/125 degrees. Patient had been found to exist between lower positive Lachman and anterior drawer extremity varus alignment and anterior testing with negative meniscal cruciate ligament tension. It is findings. After initial evaluation, a recommended that varus alignment be revision ACL reconstruction was examined in patients, especially with performed. At 7months, he returned recurrent ACL failures, as tension to full activity with a functional ACL across a malaligned knee may cause brace. Approximately 10months after graft stretching and failure regardless surgery, the patient experienced left of graft choice. Conclusions: This knee instability followed by a “pop” athletic patient underwent multiple left sensation. The patient returned for knee procedures to reconstruct the evaluation where physical exam integrity of his ACL. He experienced findings, included left knee effusion three failed reconstructions prior to with positive Lachman and anterior assessment of varus alignment. At drawer tests, consistent with an ACL 5months status post HTO procedure to tear. Differential Diagnosis: ACL correct alignment the patient is graft insufficiency, graft tunnel progressing through physical therapy misplacement, lack of graft with no complications. He continues incorporation, meniscal pathology, to demonstrate positive findings for varus alignment. Treatment: Initial

Journal of Athletic Training S-283 13088UC

ACL deficiency and is scheduled to Athletic Training Considerations tinea infections, and skin maceration proceed with revision ACL In A Below The Knee Amputee In often occur as are result of excessive reconstruction. Recognition and Football And Wrestling: A Case compression, moisture, friction, and correction of varus alignment Report infection. Uniqueness: It is estimated is crucial prior to proceeding with Horne D, Charles-Liscombe R, that among the 21 million athletes with a ligament reconstruction, in Guffey J, Lesperance M: disabilities, 5-10% have a physical particular in a young athletic Greensboro College, Greensboro, disability or physical impairment in population where varus alignment NC; College of Mount St. Joseph, which Athletic Trainers must be able combined with ACL deficiency Cincinnati, OH; Southern Guilford to provide sideline care. As athletic can be a common finding. With the High School, Greensboro, NC trainers broaden their employment Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 combination of this staged settings, the possibility for an athletic procedure, the sports medicine trainer working with a patient with a team hopes to return the patient Background: A 15-year-old male with prosthetic is more common. Similarly, to regular athletic activities and a right below the knee amputation as large numbers of military veterans prevent the need for further surgical (BKA) presented to the AT staff to return from combat operations abroad intervention. It is for these reasons participate in junior varsity football with amputations, these individuals that sports medicine professionals and wrestling. The patient had will seek out opportunities for should be aware of the reasons previously participated in youth sports competitive participation and physical for primary ACL reconstruction with few to no limitations. At the start activity. ATs should be able to provide failure and be able to provide a of the academic year, the AT staff were each patient with the necessary care full examination including required to assess the Americans with and recognize when referral is radiographic assessment to address Disabilities Act (ADA) guidelines and necessary. ADA and NCHSAA potential malalignment. the North Carolina High School regulations provide guidance to the Athletics Association (NCHSAA) practicing AT on how to care for rules and regulations regarding athletic these unique patients. Conclusions: participation for individuals with It is important as an athletic trainer prosthetics. Care and management of to provide compassionate and the prosthetic appliance and limb were appropriate care to all athletes. For also investigated. Differential an athlete who has a BKA prosthetic Diagnosis: Choke syndrome, Contact or any other prostheses it is Dermatitis, Epidermal Cyst, important to know the ADA Maceration, Tinea Infection. regulations and accommodations, Treatment: The patient was able to understand how a prosthetic is participate throughout the designed, fit, and how to repair interscholastic football and wrestling issues. The athletic trainer must also seasons with minimal complications. be able to recognize potential At the start of each football complications for prosthetic use. competition, the AT staff provided the Finally, the athletic trainer must officiating team with NCHSAA establish relationships with the required documentation of medical patient, parent, coaches, primary care necessity and demonstrated adequate giver, and the prosthetist. padding for the rigid metal hinge and post at the leg and foot interface. Prior to and during the wrestling season, the patient was required to comply with NCHSAA weight certification standards with and without the prosthetic appliance. In active individuals with prosthetic lower limbs, several dermal conditions may also present and require treatment from the AT. Complications such as choke syndrome, contact dermatitis,

S-284 Volume 48 • Number 3 (Supplement) May 2013 13099MC Left Anterior Knee Pain In A through range of motion and stretching significant because in less than ten Collegiate Women’s Track And exercises for the initial two weeks then months the athlete is completely Field 400-m Hurdler began to swim and bike. By week four asymptomatic and has returned to full Arredondo JA, Joseph CJ: strengthening exercises were team participation, despite being University of Central Florida, implemented. At week five, symptomatic for the previous five Orlando, FL prescription NSAID’s were years. More research is still needed to administered and strengthening determine an appropriate number of Background: A 19-year-old female exercises were progressed. At the start treatments to be administered, the time collegiate 400-m hurdler presented of the indoor season, additional frame in which the treatments should ultrasound images confirmed marked be administered, and the long term with left anterior knee pain over a two Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 week period following the end of her improvement with one of the two tears; efficacy of PRP therapy. freshmen year of competition. She however the other tear was still complained of pain and swelling present. As a result, her second PRP subsequent to intense workouts during treatment was administered. The same the peak of her outdoor season. For the post treatment protocol was followed. past five years, she has experienced At week four, physical therapy (PT) intermittent knee pain over her was ordered three times per week for patellar tendon throughout the course ten weeks with the team physical of her training and competitions. therapist. Two months after PT, MRI Differential Diagnosis: Patellar and ultrasound images showed tendinitis, patellar tendon strain, tibial complete resolution and she has since osteochondral defect, arthritis, medial returned to full participation. meniscal tear, inferior patellar Uniqueness: This case is unique calcification. Treatment: Following because the athlete had significant her season, the athlete was referred to intermittent knee pain for five years. the team orthopedic physician. Current literature suggests that Radiographs were negative for following multiple PRP injections for fractures and no evidence of arthritis tendinopathies, individuals return to was found. The physician’s diagnosis full activity within three to six months. was mild patellar tendinitis. The athlete This athlete returned to a highly was administered a course of oral anti- trained, collegiate level within ten inflammatories with continued rest and months and is currently asymptomatic. rehabilitation for three months. Two The majority of studies have suggested weeks into her return to fall pre-season that PRP treatments are beneficial and training, she continued to experience have a positive influence in the significant anterior knee pain and was treatment of patellar tendinopathies. referred for diagnostic musculo- This case is unique because PRP skeletal ultrasound images. Ultrasound evidence based research is still in its images revealed two significant tears infancy and is a topic of interest in the in her patellar tendon. Due to medical field. This case provides continued pain and failed conservative additional evidence to support the use treatment, she was referred for of PRP treatment for patellar platelet-rich plasma (PRP) treatment. tendinopathies. Conclusions: A Three weeks later the athlete had her collegiate female 400-m hurdler first PRP treatment administered. presented with anterior knee pain at the Following the injection, she was non- end of her freshmen season of weight bearing for the first forty-eight competition. Ultrasound images hours. For the initial four weeks, no confirmed two significant tears in her non-steroidal anti-inflammatory drugs patellar tendon. The compromised (NSAID’s) were ingested, and ice was patellar tendon was treated with two only applied for ten minutes every hour platelet-rich plasma treatments, to reduce the risk of impeding the NSAID’s, and PT. This case is healing process. She progressed

Journal of Athletic Training S-285 13114MC 13419SC

Medial Knee Pain In An In- the injury occurred on the lateral Osteochondroma Of The Season Collegiate Men’s aspect of the knee. Initial findings Scapula: An Unusual Cause Of Soccer Player indicated meniscal symptoms; Unilateral Scapular Winging In Whisenant DJ, Joseph CJ: however the injury occurred to the An Overhead Athlete University of Central Florida, lateral femoral condyle. This case is Porter PA, Ismaeli Z, Renehan E, Orlando, FL also unique because of the timeline Johnson DC, Johnson TS: to full participation. The patient was National Sports Medicine Institute, Background: A 21 year old male able to return to full athletic Lansdowne, VA collegiate soccer player presented competition in five weeks. Current research has suggested that typical with left knee pain following a game. Background: A 15-year-old male high Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 return to competition in high-level His initial pain was felt after changing school overhead athlete reported to his male soccer athletes following direction from forward to backward certified athletic trainer with a chief microfracture repair of a 2 cm2 OCD running. He complained of pain along complaint of left periscapular pain and is eight months. The fact that his the medial joint line and posterior deformity. He was a two sport athlete, OCD was relatively small, and that medial aspect of his knee with forced playing basketball and football only a few microfractures were knee flexion. Clinical examination quarterback. He reported no incident performed is the cause for his yielded a positive McMurray and of injury or known history of upper uniquely quick recovery. Current bounce home test. The athlete had no extremity or back injury. The athlete research has also suggested that prior history of left knee injuries. was aware of the mass for several years frequency of OCD on the lateral Differential Diagnosis: Medial but noted a recent increase in size and femoral condyle is fairly low (7- meniscal tear, Medial Collateral irritation. He started having pain with 20%). This poses the question of Ligament sprain, femoral bone weight training activities, such as whether size or location of an OCD contusion, tibial plateau contusion, overhead press, lat pull downs and repaired with microfracture is more femoral osteochondral defect (OCD). shoulder shrugs. He denied recent important to recovery time. Treatment: Possible meniscal illness or constitutional symptoms. Conclusions: A collegiate male pathology was confirmed by the team He complained of pain that is sharp in physician and the athlete was referred soccer player who presented with quality and intermittent in nature, for diagnostic imaging. MRI results possible medial meniscus pathology occurring with reaching and overhead revealed loose chondral fragments and was found to have loose chondral activities. Range of motion was full 1 x 1.5 cm acute lateral femoral OCD fragments and a lateral femoral OCD with some scapular crepitus. An of the left knee. The loose bodies were of the left knee. The injury was evaluation revealed unilateral scapula removed arthroscopically and the repaired arthroscopically and winging with a palpable mass on the OCD was repaired. Microfractures rehabilitation began immediately. He left side. The athlete was referred to were performed on the lateral was able to complete the remainder team physician for further evaluation. femoral condyle to promote healing of his competitive season with Differential Diagnosis: Differential of the OCD. Following surgery, the minimal symptoms; however, diagnosis includes: brachial athlete was strictly non-weight following the season, the athlete plexopathy, long thoracic nerve palsy, bearing for one week. Range of experienced lateral knee pain. This spinal accessory nerve palsy, motion and open chain strengthening is consistent with research that Parsonage-Turner syndrome, cervical exercises were implemented suggests microfracture repair radiculopathy, neoplasm. Treatment: immediately following surgery. The may cause clinical deterioration over Physical examination by physician athlete began partial weight bearing time. This case is significant because revealed severe scapula winging on the in week two, and reached full weight of the presentation of initial left and a palpable left shoulder mass bearing very quickly. Sport specific symptoms, and despite suffering that was supple and non-adherent to the activities were performed after four a potentially season ending injury, thoracic ribs. There was no axillary weeks. The athlete reached full a high-level athlete returned to lymphadenopathy. Diagnostic x-rays participation five weeks post- competition during the same season. confirmed an abnormal calcification surgery. Rehabilitation and He completed his collegiate career of the left thoracic. An MRI was treatments were continued through and has now continued with ordered and consultation with the end of his season. He was able to recreational participation. orthopaedic tumor specialist was complete the remainder of his obtained to rule out malignancy. MRI competitive season with minimal scan revealed a well circumscribed symptoms. Uniqueness: The athlete 2cm x 2cm exostosis on the anterior presented with medial knee pain, yet

S-286 Volume 48 • Number 3 (Supplement) May 2013 13094MC aspect of the lower body of the Os Acromiale In Dominant corticosteroid injection in order to scapula. The lesion was determined to Shoulder Of An Overhead decrease the pain and inflammation be an osteochondroma with a large Athlete present in the area. The injection was multi-septated cystic collection with Maguire MC, Petron DJ, Toth R, given at the site of pain which was prominent subscapular bursa that Lorens K, Hicks-Little CA: located at the acromioclavicular joint. measures 12cm X 7.5cm x 18cm. University of Utah, Salt Lake City, After 4 days of rest the athlete was Treatment options were discussed UT prescribed a shoulder rehabilitation with parents and athlete with surgical program. The program focused on excision encouraged. Surgical Background: An 18 year old, female, scapular muscle strengthening as well excision was carried out with an as an overall shoulder muscle freshmen Division 1 softball catcher Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 incision over the medial scapula with with no previous history of injury to flexibility program in an effort to take lower trapezius, latissimus dorsi, and either shoulder prior to entering the pressure off the anterior aspect of rhomboids dissected. The medial college reports to the athletic trainer her shoulder. The shoulder program scapula was retracted and the mass was with complaints of anterior shoulder consisted of multidirectional band sharply excised. Rehabilitation began pain. Due to the increases in activity work, horizontal flies, internal and at one month status post and focused from high school to collegiate external rotation exercises, raises in on periscapular and rotator cuff athletics the athlete began to the scapular plane, and scapular strengthening. Return to play criteria experience anterior shoulder pain on squeezes. Additionally, modalities including pain-free overhead ROM of her dominant (right) shoulder. The such as ice, compression, ultrasound, motion, periscapula and rotator cuff athlete reported increased pain upon and electric stimulation were strengthening was met at four months. throwing, especially long distances. prescribed. Although this particular A scapulothoracic stabilization brace Examination revealed tenderness to athlete was allowed to rest while the (used for proper scapular retraction to palpation over the right acromion injection took effect, she was never improve posture alignment, scapular process. The acromioclavicular fully with held from play. The athlete function, and reduce pain) was compression test as well as the was instructed to decrease the weight prescribed for early return to play. The Hawkins sign were both positive for she was lifting to her tolerance and her athlete has made a full recovery and pain. Internal and external rotation number of throws in practice were has returned to full athletic activity, shoulder range of motion was limited limited. As her strength increased and playing at starting quarterback position due to pain. When asked to rate her pain decreased, the amount she was in the fall. Uniqueness: Scapula pain on a scale from 1 to 10, the athlete allowed to lifted and throw increased winging is a common finding in the reported a 7 out of 10. All other range accordingly. The athlete was fully able evaluation of an overhead athlete with of motion, special tests, and manual to return to play pain free after 3 shoulder pain. The finding of unilateral muscle tests were within normal months. Uniqueness: Os acromiale scapular winging should alert the limits. Differential Diagnosis: is only present in eight percent of the practitioner/clinician to a differential Impingement syndrome, rotator cuff population and within that eight diagnosis of neuropraxia, trauma, and pathology, acromioclavicular joint percent, 33 percent have bilateral os neoplasm. Conclusions: This case sprain, biceps brachii pathology, acromiale. It is also reported to be outlines a rare cause of unilateral scapular dyskinesis, labral pathology, more prevalent in males than females. scapula winging in an overhead clavicle fracture, thoracic outlet Although it is unknown if this athlete athlete. Osteochondromas are benign syndrome, directional instability, or has bilateral os acromiale, the small lesions that usually form on long bony pathology. Treatment: The percentage of female athletes that bones. Osteochondromas are the athlete was referred to the team present with this pathology provides most common benign lesion on the physician where an evaluation resulted evidence to the uniqueness of this case. scapula and although rare (3-5% of in the diagnosis of impingement Conclusion: According to current all cases), should be considered in syndrome. The team physician research, the majority of anterior cases of unilateral scapula winging however, ordered an x-ray to rule out shoulder pathologies can be treated by when there is no definitive any other pathology. The x-ray correcting scapula deficiencies. In this mechanism of injury. Full recovery revealed an os acromiale. Os particular case, using NSAIDs and a and return to competitive overhead acromiale is found when one or more cortisone injection provided the sports can be achieved after successful of the three growth plates in the athlete with significant pain relief surgical excision and rehabilitation of acromion process have not closed. The which enabled her to participate in the periscapular musculature. athlete was given non-steroidal anti- rehabilitation. Within a month of inflammatory drugs (NSAIDs) and a diagnosis, the strength of the athletes’

Journal of Athletic Training S-287 13445SC posterior musculature had increased Left Shoulder Pain In High all contact activities for an and her anterior shoulder pain had School Athlete anticipated 10-12 weeks. Physical significantly decreased. This case Least B, Johnson J, Hosey R: therapy was initiated after 6 weeks provides further support that even with University 0f Kentucky, Lexington, of restricted motion and non-weight a bony deformity, such as os KY, and Henry Clay High School, bearing. The athlete was seen every acromiale, that results in significant Lexington, KY 2 weeks for repeat rib radiographs. anterior shoulder pain, implementing Callus formation was noted after 1 a scapular strengthening program aids Background: A 17 year old right month and healing progressed in rehabilitating the athlete back to handed high school football player thereafter. At 6 weeks the patient pain free return to play. began conditioning activities, presented to the athletic training room Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 with diffuse left shoulder pain. He progressed to weight lifting after 8 noted discomfort superior to his weeks and released for full contact clavicle with radiation into his upper after 10 weeks. At that time, he had trapezius and deltoid. He could not full pain free ROM and strength. recall a specific mechanism of injury Therapy was continued for but stated discomfort began during progressive strengthening. The tackling drills. Due to the significant patient missed the remainder of the pain, the athlete noted difficulty football season but was cleared for raising his arm above shoulder level wrestling activities. Uniqueness: and taking a deep breath. He denied The case denoted a rare presentation previous history of injury to the of a first rib fracture with symptoms shoulder, numbness, tingling, or neck that mimicked a clavicle or AC joint pain. On examination the patient was injury. The patient’s symptoms were tender superior to the proximal left non-specific, and without a given clavicle and within the mid-belly of the mechanism of injury, could have trapezius and sternocleidomastoid. been attributed to numerous soft Shoulder ROM was limited to 90 tissue and bony shoulder pathology. forward flexion and 90 abduction Conclusion: The athlete responded secondary to pain. Neck ROM was well to conservative management. antalgic to left lateral bending but He returned to wrestling activities otherwise full. Strength within the initially at full participation but shoulder was antalgic but full and he activity level had to be scaled back had preserved strength and sensation due to pain recurrence. He will be throughout the remainder of the left gradually progressed through pain upper extremity. Differential free activity with a return to full Diagnoses: Soft tissue contusion, participation in another 2 weeks. He clavicle fracture/ contusion, denied additional acute injury and acromioclavicular sprain, shoulder repeat radiographs noted a capsular sprain, rib fracture. completely healed left first rib Treatment: Initial treatment fracture with adequate callus consisted of symptom management. formation. Final evaluation The athlete was restricted from sport indicated a non-tender shoulder with specific activities, utilized over the symmetric ROM and strength counter anti-inflammatory medi- between the uninvolved dominant cations for pain relief and and involved non-dominant extensively iced the shoulder. With extremity. Although rare, the a lack of improvement, he was seen diagnosis of a first rib fracture by the team physician. Plain requires a heightened suspicion from radiographs were pertinent for a non- medical professionals. Prolonged displaced fracture of the left first rib. conservative management can yield The athlete was placed in a sling with satisfactory results and return to instructions for non-weight bearing previous level of activities. of the left upper extremity and restricted ROM. He was held out of

S-288 Volume 48 • Number 3 (Supplement) May 2013 13422MC

Suprascapular Neuropathy In A season, pain and atrophy returned, 2013 season. Uniqueness: This case Collegiate Baseball Pitcher: A which was confirmed by EMG testing is unique because the diagnosis of Case Study on 3/18/11. At this time surgery was suprascapular neuropathy associated Klass SE, Chelette CJ, Yochem recommended, but the athlete opted to with repetitive overhead throwing is EM, Burks RT, Petron DJ, Hicks- try Accelerated Recovery uncommon, and easily misdiagnosed. Little CA: New York University, Performance (ARP) wave treatment This can lead to improper New York, NY, and University of instead. After 5 weeks of treatment, the rehabilitation, which may exacerbate Utah, Salt Lake City, UT symptoms remained unresolved, and the problem. Conclusions: on 5/10/11 the athlete underwent Evidence suggests that suprascapular surgery to decompress the neuropathies in overhead throwers Background: A healthy 19-year-old Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 male in his first year as an NCAA suprascapular nerve. Nine months of can be complex and potentially Division I baseball pitcher complained rehabilitation, including scapular misdiagnosed due to a similar of pain in his right anterior and correction, eccentric exercise, and presentation as common rotator posterior shoulder that he rated as a throwing followed the surgery, and he cuff tendonopathies. Clinicians 7-8/10. Pain occurred on 5/11/10 returned to pitching and all team should be aware that atrophy of after pitching 4 innings. The athletic activities on 1/9/12. After 7 weeks of the infraspinatus may be caused by trainer’s initial physical examination successful pitching, complaints of a compression of the suprascapular revealed point tenderness over the scapular tightness began. Prolonged nerve. This case study hopes to rotator cuff musculature, full AROM, tightness led to a follow up shoulder improve the effectiveness of and weakness (4/5) with manual MRI on 3/24/11, which was deemed clinicians in diagnosing and treating muscle testing in flexion, adduction normal. Acupuncture, suction cup, and suprascapular neuropathies. and external rotation. Resisted massage therapy were attempted to external rotation specifically relieve the tightness with limited reproduced the pain. Differential success. Lack of relief led to a CT Diagnosis: Rotator cuff pathology, scan of the right shoulder on 4/6/12 suprascapular neuropathy, labral to rule out quadrilateral space pathology, subacromial impingement, syndrome. The scan revealed a brachial plexopathy, C5-6 possible occlusion of the radiculopathy, quadrilateral space suprascapular artery, potentially syndrome, and space occupying lesion. causing thoracic outlet syndrome Treatment: The team physician’s during throwing. Upon consulting a examination on 5/12/10 identified vascular specialist, it was concluded severe atrophy of the infraspinatus that thoracic outlet syndrome was not with scapular dyskinesis. The atrophy the cause of the symptoms. Referral was attributed to a suprascapular nerve to a physician with several years compression in the spinoglenoid experience in major league baseball region, which was thought to be from did not uncover any new evidence. To a ganglion cyst. An x-ray showed no rule out a cervical radiculopathy, a abnormalities, and an MRI revealed no neck MRI was performed on 4/23/ space occupying lesion, rotator cuff or 12 that showed no irregularities. labral pathology. A decreased Symptoms again improved with rest, neuromotor signal in the suprascapular and a throwing program was initiated nerve was confirmed by an the following fall on 6/18/12. This Electromyography (EMG) test. irritated the athlete’s right latissimus Surgeons who specialize in baseball dorsi muscle. As a result the athlete injuries were consulted on the case, and consulted a chiropractor, who added they collectively recommended a 6 supplemental K-Laser treatments to month period of rest, rehabilitation, the existing rehabilitation exercises. and a slow throwing progression. The By slowing the athlete’s progression athlete improved steadily, and was and modifying mechanics, he cleared for full participation on 12/7/ continues to improve with minor 10 after an improved EMG test and setbacks. To date the athlete is on successful bouts of pain free pitching schedule to participate in the 2012- at full strength. During the spring

Journal of Athletic Training S-289 13051UC

Wrist Pain In A Female ulnaris tendinopathy, pronator teres second extensor (extensor carpi Intercollegiate Javelin Thrower tendinopathy, De Quervain radialis longus, brevis) compartment Brodeur A, Rothbard M, Davis C: tenosynovitis, and intersection and can easily be clinically Southern Connecticut State syndrome. Treatment: After initial misdiagnosed. The condition is caused University, New Haven, CT evaluation, the patient received by excessive friction between the two conservative treatment encompassing compartments or entrapment from Background: A 20 year-old, 64cm, massage and a wrist orthosis limiting stenosis. It presents with pain, 72.6kg female javelin thrower wrist and thumb extension and was swelling, and creptius in the distal presented with right, dull, radiating referred to the team orthopedist. The dorsoradial forearm. Intersection team orthopedist definitively syndrome responds favorably to mid-forearm pain with crepitus Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 secondary to repetitive stress. She diagnosed the patient with intersection conservative management within eight reported being able to perform ADL, syndrome. Based on his clinical weeks. This includes modifying sport but unable to perform unrestricted examination, he recommended she activities to decrease stress on the sport activities. Pain quotient was 5/ remain in the orthoses and take two wrist and forearm, physical agents, and 10 at rest, 8/10 with activity, and 6/10 months off from throwing. He also therapeutic exercises to reduce pain after activity. Pain was alleviated by prescribed cryotherapy, compression, and swelling, which improve tendon rest and aggravated by wrist flexion and elevation, and NSAID therapy for gliding between compartments. extension. Initial examination revealed seven days. Status-post one week, the posterolateral wrist and forearm patient began a rehabilitation program swelling and palpabable tenderness. emphasizing further pain and swelling ROM was WNL, but forearm reduction and restoring soft tissue pronation and wrist and thumb mobility and strength of the wrist and extension were painful. MMT revealed thumb. The rehabilitation program pronation and wrist and thumb consisted of physical agents to extension at 4/5. Special tests decrease inflammation and therapeutic demonstrated no ligamentous, exercises focusing on fine motor vascular, or neurological pathology. control and dexterity, and eccentric The patient’s previous medical history strengthening to increase grip and was significant for right wrist sprains twisting strength. Status-post eight at 11 and 14 years old, and a fractured weeks, the patient was cleared for right ulna at 13 years old. At age 18, conference championships and was she reported dull pain, crepitus, and able to throw with minimal discomfort. swelling in her wrist, and a noticeable She continues to manage any post- forearm deformity, but was non- activity inflammation with compliant to treatment. Related cryotherapy. Uniqueness: Inter- history also included an unknown section syndrome is unusual with an elbow and forearm pathology with incidence rate of less than 1% of all similar symptoms in the forearm, forearm, wrist, and hand injuries. The which were treated with rest, condition is primarily seen in cryotherapy, and therapeutic exercises. individuals who perform repetitive The elbow pathology resolved, but the wrist actions during occupational forearm pain persisted. The patient activities such as raking and shoveling self referred to a chiropractor twice where excessive grasping, wringing, per week and was treated with Graston and twisting of the wrist occur. tools, which caused swelling, bruising, Intersection syndrome is rarely and pain. She was referred from the studied in athletic training education chiropractor to an orthopedist who curricula. Conclusions: Intersection ordered radiographs, which were syndrome is an inflammatory unremarkable, and a corticosteroid condition that occurs at the injection that did not provide relief. intersection or crossover point of the Differential Diagnosis: inflamed first extensor (extensor pollicis brevis, extensor reticulum, radial stress extensor carpi radialis longus) and the fracture, radial neuritis, extensor carpi

S-290 Volume 48 • Number 3 (Supplement) May 2013 13160UC

Conservative Treatment For long head tendonitis, supraspinatus lesion. Conclusion: Circus athletes Osteolysis Of The Distal tear, rotator cuff impingement. have extreme flexibility making Clavicle And An ALPSA lesion In Treatment: The MRI results the assessment difficult. Some of A National Circus School Athlete indicated the distal end of the clavicle the performances require weight Rondeau V, Dover GC: Concordia and to a lesser extent, the medial bearing activities and may not be University, Montreal, QC acromion were irregular from bone easily recognized as typical resorption indicating a post traumatic mechanisms of injury. More studies Background: We are presenting the osteolysis. In addition there was a soft are needed on this type of athlete and case of a 24 year old male circus tissue mass at the AC joint. Moreover non-operative treatment for there was a high signal intensity of the osteolysis and ALPSA lesions. student from l’École Nationale de Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Cirque with a history of bone marrow suggesting edma coracobrachialis tendonitis. The formation of the distal clavicle. Also, student majors in straps which is an the antero-inferior labrum appeared acrobatic specialty consisting of two detached from the bone of the glenoid thin parallel straps several meters in but remains attached distally to the length, which he rolls and unrolls using periosteum indicating an Anterior the wrists and arms to execute held Labral Ligamentous Periosteal Sleeve poses, while being suspended. The Avulsion (ALPSA) Lesion. We started athlete started to feel pain at a conservative treatment by addressing particular performance where he was his poor posture including scapular lifting people onto the shoulders of stability exercises and strengthening other performers. During this exercises (trapezius, rhomboids, and performance the tower is not stable and rotator Cuff). We released tight the weight is not distributed evenly. muscles (trapezius, rhomboids, rotator The athlete was standing with knees cuff), and performed AP gleno- fully flexed, holding another artists humeral glides. We used K-tape to leg, one hand at the end of his calf and maintain his scapulae in a retracted the other just below his knee. His position, which the athlete indicated elbows were flexed and abducted due was effective in reducing his pain. After to the lack of space. He was assessed 3 weeks of moderate success, the with having biceps tendonitis and athlete received a cortisone injection prescribed rest. After 6 weeks of rest and felt significantly better. there was no change in pain. His first Uniqueness: Trauma and repetitive assessment back revealed poor posture injuries are often the cause of post- including rounded shoulders. Right traumatic osteolysis of the distal shoulder ROM; extension 60° with 1/ clavicle, and often occurs in 10 rating for pain, flexion 185° (2/10), weightlifters with pain during shoulder ABD 185° pain-free, ADD 0° (3/10), elevation and adduction. This case internal rotation 95° (4/10) and involved a similar mechanism in a external Rotation 80° pain-free. circus performer who performed his Manual muscle testing of the mid and straps routine with his body weight. lower traps, rhomboids, and rotator ALPSA lesions were first described in Cuff were weak (3/5) and pain-free. 1993 as detached capsulolabral Coracobrachialis had 5/5 strength with complexes which healed medially on 1/10 for pain. Special Tests; the scapular neck. A history of multiple impingement and speed’s test were dislocations is usually present in positive. After two weeks of ALPSA lesions, but not in this case. strengthening exercises, laser When conservative treatments fail, treatments, and decreased activity operative treatments are often there was limited success. He was then considered however, the prognostic referred to a sports doctor who implications of arthroscopic repair are recommended x-rays and an arthro- unclear. Additionally, the recurrence MRI. Differential diagnosis: Biceps of instability after repair for an ALPSA lesion is twice as high as the recurrence after repair of a Bankart Journal of Athletic Training S-291 13370SC

Left Upper Extremity Swelling symptoms, an MR arthrogram was Conclusions: Although a rare In A Collegiate Football Punter obtained. The MRA was unremarkable, pathology, PSS carries the potential Harkins TW, Harkins KR, Fuller but was documented as “inconclusive” of significant morbidity and JD: Marshall University, due to the fact that the subclavian vein potentially fatal complications such Huntington, WV was not evident. A venogram was then as post-thrombotic syndrome and ordered which revealed a 5-7 cm fixed pulmonary embolism. Therefore, it Background: A 22 yr old male, occlusion of a segment of the is imperative that athletic trainers Division I collegiate football punter subclavian vein with collateral recognize the signs and symptoms of (5’8’, 191 lbs), reported to the athletic formation beginning and reconstituting PSS to facilitate appropriate and the brachiocephalic vein indicating that timely referrals, and remain diligent training staff on Monday following a Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 game. The athlete was not a member the occlusion had been present for at until a pathology is detected. of the travel squad and had participated least one month. Treatment was in a non-travel training session on the initiated the same day and consisted of previous Friday. Athlete reported thrombolysis via interventional feeling an “unusual tightness” in his radiology with Heparin and TPA left upper extremity during the infusion at 1 mg/hour for 24 hours. The military press which had not subsided. next day a 10 cm x 4 cm balloon was The athlete had no previous history of inserted into the subclavian vein which upper extremity trauma and no relevant yielded an excellent final angiographic medical history. Physical examination result. However, it was noted that the revealed slight edema about the vein was likely to re-occlude due to entirety of the left arm with mild first rib pathology. The athlete was hyperemia but no true ecchymosis. He prescribed a regimen of Coumadin and reported no discomfort. The skin of Lovenox. Due to the likelihood of the left upper extremity was free of recurrence, the athlete was referred lesions and completely intact, but for left transaxillary rib resection. The clearly distended. Neurological athlete was cleared for full activity evaluation revealed slightly reduced approximately 5 weeks following the sensation about the entire left upper rib resection, at which point the extremity but no myotomal weakness. Coumadin was discontinued. The He had normal and equal pulses athlete had no incidence related to the bilaterally, and no lymphadenopathy. pathology upon returning to his normal Differential Diagnosis: Thoracic activity regimen. Uniqueness: Paget- outlet syndrome (TOS), deep vein Schroetter Syndrome (PSS) is a rare thrombosis (DVT) or embolism, presentation of upper-extremity DVT, arterial or venous aneurysm, occurring in approximately 1-2/ superficial thrombophlebitis, 100,000 persons per year. As in this infection, musculotendinous rupture. case, patients are commonly without Treatment: The athlete was evaluated previously recognized pro-thrombotic by a team physician who ordered an X- risk factors. PSS typically manifests ray to rule out rib-implicated TOS, in the dominant extremity of the which it did. He was referred for an patient, which was not true in this case. ultrasound the next day which Based on the amount of collateral demonstrated no evidence of DVT. An circulation that had developed, it MRI was obtained which demonstrated appears that the occlusion had been no evidence of DVT. During this time, present for a minimum of one month. the athlete reported an increase in his The ability of the athlete to lift weights upper extremity tightness. Additional with the same intensity over the course physical examination revealed strength of the season without symptoms deficits and noticeable discoloration makes this case unique. It is also (“mild purplish hue”) about the arm. interesting that numerous diagnostic Due to the persistence of his tests did not reveal the pathology.

S-292 Volume 48 • Number 3 (Supplement) May 2013 Berkoff DJ, S-256 Chinn L, S-208, S-209, S-213 Author Index Berry DC, S-24, S-52, S-53, S-234, S-242 Chmielewski TL, S-231 Beutler AI, S-37, S-65, S-92, S-96 Christie SR, S-276 A Blackburn JT, S-27, S-37, S-50, S-162, S-228 Clack SF, S-276 Blackburn T, S-256 Cleary MA, S-104 Abdenour TE, S-62 Blemker S, S-229 Clements AE, S-12, S-36 Abt JP, S-64, S-89, S-166, S-231 Bliven K, S-99 Clines SH, S-149 Acocello S, S-17, S-33, S-248 Boehret SA, S-141 Coates A, S-272 Adams JD, S-11 Boland SA, S-183 Coldiron GR, S-163 Adams WM, S-119 Boley HA, S-106 Comstock RD, S-83 Adkins SG, S-144 Bolgla L, S-93, S-94, S-97, S-254 Conchola EC, S-131 Akehi K, S-131 Bolgla LA, S-255 Cone JC, S-161 Akins JS, S-89 Boling MC, S-92, S-145, S-170, S-171 Conrad BP, S-231 Al-Darraji SJ, S-115, S-148, S-195 Bonacci JB, S-11 Cooke A, S-17 Alberts JL, S-55 Bookhout JL, S-135 Cooper E, S-85 Albritton, DL, S-139 Borchers J, S-159 Cooper ER, S-83, S-84, S-85, S-152 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Allison KF, S-166 Boscolo MS, S-136 Copple TJ, S-168 alovich McLeod TC, S-160, S-199 Boucher T, S-184 Cordova MM, S-131 Aminaka N, S-93 Boucher TM, S-132, S-205 Cortes N, S-217 Amponsah G, S-150 Bowman J, S-159 Covassin T, S-202 Anastasio SM, S-175 Bowman TG, S-34, S-234 Cowden NE, S-34 Anderson B, S-13, S-25, S-193 Bradley MH, S-269 Cox SJ, S-200 Anderson BL, S-27 Bradney DA, S-34 Cram TR, S-27 Andrews CA, S-273 Brandt MS, S-113 Creedon D, S-281 Apicella JM, S-20 Braun PA, S-14 Creighton BC, S-20 Armour Smith J, S-66 Breitbach AP, S-235 Creinin K, S-239 Armstrong LE, S-22 Brewer ME, S-241 Crowley E, S-211 Arnold BL, S-77, S-212 Bric JD, S-115, S-148, S-195 Cruickshank JA, S-101 Arnold E, S-184 Bridges J, S-230 Crutcher B, S-202 Ashley A, S-188 Bright N, S-68, S-115 Csonka J, S-126 Ashton J, S-283 Bright NB, S-68 Curry PJ, S-84, S-85 Ashton JM, S-43 Brismée JM, S-124 Curry PR, S-83, S-85, S-152, S-194 Atkins LT, S-124 Brodeur A, S-290 Austad MA, S-251 Broglio SP, S-17 D Awoniyi S, S-239 Brooks KL, S-101 Daniels EJ, S-158 Ayotte J, S-265 Brooks MA, S-198 David SD, S-177 B Broshek D, S-17 David SL, S-52, S-56 Broshek DK, S-33, S-197 Davis B, S-89 Baellow AL, S-145, S-170, S-171 Brown CN, S-181, S-196, S-210, S-216 Davis C, S-290 Baer DJ, S-140 Brownell EH, S-263 de la Motte SJ, S-65 Baer GS, S-244 Buckley TA, S-179, S-202, S-203, S-204 De Maio VJ, S-192 Bailey B, S-22 Buening BJ, S-11 DeAngelis AI, S-174 Baker CS, S-186 Burgess MJ, S-70 Decoster LC, S-115, S-148, S-195 Baker R, S-193 Burkhart S, S-202 Dedrick GS, S-124 Balasubramanian E, S-141 Burks RT, S-289 DeMartini JK, S-19, S-20, S-22 Ballard K, S-22 Burne JA, S-259 Demchak TJ, S-243, S-245 Bamberg SJM, S-163 Bush HM, S-42, S-144 DeMont RG, S-257, S-258 Barber Foss KD, S-141, S-182, S-253 Butterfield TA, S-250, S-263 Denegar CR, S-169 Barlow G, S-134 Butterworth C, S-206 Dettl MG, S-142 Barone CM, S-59, S-61, S-149 Byon KK, S-194 Di Stasi SL, S-182 Barry KE, S-111 C Dicesare CA, S-182 Barry MA, S-169 Dicharry J, S-208 Bass J, S-147 Caccese JB, S-90 Dill KE, S-128 Bass JA, S-188 Cacolice PA, S-155 DiStefano LJ, S-28, S-65, S-96, S-107, S-108, Bates NA, S-182 Cameron KL, S-48, S-65, S-92, S-96 S-167, S-169, S-211, S-226 Baumeister J, S-16 Campbell SE, S-48 Dixon JB, S-158 Baumgartner TA, S-196 Capilouto G, S-186 Docherty CL, S-75, S-129, S-155, S-215, S-236 Bay RC, S-76, S-100, S-198, S-199, S-238 Carcia CR, S-155, S-180 Dodge EB, S-183 Bazett-Jones DM, S-93 Carey SE, S-106 Dodge TM, S-234 Beals K, S-166 Carr KE, S-109 Doeringer JR, S-186, S-226 Bedi A, S-224 Casa D, S-83 Dolan N, S-241 Beese ME, S-29 Casa DJ, S-19, S-20, S-22, S-83, S-119 Dominguez JA, S-231 Begalle RL, S-27, S-128 Castillo KH, S-242 Donahue M, S-129, S-215 Beidler E, S-33 Caswell A, S-143 Donahue MS, S-188 Beisner A, S-159 Cattano NM, S-141 Donovan L, S-15, S-134, S-173, S-215 Bell DR, S-107, S-108, S-157 Chang EW, S-40 Dorminy ML, S-191 Bennett CC, S-24 Chang SD, S-130 Dover GC, S-238, S-291 Benson A, S-268 Charles-Liscombe R, S-284 Downey DL, S-235 Benson S, S-197 Chelette CJ, S-271, S-289 Driban JB, S-141, S-223 Bergens BL-F, S-104 Chicoine N, S-238 DuBose DF, S-231

Journal of Athletic Training S-293 E Greska EK, S-165 Horne D, S-284 Gribble P, S-93 Hornor SD, S-196 Earl-Boehm J, S-93, S-94, S-97, S-254, S-255 Gribble PA, S-12, S-25, S-36, S-75, S-106, S-128, Hosey R, S-288 Eberman LE, S-61, S-243 S-183, S-209 Hosey RG, S-220 Elbin RJ, S-202 Griebert MC, S-90 Houston MN, S-107, S-153, S-211 Eley DM, S-24, S-52, S-53 Griffin L, S-175 Howard JS, S-45, S-220, S-251 Emerson CC, S-21, S-22, S-23 Grindstaff TL, S-241 Howell D, S-51 Emery CA, S-93, S-94, S-97, S-254, S-255 Groff D, S-30 Hubbard-Turner T, S-218 Ericksen HM, S-12, S-36 Grooms D, S-159 Hudson SR, S-17 Erickson SM, S-20 Grove KA, S-236 Huggins RA, S-19, S-20 Erwin JR, S-276 Gruber DM, S-44 Hunter I, S-230 Grundstein A, S-83, S-84, S-85 Hunter LA, S-204 F Grundstein AJ, S-85, S-152 Huxel Bliven KC, S-27 Farmer KW, S-231 Guffey J, S-284 Farnsworth JL, S-56 Gumucio JP, S-224 I Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Fayson SD, S-145 Gurchiek LR, S-136 Iannetta T, S-114 Feger M, S-215 Guskiewicz KM, S-30, S-34, S-153, S-190 Igawa T, S-254 Felton SD, S-139, S-200, S-273 Gustavsen G, S-206 Ingram RL, S-179, S-202 Ferber R, S-93, S-94, S-97, S-134, S-254, S-255 H Ingriselli JM, S-192 Ferrara MS, S-83, S-84, S-85, S-152, S-194, S-196 Ismaeli Z, S-286 Ferraro EM, S-59, S-61, S-149 Hackett TR, S-43, S-283 Filep EM, S-81 Hackney AC, S-175 J Fiorentino N, S-229 Hafner R, S-75 Jackson MJ, S-54 Ford A, S-25 Haley JT, S-35 Jacobs MM, S-177, S-269 Fowler L, S-188 Hall BT, S-148 Jagger J, S-277 Frager A, S-235 Hall EA, S-155 Jarman NF, S-124 Francis C, S-264 Hamson-Utley JJ, S-188 Jarvis DN, S-66 Frank BF, S-28, S-40 Hamstra-Wright KL, S-93, S-94, S-97, S-254, Jensen K, S-22 Frank BS, S-27, S-128 S-255 Johnson AW, S-230 Fricker D, S-261 Hankemeier DA, S-63, S-207, S-238 Johnson D, S-272 Frymyer JL, S-200, S-273 Hanley M, S-121 Johnson DC, S-286 Fuller JD, S-292 Hanline VL, S-54 Johnson J, S-288 Furutani T, S-100 Hansen RA, S-188 Johnson KM, S-113 Furutani TM, S-103, S-201 Hardy A, S-249 Johnson ST, S-186, S-226 G Harkey MS, S-75, S-128 Johnson TS, S-286 Harkins KR, S-292 Johnston T, S-264 Ganio MS, S-11 Harkins TW, S-292 Jones DL, S-231 Gatti JM, S-180 Harris AM, S-278 Joseph CJ, S-286 Gaven SL, S-127, S-217, S-227 Hart J, S-208 Joseph MF, S-107, S-169, S-226 Gay CR, S-251 Hart JM, S-15, S-38, S-39, S-40, S-89, S-134, Joy EA, S-29 Gear WS, S-135 S-163, S-173, S-185, S-213, S-215, S-218, Joyner AB, S-203, S-204 Geiger A, S-80 S-229, S-248 Judge LW, S-258 Geiser CF, S-169 Heebner NR, S-126 Juzeszyn LS, S-61 Gilbreath JP, S-127 Heitman RJ, S-136 Gildard M, S-220, S-268, S-281 Herb CC, S-214, S-229 K Herman D, S-231 Gilsdorf CM, S-40 Kahanov L, S-61, S-243 Hertel J, S-15, S-33, S-38, S-40, S-89, S-134, Giovanello K, S-192 Kaminski TW, S-14, S-88, S-90, S-125, S-145, S-173, S-208, S-209, S-213, S-214, S-215, Giuliani C, S-162 S-171, S-172, S-174, S-206, S-236 S-218, S-229, S-247 Glass MJ, S-227 Kamp A, S-120 Hettinga BA, S-134 Glass SM, S-212 Kana DE, S-55 Hetzel S, S-198 Glaviano NR, S-197 Kanaoka T, S-103 Hetzel SJ, S-109 Glodowskk C, S-188 Kang M, S-35, S-56 Hewett TE, S-42, S-51, S-141, S-182, S-253 Glutting J, S-141 Kang TK, S-159 Hibberd EE, S-154 Goeckeritz LM, S-103 Kasamatsu TM, S-104 Hicks-Little CA, S-29, S-163, S-271, S-287, S-289 Goerger BM, S-37, S-40 Katch RK, S-242 Higgins M, S-115, S-191 Goetschius J, S-39 Kavouras SA, S-11 Higginson JS, S-16 Gonzalez L, S-42 Keenan KA, S-89, S-126, S-231 Hildenbrand KJ, S-104 Goodkin HP, S-197 Kerner M, S-211 Hintze D, S-147 Goodman A, S-59, S-60, S-61, S-149 Kerr ZY, S-83 Hirsch JR, S-55 Goodrich ME, S-137 Kido Y, S-126 Hirth CJ, S-27 Gorgos KS, S-177 Kim CY, S-166 Hix RI, S-247 Goto S, S-15, S-30, S-137 Kim KM, S-40, S-89, S-218 Hoch JM, S-42, S-269, S-279 Gould TE, S-184, S-190, S-194 Kim Y, S-56 Hoch MC, S-98, S-107, S-127, S-149, S-153, Graber DK, S-55 Kimmel W, S-134 S-178, S-211, S-217 Granquist MD, S-249 Kingma J, S-129, S-155 Hoffman MA, S-186, S-226 Gravelin EM, S-263 Kipp K, S-169 Holcomb WR, S-246 Gray KA, S-11 Klass SE, S-289 Hollis JM, S-136 Greenwood LD, S-132, S-205 Klossner J, S-236 Greis PE, S-271 Hoogeveen AM, S-191

S-294 Volume 48 • Number 3 (Supplement) May 2013 Klossner JC, S-155 M Mullaney KP, S-139 Knight CA, S-14, S-174, S-236 Mulligan RP, S-98, S-149 Ko JP, S-152, S-181, S-210, S-216 Macciocchi SN, S-196 Munkasy BA, S-179, S-202, S-203, S-204 Kocher M, S-100 MacDonald A, S-272 Munõz CX, S-19 Kocher MH, S-103, S-201 Maguire MC, S-287 Muñoz CX, S-20 Kollock RO, S-173 Maresh CM, S-19, S-22 Murata N, S-100 Komaroff E, S-68 Marshall SW, S-37, S-65, S-83, S-92, S-96, S-153, Murata NM, S-103, S-201 Kontos A, S-202 S-192 Murray SR, S-251 Kostishak N, S-13 Martin GM, S-274 Musto A, S-157 Kovaleski JE, S-136 Martinez JC, S-107, S-108, S-169, S-211, S-226 Mutchler J, S-98, S-149, S-178 Kramer N, S-229 Martini DN, S-17 Myer GD, S-141, S-182, S-253 Krasinski D, S-246 Mattacola CG, S-42, S-45, S-51, S-186, S-251 Myers JB, S-50, S-137, S-154 Krazeise DA, S-203 Matteau E, S-211 Myrer JW, S-230 Krazeize DA, S-202 Matthews A, S-11 Krzeminski DE, S-184, S-190 Mauntel TC, S-27 N Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Kuei CY, S-131 Mayfield RM, S-67, S-69, S-102, S-105, S-160 Nagai T, S-64, S-231 Kuenze C, S-38, S-39, S-185, S-229 Mazerolle SM, S-59, S-60, S-61, S-62, S-149, Nagle EF, S-166 Kulig K, S-66 S-234 Nakajima MA, S-113 Kulow SM, S-77, S-151 Mazoué C, S-110 Naugle KE, S-130 Kuntzelman KS, S-181 Mc Elhiney D, S-56 Naugle KM, S-130 Kupchak B, S-22 Mc Elhiney DS, S-31, S-35 Needle AR, S-16, S-88, S-90, S-145, S-171, S-174, Kupchak BR, S-19 McCarty CW, S-26, S-67, S-69, S-70, S-102, S-213 Kusumoto S, S-254 S-165, S-238 Neefe HI, S-222 McCrea M, S-198 L Nelson C, S-146, S-275 McDermott BP, S-11, S-20 Neumann M, S-25, S-27 La Bounty PM, S-184 McDevitt J, S-68 Neves C, S-230 LaFevor ME, S-32 McDevitt JK, S-68, S-191 Neves KA, S-230 Laidlaw CR, S-70 McDonald J, S-239 Nguyen A, S-92, S-145, S-170, S-171 Lake AW, S-101 McDonald LM, S-125 Norcross MF, S-186, S-226 Lam A, S-175 McElhiney DS, S-32, S-56 Norte GE, S-185 Lam KC, S-13, S-76, S-77, S-99, S-151, S-160, S- McFate DA, S-64, S-126 193 McGrath ML, S-162 O McGuine TA, S-109, S-198, S-244 LaRue MJ, S-237 Oates DC, S-171 Lattermann C, S-42, S-45, S-272 McKeon PO, S-137, S-161, S-186, S-207, S-209, S-214 Oberg C, S-147 Laudner K, S-49, S-124 Olson BL, S-54 Least B, S-288 McLeod MM, S-75, S-128 McLeod RL, S-242 Olson ME, S-157 Lee E, S-22 omstock RD, S-144 Lee HD, S-159, S-166 McNulty MB, S-161, S-278 Meade AR, S-251 Onate J, S-159 Lee SC, S-159, S-166 Oñate JA, S-173 Lee SY, S-159, S-166 Medel, M, S-54 Medina McKeon JM, S-42, S-144, S-182, S-186 Onofrio MC, S-238 Lephart SM, S-64, S-89, S-166, S-231 Onuki T, S-49 Lepley AS, S-12, S-36 Meinerz CM, S-169 Meister K, S-49, S-124 Orapello NS, S-268 Lepley LK, S-37 Oshiro JY, S-201 Lesperance M, S-284 Melinchak M, S-173 Mendias CL, S-224 Oshiro RS, S-100, S-103, S-201 Letendre MA, S-20 Ostrowski JL, S-70 Levine JW, S-12, S-36 Mensch JW, S-116 Mettler A, S-209 Owens BD, S-48, S-96 Lewek MD, S-162 Oyama S, S-50, S-137, S-154 Li L, S-50 Meyer J, S-107 Linder SM, S-55 Meyer JD, S-226 P Linens SW, S-77 Michelini KJ, S-274 Paden A, S-115 Lins LAB, S-247 Michener LA, S-199 Padua DA, S-15, S-27, S-28, S-37, S-40, S-50, Lippa NM, S-184, S-190 Mihalik J, S-195 S-65, S-92, S-96, S-128, S-162, S-167 Littleton AC, S-34, S-192 Mihalik JP, S-115, S-148, S-153, S-190, S-192 Pagnotta K, S-22 Liu K, S-206 Miles JD, S-83, S-84, S-85, S-152, S-194 Pagnotta KD, S-19, S-119 Liu W, S-136 Miller KC, S-259 Palmer TB, S-131 Lohman CM, S-124 Miller M, S-159 Palmer TG, S-51 Long BC, S-131 Miller MG, S-246 Palmieri-Smith RM, S-37 Lopez R, S-121 Millward MJ, S-111 Pamukoff DN, S-228, S-256 Lopez RM, S-22, S-81, S-222 Minton DM, S-21, S-22, S-23 Paper S, S-21, S-22 Lorens K, S-287 Mitchell SM, S-136 Parr JJ, S-130 Lovalekar MT, S-89, S-166 Moffit DM, S-175 Parsons JT, S-67, S-69, S-102, S-105 Luc BA, S-223 Monfreda AM, S-25 Partner SL, S-248 Lynall R, S-49, S-124 Montgomery MM, S-161, S-164, S-189 Pass AN, S-231 Lynall RC, S-153 Mooney C, S-282 Paszkewicz JR, S-26 Lynch EB, S-224 Moore MT, S-158 Morin G, S-265 Patton TS, S-267 Morrell M, S-25 Peck KY, S-48, S-65, S-96 Morton SK, S-241 Peer KS, S-267 Moser MW, S-231 Pennuto AP, S-107, S-108, S-157

Journal of Athletic Training S-295 Penny JM, S-234 Ross SE, S-65, S-77, S-212 Starkey C, S-11 Peters J, S-146 Rothbard M, S-80, S-146, S-265, S-275, S-290 Stavinski-Ciocco MM, S-123 Peterson K, S-44 Roti M, S-22 Stearne DJ, S-175 Petron DJ, S-271, S-287, S-289 Royer T, S-174 Stearns RL, S-19, S-20, S-22, S-119 Pettitt RW, S-251 Rubino T, S-107, S-226 Stephenson LJ, S-167 Pietrosimone BG, S-12, S-25, S-36, S-75, S-93, Rullestad EA, S-106 Steppe E, S-243, S-245 S-128, S-209, S-223, S-241 Rupp KA, S-247 Stergiou N, S-162 Pietz KM, S-104 Russ AC, S-175 Stiffler MR, S-108, S-157 Piland SG, S-184, S-190, S-194 Ryan C, S-115 Stollery JC, S-81 Pitney WA, S-59, S-60, S-61, S-62, S-63 Stubblefield ZS, S-282 Pittman J, S-217 S Sugimoto D, S-182, S-253 Plos JM, S-247, S-274 Saade N, S-257, S-258 Sutherlin MA, S-163, S-248 Podell JT, S-213 Sakr M, S-256 Sutton K, S-21, S-22 Podlog L, S-188 Salesi T, S-126 Svoboda SJ, S-96 Pollack M, S-110 Saliba S, S-17, S-33, S-39, S-197, S-208, S-209 Swanik CB, S-14, S-16, S-88, S-171, S-172, S-174, Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Pollard CD, S-186, S-226 Saliba SA, S-218, S-247, S-248 S-213, S-236 Polubinsky RL, S-247 Samson CO, S-181 Swann W, S-250 Poole D, S-264 Sauers EL, S-99 Swartz EE, S-115, S-148, S-195, S-196 Popp JK, S-258 Saunders RP, S-116 Switzler CL, S-29, S-163 Porter PA, S-286 Scharmann S, S-188 T Pouliot S, S-80 Schindler DD, S-55 Powden CJ, S-107, S-211 Schmidt JD, S-30, S-190, S-192 Taggart KE, S-244 Powell JP, S-83 Schmitz RJ, S-65, S-161, S-164, S-168, S-225 Tamura K, S-100, S-201 Powell MP, S-107 Schmolesky M, S-188 Tanen LM, S-75 Powell MR, S-211 Schrader J, S-129 Tapia-Lover TG, S-202 Power ME, S-31 Schrader JW, S-75 Tarzon M, S-236 Powers ME, S-220, S-268, S-281 Schreppel B, S-126 Taylor ST, S-242 Prentice WE, S-40 Schroeder M, S-159 Teblum JB, S-132 Price EA, S-177 Schubert M, S-16 Tenan MS, S-175 Pryor RR, S-119 Schulte S, S-188 Terada M, S-106, S-209 Purdoff MJ, S-204 Schultz SM, S-177 Tevald MA, S-128 Pye ML, S-65 Schussler E, S-159 Thomas AC, S-209, S-223 Scibek JS, S-155, S-180 Thomas SM, S-182 Q Scott SM, S-17 Thornton AL, S-279 Quinlevan ME, S-106, S-183 Sefcik N, S-44 Thrasher A, S-246 Selkow NM, S-124 Thrasher AB, S-63, S-72, S-207 R Sell TC, S-64, S-89, S-126, S-166, S-231 Tierney RT, S-68, S-115, S-175, S-191 Ragan BG, S-11, S-31, S-32, S-35, S-52, S-54, Sesma AR, S-122 Tillman SM, S-231 S-56, S-142, S-143, S-177, S-181 Sexton PJ, S-251 Toepper BW, S-129 Rakeja S, S-257 Sheaffer AE, S-205 Tomchuk D, S-261 Rakheja S, S-258 Sheldon AM, S-189 Tomczyk, KM, S-52, S-53 Rasmussen J, S-198 Shepherd LI, S-198 Toonstra JL, S-251 Rawlins JW, S-184, S-190 Shields C, S-88 Torres-McGehee TM, S-21, S-22, S-23 Register-Mihalik JK, S-30, S-192 Shimizu A, S-100 Toth R, S-287 Reinbold KE, S-242 Shimokochi Y, S-254 Travers E, S-275 Reinecke K, S-16 Shultz SJ, S-65, S-161, S-164, S-168, S-225 Trinidad KJ, S-30 Rendos NK, S-157 Sibilsky Enselman ER, S-224 Tritsch AJ, S-161 Renehan E, S-286 Signorile J, S-157 Trojian TH, S-107, S-169, S-211, S-226 Resch JE, S-196 Simon J, S-75 Trotter N, S-268 Rettig LA, S-138 Simon JE, S-155 Trowbridge CA, S-245 Reyes AD, S-236 Sinha G, S-54 Tsang KKW, S-131 Rhea CK, S-168, S-212 Sitler MR, S-141 Tucker MA, S-11 Rice T, S-160 Slone SW, S-48 Tucker WS, S-48, S-179, S-196, S-241 Ridgeway J, S-277 Smalley BW, S-64, S-231 Tufaro VJ, S-163 Rigby R, S-184 Smith DH, S-34 Turn KK, S-165 Riley Z, S-215 Smith J, S-114 Turner MJ, S-218 Ringleb SI, S-173 Smith MD, S-108, S-157 U Rink D, S-188 Smith MP, S-124 Roberts D, S-185 Smith S, S-261 Uhl T, S-186 Rodriguez J, S-199 Snook EM, S-143 Uhl TL, S-51, S-150, S-193 Roewer BD, S-182 Snyder B, S-261 Uota S, S-254 Rondeau V, S-291 Snyder MM, S-111 Usher E, S-186 Rooks Y, S-122 Snyder Valier AR, S-199, S-204 Uyeno RK, S-103, S-201 Rose WC, S-88 Sohn DH, S-12, S-36 Rosehart S, S-21, S-22 Solyntjes AL, S-135 Rosen AB, S-152, S-181, S-210, S-216 Soontararak M, S-107, S-226 Ross K, S-261 Sroufe AM, S-20 Ross RG, S-222 Stanislawski VM, S-283

S-296 Volume 48 • Number 3 (Supplement) May 2013 V Y Valovich McLeod TC, S-13, S-25, S-67, S-69, Yamamoto LM, S-22 S-77, S-100, S-102, S-105, S-151, S-193, Yau R, S-96 S-198, S-204 Yeargin BE, S-138 Van Der Pol BJ, S-75 Yeargin SW, S-21, S-22, S-23, S-138 Van Lunen B, S-173 Yim DW, S-220 Van Lunen BL, S-26, S-70, S-98, S-127, S-149, Yingling VR, S-175 S-153, S-165, S-177, S-178, S-217, S-227, Yochem E, S-271 S-238 Yochem EM, S-289 Vandermark LW, S-119 Young K, S-243 Varnell MS, S-89, S-126 Younger R, S-110 Vaughan AJ, S-256 Yu B, S-50 Veasley SJ, S-107, S-226 Vela L, S-239 Z Vela LI, S-249 Zawadzki-Brzoska A, S-123 Downloaded from http://meridian.allenpress.com/jat/article-pdf/48/3 Supplement/S-1/1454405/1062-6050-48_3_s1.pdf by guest on 02 October 2021 Viele K, S-51 Zhu W, S-136 Volk BM, S-19, S-22 Zinder SM, S-128, S-137 Vomer R, S-180 W Wahl T, S-100 Wahl TP, S-103, S-201 Walker ML, S-217 Walker SE, S-63, S-72 Wall A, S-150 Walpert K, S-196 Wang HM, S-168, S-225 Ward BL, S-121 Warner KD, S-52 Wasylyk NT, S-177 Watanabe Y, S-254 Waters B, S-165 Waters-Banker C, S-250 Waugh AM, S-220 Weber ML, S-102 Webster KJ, S-278 Weindorf JH, S-17 Weinhandl J, S-178, S-227 Wells AM, S-128 Wells KA, S-56 Weltman AL, S-218 Werner JL, S-193 Werner SL, S-125 Westrick RB, S-48 Wham GS, S-116 Whetstone JM, S-139 Whisenant DJ, S-286 Whittington E, S-21, S-22 Wigglesworth JK, S-247 Wikstrom EA, S-207 Wilckens JH, S-37 Wilder R, S-208 Wilkinson RD, S-71 Williams EM, S-262 Williams KN, S-111 Williams SJ, S-120 Williams TA, S-77 Wilson JJ, S-244 Winterstein AP, S-109 Wirt MD, S-64, S-231 Wong R, S-49 Wood CM, S-169 Wood JM, S-43 Wordeman SC, S-182 Wright RD, S-220

Journal of Athletic Training S-297