JOURNAL OF ATHLETIC TRAINING Official Publication of the National Athletic Trainers’ Association, Inc Volume 46, Number 3, Supplement, 2011 2011 Free Communications Thomas Dompier, PhD, ATC Robert T. Floyd, EdD, ATC, CSCS Committee University of South Carolina The University of West Alabama Thomas Dompier, PhD, ATC, Chair Jennifer Earl-Boehm, PhD, ATC M. Susan Guyer, DPE, ATC, LAT, University of South Carolina University of Wisconsin, Milwaukee CSCS Springfield College Joseph Hart, PhD, ATC Michael Ferrara, PhD, ATC University of Virginia University of Georgia MaryBeth Horodyski, EdD, ATC University of Florida Lisa Jutte, PhD, ATC, LAC Tricia Hubbard, PhD, ATC, LAT Ball State University University of North Carolina – Robert D. Kersey, PhD, ATC, Charlotte CSCS Thomas Kaminski, PhD, ATC, FNATA California State University – University of Delaware Lennart Johns, PhD, ATC Fullerton Quinnipiac University Melanie McGrath, PhD, ATC Kenneth W. Locker, MA, ATC University of Nebraska Omaha Kristen Kucera, PhD, ATC, LAT Texas Health Sports Network Duke University Medical Center Darin Padua, PhD, ATC Tamara C. McLeod, PhD, ATC, CSCS University of North Carolina at Riann Palmieri-Smith, PhD, ATC Arizona School of Health Sciences Chapel Hill University of Michigan Valerie Moody, PhD, ATC, AT, Kimberly Peer, EdD, ATC, LAT Kimberly Peer, EdD, ATC, LAT CSCS, WEMT-B Kent State University Kent State University University of Montana William Pitney, EdD, ATC Brian Ragan, PhD, ATC Sally E. Nogle, PhD, ATC Northern Illinois University Ohio University Michigan State University Brian Ragan, PhD, ATC Eric Sauers, PhD, ATC David H. Perrin, PhD, ATC Ohio University A.T. Still University University of North Carolina at Steven Straub, ATC Sandra Shultz, PhD, ATC, FNATA Greensboro Quinnipiac University University of North Carolina at Charles J. “Charlie” Redmond, MS, Greensboro MEd, ATC Charles Thigpen, PhD, ATC, PT Springfield College Proaxis Therapy NATA Foundation Board of Directors Kavin Tsang, PhD, ATC Robb Rehberg, PhD, ATC, NREMT California State University, Fullerton Mark A. Hoffman, PhD, ATC William Paterson University President Susan Yeargin, PhD, ATC Oregon State University Clinton B. Thompson, MA, ATC Indiana State University Retired Michelle D. Boyd, MS, ATC NATA Foundation Truman State University 2011 Research Committee Robert J. Casmus, MS, ATC Darin Padua, PhD, ATC, Chair Catawba College University of North Carolina at Ralph Castle, PhD, ATC Chapel Hill Louisiana State University

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 2011 by The National Athletic Trainers’ Association, Inc. All rights reserved. Printed in the U.S.A. Journal of Athletic Training S-1 Bring this Supplement to New Orleans 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 document contains abstracts presented at the 2011 NATA Annual Meeting & Clinical Symposia as part of the National Athletic Trainers’ Association Research & Education Foundation’s Free Communications Program.

The Free Communications Program provides certified athletic trainers, students and other health care 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 and clinical case reports. These presentations span a wide spectrum of topics. In addition, the Clinical Case Reports sessions allow you to test your clinical assessment skills.

For your convenience, research abstracts are printed in order of presentation at the NATA Annual Meeting in New Orleans. We encourage you to attend these sessions.

The NATA Foundation funds research, a variety of educational programs and annual scholarships to undergraduate and graduate athletic training students. Support from NATA members, corporations and other affiliated groups make this supplement and all of our other programs possible.

Please note projects funded by the NATA Foundation are identified in this Supplement. To make an investment in the future of the profession, please contact the NATA Foundation today at 972-532-8837.

NATA and its Foundation are pleased to offer this supplement as a service to NATA members. We hope 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 Marjorie J. Albohm, MS, ATC President, President, NATA NATA Research & Education Foundation

S-2 Volume 46 • Number 3 (Supplement) May 2011 Dear Colleagues:

On behalf of the National Athletic Trainers’ Association Research & Education Foundation and the Free Communications Committee, we would like to thank the authors who submitted abstracts to the NATA Foundation’s Free Communications Program. More than 360 submissions in the Peer Reviewed and Student Exchange tracks were received for the 2011 program.

This year’s Free Communications Program contains an exciting mix of both high-caliber research reports and clinical case study reports. Please keep in mind that we consider oral and poster presentations to be equal in terms of stature and we encourage clinicians and researchers to attend both oral and posters sessions.

We would like to take this opportunity to extend a special thanks to the NATA Foundation staff and especially Patsy Brown, 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: Joseph Hart, PhD, ATC; Lisa Jutte, PhD, ATC, LAC; Thomas Kaminski, PhD, ATC, FNATA; Melanie McGrath, PhD, ATC; Darin Padua, PhD, ATC; Kimberly Peer, EdD, ATC, LAT; William Pitney, EdD, ATC; Brian Ragan, PhD, ATC; Steven Straub, ATC; Charles Thigpen, PhD, ATC, PT; Kavin Tsang, PhD, ATC; and Susan Yeargin, PhD, ATC for their many hours of abstract reviews and preparation for our 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 will 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 readers expect from the Journal of Athletic Training. We appreciate the feedback we have received from authors. Suggestions are always welcomed and discussed in committee meetings to further improve the process.

We look forward to seeing you in New Orleans and hope you will 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,

Tom Dompier, PhD, ATC Free Communications Committee Chair

Journal of Athletic Training S-3 JOURNAL OF ATHLETIC TRAINING Official Publication of the National Athletic Trainers’ Association, Inc Volume 46, Number 3, Supplement, 2011

Table of Contents Moderator(s) Page

Free Communications: Room 217 Monday, June 20, 2011 8:00AM-9:00AM ...... EBF: Ankle ...... S-12 9:15AMAM-10:30AM .. Clinical Ankle Measurements ...... Tricia Hubbard, PhD, ATC ...... S-12 10:45AM-11:45AM .... EBF: Concussion ...... S-15 12:00PM-1:00PM ...... Concussion Issues ...... Ryan Tierney, PhD, ATC ...... S-15

Tuesday, June 21, 2011 8:00AM-9:00AM ...... Spine Injury Emergency Care ...... Laura Decoster, ATC ...... S-18 9:15AM-10:15AM...... EBF: Heat or Hydration ...... S-21 10:30AM-11:30AM ..... Heat Illness Prevention ...... Lindsey Eberman, PhD, ATC ...... S-21

Wednesday, June 22, 2011 8:00AM-8:45AM ...... Shoulder Girdle Adaptations In Overhead Athletes ...... S-24 and 9:00AM-9:45AM ...... TBD ...... 10:00AM-11:00AM ..... EBF: Knee ...... S-28 11:15AM-12:45PM ..... Knee Injury Prevention Strategies ...... Grace Golden, PhD, ATC ...... S-28 Free Communications: Room 218 Monday, June 20, 2011 8:00AM-9:00AM ...... Shoulder Diagnoses and Outcomes ...... Kelly Blivens, PhD, ATC ...... S-32 9:15AM-10:15AM ..... EBF: Shoulder ...... S-35 10:30AM-11:45AM .... Finalists Doctoral Oral Presentations ...... Brian Ragan, PhD, ATC ...... S-35 12:00PM-1:15PM ...... Master’s Oral Finalist Presentation ...... Kristin Kucera, PhD, ATC ...... S-39

Tuesday, June 21, 2011 8:00AM-9:00AM ...... Rehabilitation Techniques ...... John Miller, PhD, ATC ...... S-43 9:15AM-10:15AM ..... Tissue Response to Damage and ...... Treatment ...... Chad Starkey, PhD, ATC ...... S-46 10:30AM-11:30AM .... EBF: Modalities ...... S-49 4:30PM-6:00PM ...... Patient Oriented Outcomes ...... Luzita Vela, PhD, ATC ...... S-49

Wednesday, June 22, 2011 8:00AM-9:00AM ...... Issues in Teaching and Learning .... Tim Spiecher, PhD, ATC ...... S-53 9:15AM-10:00AM...... EBF: Education ...... S-56 10:30AM-11:15AM .... Gender Issues In Athletic Training . Ashley Goodman, PhD, ATC ...... S-56 11:30AM-12:45PM .... Evidence Based Practice in Athletic ...... Training ...... Bonnie Van Lunen, PhD, ATC ...... S-58 1:00PM-2:00PM ...... Measurement of Concussion ...... Tracy Covassin, PhD, ATC ...... S-61 2:00PM-3:00PM ...... Unique Conditions in Adolescent ...... Athletes...... Mary Barron, PhD, ATC ...... S-64 3:30PM-4:30PM ...... Management of Unique Orthopaedic ...... Injuries ...... Kelly Pugh, MS, ATC ...... S-67

S-4 Volume 46 • Number 3 (Supplement) May 2011 Moderator(s) Page Free Communications: Room 219 Monday, June 20, 2011 9:00AM-10:15AM..Youth & Adolescent Injury ...... Tamara McLeod, PhD, ATC...... S-70 10:30AM-12:00PM..Thematic Poster: Core Temperature ...... & Heat Illness ...... Sandra Fowkes-Godek, PhD, ATC ...... S-74 12:15PM-1:15PM ...Influencing Factors on the Athletic ... TBD ...... Shoulder ...... S-79

Tuesday, June 21, 2011 8:00AM-9:00AM ..... Exercise Fatigue & Lower Extremity...... Biomechanics...... Abbey Thomas, PhD, ATC ...... S-82 9:15AM-10:00AM... Injury Epidemiology ...... Steve Zinder, PhD, ATC...... S-85 10:15AM-11:30AM Professional Issues ...... Jim Mensch, PhD, ATC ...... S-87 4:30PM-6:15PM ..... Thematic Poster: General Medical ...... Conditions ...... Matt McQueen, MD...... S-91

Wednesday, June 22, 2011 8:00AM-9:00AM ....Intervention for Chronic Ankle Instability ...... Patrick McKeon, PhD, ATC ...... S-96 11:30AM-12:45PM .Ankle Injury and Postural Control ...... Alan Needle, MS, ATC ...... S-99 1:00PM-2:30PM .....Thematic Poster: Lower Extremity Function & ...... Physiology Following Knee Injury...... Melanie McGrath, PhD, ATC ...... S-102 3:00PM-4:30PM .....Thematic Poster: Ankle Taping & ...... Bracing ...... Thomas Kaminski, PhD, ATC ...... S-109

Poster Presentations: Main Level, Outside Hall A Monday, June 20, 2011 Authors Present 8:00AM-12:00PM ...Undergraduate Poster Awards ...... 11:00AM-12:00PM ...... S-114 8:00AM-12:00PM ...Master Poster Awards ...... 11:00AM-12:00PM ...... S-118 8:00AM-12:00PM...Doctoral Poster Awards ...... 11:00AM-12:00PM ...... S-122 8:00AM-12:00PM...Injury & Therapeutic Treatment...... 11:00AM-12:00PM ...... S-126 8:00AM-12:00PM ...Upper Extremity Assessment & Exercise ...... 11:00AM-12:00PM ...... S-132 1:00pm-5:00PM .... Case Studies ...... 4:00PM-5:00PM ...... S-139

Tuesday, June 21, 2011 8:00AM-11:30AM ...Knee & Hip Mechanics ...... 10:30AM-11:30AM ...... S-158

Wednesday, June 22, 2011 8:00AM-12:00PM...The Ankle ...... 11:00AM-12:00PM ...... S-178 8:00AM-12:00PM ...Injury Prevention & Treatment ...... 11:00AM-12:00PM ...... S-185 8:00AM-12:00PM ...ProfessionalDevelopment ...... 11:00AM-12:00PM ...... S-189

The Medal for Distinguished Athletic Training ...... S-6 The New Investigator Award ...... S-8 The Doctoral Dissertation Award ...... S-8 Author Index ...... S-192 Subject Index ...... S-197 Editorial Staff

Editor-in-Chief Business Office Manager Managing Editor Editorial Assistant Christopher D. Ingersoll, John Honaman, CFRE Leslie E. Neistadt, ELS Ashleigh Langfitt PhD, ATC, FNATA, FACSM National Athletic Hughston Sports Columbus, GA University of Virginia Trainers’Association, Inc Medicine Foundation, Inc Charlottesville, VA Dallas, TX 75247 Columbus, GA 31909 Journal of Athletic Training S-5 The Medal for Distinguished Athletic Training Research Presented in Honor of Joe Torg, MD

Jay Hertel, PhD, ATC, FNATA, FACSM University of Virginia

For Jay Hertel, PhD, ATC, FACSM, FNATA, recipient of the 2011 Medal for Distinguished Athletic Training Research, athletic training was a profession he became interested in at an early age. Although he did not have much exposure to athletic training in high school, his father’s high school football coach was Dominic Gentile, the first full-time athletic trainer for the Green Bay Packers. After his father put him in touch with Dominic, Hertel knew that athletic training was the career for him.

Over the years, Hertel’s research has focused on the challenges of ankle sprains and chronic ankle instability. Ankle sprains are one of the most common injuries in organized sports and one that some athletes tend to disregard; however, ankle instability resulting from sprains can cause long-term disability in athletes, a problem that Hertel hopes his research will aid in reducing.

Today, Hertel is working to better understand the physiology and pathomechanics associated with chronic ankle instability in order to optimize treatment strategies such as manual therapies and balance training to treat the condition and prevent those long-term consequences. Although many sports medicine practitioners use similar treatment approaches for all patients with a specific condition, Hertel believes that “if we can identify which particular treatment approaches work best in patients who present with specific patters of signs and symptoms, we can really make a difference in improving the outcomes of patients with ankle sprains and chronic ankle instability.”

This view on research and clinical care has developed from a career dedicated to asking informed questions and finding both expected and unexpected answers. Hertel says that he now looks at his research agenda much differently than when he started. Even though he feels as if he has made substantial advances in the recognition and treatment of ankle instability, he also realizes that there are countless research questions that sill need to be answered.

With hundreds of published articles, abstracts, and presentations, Hertel has had a significant influence on the world of athletic training and sports medicine. Hertel is an associate professor of Kinesiology and Physical Medicine & Rehabilitation at the University of Virginia, an associate editor for 2 journals (including the Journal of Athletic Training), and the cofounder, with Thomas W. Kaminski, PhD, ATC, FNATA, of the International Ankle Consortium, an international community of scholars interested in ankle instability.

Two points of view that he hopes to pass on to future athletic training scholars are being open to reading original research in areas outside of sport medicine and being willing to “push the envelope of accepted theories.” “Too often,” Hertel says, “we come up with a research question, and feel that if we do a study and answer the question in an unanticipated way, it is viewed as a failed study.” Instead of viewing such studies as mistakes, Hertel emphasizes using those unexpected results to advance the overall understanding of the topic at hand.

Over the years, Hertel’s influences have included Craig R. Denegar, PhD, ATC, PT; Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM; and David H. Perrin, PhD, ATC, FACSM, who have all provided examples as excellent mentors, scholars, and educators. He is grateful for the service opportunities he has had with the NATA, which have helped to shape his view of translational and clinical research. Hertel also thanks his parents, Jim and Kay Hertel; his wife, Tammy Jandrey Hertel; his children, Reese and Sonia; and all of his former and current students and colleagues, without whom he wouldn’t have accomplished what he has. S-6 Volume 46 • Number 3 (Supplement) May 2011 Joe Torg, MD

Joe Torg, MD, has long been a leader in sports medicine. Widely recognized for his work with spinal cord injuries, Dr. Torg is also responsible for perfecting medical techniques and spurring participation guidelines in sports.

A graduate of Haverford College and the Temple University School of Medicine, Dr. Torg is the founding director of the Temple University Center for Sports Medicine, the first affiliated with a university, which provided care for the athletes of Philadelphia. His research on the effect of the shoe–playing surface interface and its relationship to football knee injuries was directly responsible for both the National Federation of State High School Associations and the National Collegiate Athletic Association mandating that cleats be no longer than one-half inch. His published description of the Lachman Test for anterior cruciate ligament instability, which he named for his professor, John Lachman, MD, is widely regarded as a classic work. Dr. Torg was also instrumental in opening Little League baseball to girls.

Dr. Torg’s most well-known contribution has been his research identifying catastrophic cervical spine and cord injuries that result from the previously unrecognized axial loading mechanism of the spine from spearing and head-down contact. After analyzing data from the National Football Head and Neck Injury Registry, Dr. Torg recommended rule changes that resulted in a marked decrease in cervical cord injuries resulting in quadriplegia at both the high school and college levels. He also described cervical cord neurapraxia resulting in transient quadriplegia as a distinct, benign clinical entity. Dr. Torg has published criteria for return to play following cervical spine injury.

In 1978, Dr. Torg was appointed Professor of Orthopedic Surgery and Director of the University of Pennsylvania Sports Medicine Program, where he initiated one of the first Sports Medicine Fellowships. He has since trained 36 fellows.

Dr. Torg has co-authored three textbooks and well over 100 articles published in prestigious peer-reviewed journals. He served on President Reagan’s Council on Physical Fitness and Sports.

Dr. Torg received the Ninth Annual Eastern Orthopedic Association award for spinal research, the Nicholas Andre Award, the North American Spine Association annual award, the NATA President’s Challenge award and the 2004 Elizabeth Winston Lanier Kappa Delta award. He is also an AOSSM Hall of Fame member.

Journal of Athletic Training S-7 The New Investigator Award Presented in Honor of Freddie H. Fu, MD

Steven P. Broglio, PhD, ATC University of Michigan

Although athletic training has not always been his first choice, Steven P. Broglio, PhD, ATC, the recipient of the 2011 New Investigator Award, “fell into” the profession with grace. Broglio began his college years as a molecular genetics major at The Ohio State University (OSU), but after deciding that genetics was not his true calling, he began to search for a new major. A close friend, who had been the manager of the OSU football team, suggested that he contact OSU athletic trainer Bill Davis, and a newfound passion was born.

At the University of North Carolina at Chapel Hill, where he transferred after deciding to pursue a career in athletic training, Broglio also began to cultivate an interest in head injuries, beginning with an honors project recommended by mentor Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM. Today, 10 years after his initial project, Broglio has become a top researcher in concussions, with numerous funded grants resulting in published articles that influence the treatment of concussions around the world.

Currently, Broglio is studying the biomechanics of concussion in high school athletes in “real time” and the long- term effects of concussion on the athlete, attempting to both identify the causes of concussions and develop ways to assist retired athletes with the physical and mental consequences of years of neural trauma. As the former director of the Neurotrauma Research Laboratory and the undergraduate and graduate athletic training education programs at the University of Illinois at Urbana-Champaign, Broglio has made substantial contributions to neurotrauma prevention, diagnosis, and rehabilitation and to athletic training education. This fall, he will bring his expertise and research to the University of Michigan as an assistant professor in the school of Kinesiology and director of the Neurotrauma Laboratory.

Along with his countless publications in a variety of journals, Broglio is also on the editorial boards of the Journal of Athletic Training, the British Journal of Sports Medicine, and Athletic Training & Sports Health Care, and he is a reviewer for 18 journals.

As for future athletic trainers who hope to one day follow in his footsteps? Broglio says that the keys are “getting lucky” and working hard – “don’t be afraid to ask questions, even if you don’t understand; just because something has always been done a certain way, [it] doesn’t mean it’s the right or the best way.”

Broglio credits much of his success to his time with Kevin Guskiewicz, who set him on the investigative path to concussions, and Michael S. Ferrara, PhD, ATC, FNATA, who was instrumental in helping him to “polish” his work and see the bigger picture in all of his research.

He also thanks his parents, Joyce and Dennis Broglio, for encouraging him to earn his doctorate and reach to achieve his goals; his wife, Jane, who has provided unwavering support; his daughter, Lillian; and the NATA Research & Education Foundation and the Journal of Athletic Training, which have allowed him to “give back” to athletic training and share his enthusiasm for his work with students and colleagues.

S-8 Volume 46 • Number 3 (Supplement) May 2011 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.

Journal of Athletic Training S-9 The Doctoral Dissertation Award Presented in Honor of David H. Perrin, PhD, ATC Sponsored by Friends of Dr. Perrin

Jason P. Mihalik, PhD, ATC University of North Carolina at Chapel Hill

As an avid athlete throughout his high school years, Jason P. Mihalik, PhD, CAT(C), ATC, was injured multiple times, but because of the capable care he received from an athletic therapist, he went on to enjoy his active lifestyle. Through this athletic therapist, Mihalik, recipient of the 2011 Doctoral Dissertation Award, discovered a way to merge sports with clinical practice – athletic therapy. A few years later, an undergraduate project caused him to read an athletic training journal on concussions, sparking a number of unanswered questions and sending him on an unexpected journey from Canada to his current home at The University of North Carolina at Chapel Hill.

Today, Mihalik continues to influence the study of concussions in multiple settings, from high schools and youth sports to the United States military, where he promotes athletic trainers as medical providers for soldiers with traumatic brain injuries. He is exploring the biomechanics and the sex differences behind head impacts sustained by female and male hockey players, as investigators have shown that female players may be at higher risk for concussion, even though body checking is not allowed in women’s ice hockey.

Mihalik hopes that research advances in the area of concussions will encourage the NCAA, the NHL, and other leading athletic organizations to update their safety rules as needed. For example, whether to allow body checking at younger ages in ice hockey is in debate. One goal of Mihalik’s work is to understand if teaching players how to body check correctly will result in less direct head contact and fewer concussions overall.

Despite all of the research that has been done, Mihalik believes the world of medicine still knows very little about the brain, a subject that he plans to continue studying for many years to come. As an assistant professor at Chapel Hill, a reviewer for more than 8 journals, and an editorial board member of Athletic Training & Sports Health Care, Mihalik is steadily contributing to our knowledge of concussions and their long-term effects.

For those who are interested in athletic training, Mihalik offers the following advice: don’t back away from research, as “research for athletic trainers tends to be very clinically applicable. My recommendation for those who don’t pursue research is to understand [that] there needs to be evidence for what they do in the clinic.”

Mihalik thanks Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM, for being a strong mentor and now a great colleague; Joseph Myers, PhD, ATC, for mentoring him as a graduate student; Stephen W. Marshall, PhD, for his continued support; and Johna Register-Mihalik, PhD, ATC, for being a wonderful wife and colleague and always providing him with love, encouragement, and support.

S-10 Volume 46 • Number 3 (Supplement) May 2011 David H. Perrin, PhD, ATC, 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. He currently serves on the NATA Foundation Board of Directors.

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.

Journal of Athletic Training S-11 EBF: Ankle Monday, June 20, 2011, 8:00AM-9:00AM, Room 217 Free Communications, Oral Presentations: Clinical Ankle Measurements Monday, June 20, 2011, 9:15AM-10:30AM, Room 217; Moderator: Tricia Hubbard, PhD, ATC 11024MODI 11046MODI

Comparison Of Low And High examiner reliability estimates (ICC3,1) Comparison Of Arthrometry And Frequency Ultrasound Imaging In for the length measures in the three Stress Ultrasound Imaging In The The Measurement Of Anterior conditions ranged from .77 to .91 and Assessment Of Laxity In Healthy Talofibular Ligament Length .93 to .96, respectively (SEM: 0.3 to 0.4 Ankles Childress S, Croy T, Hertel J, Saliba mm). Paired t-tests were conducted to Sisson L, Croy T, Saliba S, Hertel J: S: University of Virginia, compare measures: 1) from the neutral University of Virginia, Charlottesville, VA and stress images within each device, Charlottesville, VA and 2) the percent length changes Context: Lateral ankle sprains are between devices. Bland-Altman plots Context: Ultrasonography (US) may common and assessment of ligament were also assessed to evaluate the aid in the assessment of the anterior injury is challenging. Ultrasound (US) agreement in length measures between talofibular ligament (ATFL) injury after imaging may help identify anterior devices. Results: ATFL length lateral ankle sprains by visualizing and talofibular ligament (ATFL) injuries by significantly increased from the neutral measuring the injured ligament length allowing for the quantification of ATFL to the inversion positions with the low- changes during anterior drawer and length changes during ankle stress frequency (neutral=18.7±1.4 mm, inversion stress maneuvers. Validation maneuvers. US devices operating at inversion =20.1±2.0 mm, p=.001) and of US against an established and higher frequencies provide improved high-frequency (neutral=16.9±1.9 mm, objective method of anterior talocrural tissue resolution, but it is unknown inversion=17.6±1.3 mm, p=.03) devices. and inversion laxity, such as ankle whether clinicians using US devices No significant between-device arthrometry (AA), is needed. Objective: operating at differing frequencies can difference in percent length change was To evaluate the relationships between produce agreement in ATFL length observed (low frequency=6.7±7.9%, the ATFL length measurements taken measurements. Objective: To compare high frequency= 4.6±8.1%, p=.36). with US during anterior drawer and ATFL length in neutral and inversion Bland-Altman plots demonstrated inversion stress to the maximum stress positions between two US consistent mean differences between inversion and anterior drawer devices, a low-frequency device (8MHz, devices with ATFL length measures with displacement observed with AA in 38 mm linear probe) and a high- the low-frequency device being a mean healthy subjects. Design: Descriptive frequency (15 MHz, 23 mm linear probe) of 2.1 mm (95% CI: -1.8 to 6.2 mm) longer laboratory study. Setting: Laboratory. device. Design: Descriptive laboratory than with the high-frequency device. Patients or Other Participants: 20 study. Setting: Laboratory. Patients or Conclusions: Significant increases in subjects without a history of ankle Other Participants: 20 subjects without ATFL length with inversion stress were injury (height: 171±9.5 cm; mass history of ankle injury (height=171±9.5 shown on images taken with both US 73.5±18.3 kg; age 24.7±4.2 years) cm, mass=73.5±18.3 kg, age=24.7±4.2 devices. While the low frequency volunteered. Interventions: Anterior years) volunteered. Intervention(s): device produced consistently longer drawer talocrural laxity was assessed Three US images of the ATFL were ATFL length measures in both neutral with two methods; US imaging and AA. taken in a neutral position and at end- and inversion stress images, percent US imaging of the ATFL (USAD) was range inversion with both the low- change scores were not significantly performed in sidelying with the ankle frequency and high-frequency devices. different between devices. Both devices under 125N of sustained anterior drawer Main Outcome Measures: Images were were able to identify ATFL length stress. AA (AAAD) was performed analyzed using imaging software and changes similarly. Differences in using a 125 N anterior drawer force. the linear distance between the ATFL’s absolute ATFL length measures Inversion laxity was measured during malleolar origin and talar insertion was between devices used in this study may end-range inversion stress with US measured with a digital calipers. Mean be due to either probe length or (USINV) stress imaging and then again ATFL lengths (mm) from low-frequency frequency. with AA (AAINV) at 4000N*mm of and high-frequency US images were inversion torque in the supine position. measured in the neutral and inversion Three US images were taken in USAD positions. The percent change in and USINV positions and mean ATFL ligament length from the neutral to lengths calculated. Three trials of inversion stress positions was also AAAD and AAINV were performed and calculated. Interexaminer and intra- the mean maximum anterior drawer

S-12 Volume 46 • Number 3 (Supplement) May 2011 translation (mm) and inversion (°) magnitude of force and torque applied exercise for the braced ankle (33.95 laxity values were calculated. Main can be controlled so that meaningful ± 15.6°, P = .09). For inversion- Outcome Measures: USAD (mm), comparisons can be made. eversion loading, ankle complex AAAD (mm), USINV (mm) and Measurement reliability is critical when rotation decreased 25.2° between the AAINV (°) and normalized ATFL length new devices or techniques are NB (62.51 ± 17.4°) and braced (37.3 change scores during anterior drawer developed. Objective: To design a ± 10.0°, P = .001) conditions, with a (USAD%) and inversion (USINV%). motorized ankle testing device with a 1.1° rotation increase after exercise Descriptive statistics and correlations six degrees-of-freedom linkage to for the braced condition (38.4 ± 9.9°, between dependent variables were accurately and reproducibly measure P >.05). Conclusions: Excellent test- calculated. Results: Group means ankle complex motion. The device was retest correlations were observed, and were: USAD (19.0±0.2 mm), USINV used to make comparisons among no comparison results indicate that the NB (20.1± 0.2 mm), AAAD (5.6 ± 2.8 braced (NB), braced and post-exercise and braced ankles varied significantly, mm), AAINV (25.7 ± 9.1º), USAD% braced conditions. Design: Measure- but not between the pre-post exercise- (1.7 ± 10.5%), and USINV% (7.6 ± ment reliability was examined using a braced ankles. We plan to use this 9.9%). No significant correlations test-retest design for the non-braced device in future studies to offer new were observed between USAD and ankle and repeated measures compared evidence as to which method of ankle AAAD (r=-.34, p=.09) or USINV and ankle complex stability among the no support is more effective in maintaining AAINV (r=-.04, p=.85) The AAAD and brace and braced conditions. Setting: ankle complex stability. AAINV measures were positively Research laboratory. Participants: correlated (r=.61, p<.0001) as were Six normal fresh-frozen cadaver 11120DOIN USAD and USINV (r= .762, p<.0001). ankles. Interventions: The specimen Plantar Flexion And Inversion Likewise, USAD% and USINV% were was mounted to a jig proximally via a Strength Deficits Revealed In positively correlated (r=.764, tibial rod cemented into the tibial Previously Sprained Ankles p<.0001). Conclusions: US measures medullary cavity and distally via an Liu K, Naguib SA, Gustavsen G, of anterior drawer and inversion laxity athletic shoe fixed to a mounting plate Kaminski TW: University of were not significantly correlated with of the testing machine. The specimens Delaware, Newark, DE AA measures in healthy ankles. were loaded to 2 Nm in internal- Differences between the US and AA external rotation at 0° plantar-flexion Context: Ankles are the most devices and procedures that may have (PF), as well as 4 Nm inversion- frequently injured joint in sport, and it affected these results include different eversion rotation at 15° PF. Two is estimated that up to 40% of people rates of joint loading and subject repeated measurements were performed sustaining a significant sprain are left positioning. Change scores demon- on each ankle for each test. Exercise with residual problems (pain, strated relatively small levels of consisted of dorsi-plantar flexion (DPF) weakness) despite optimal lengthening in healthy ankles and cycling to ± 1.5 Nm for 10 minutes. rehabilitation. Although counter- results may differ in ATFL-injured Main Outcome Measurements: intuitive, deficits in plantar flexion ankles where joint laxity is greater. Measurements included total internal- (PF) and inversion (INV) strength have external and inversion-eversion (I-E) ankle been mentioned as possible risk 11068FOPR complex rotation. Intraclass correlation factors for recurrent ankle sprains and/ Development Of A New Motorized coefficients (ICC 2,1) assessed or instability. Objective: To examine Ankle Tester And Its Use In The reliability. Separate one-way repeated differences in isokinetic strength in Measurement Of The Effectiveness measures ANOVA’s examined effects of those with a history of ankle sprain Of Bracing an ankle de-rotation orthosis on ankle (SP) and those without a history of Kovaleski JE, Gurchiek LR, Hollis JM, complex rotation. Significance was set ankle sprain (NS). Design: Cross- Heitman RJ: Andrews Institute, Gulf a priori at P < .05. Results: Test-retest sectional study. Setting: Athletic Breeze, FL; Blue Bay Research, data indicate high reliability Training Research Laboratory. Navarre, FL; University of South measurement for internal-external Patients or Other Participants: Alabama, Mobile, AL rotation (Measurement 1 = 43.05 ± 18.4° Forty-seven NCAA Division I and Measurement 2 = 44.19 ± 18.9°, ICC collegiate athletes (age= 18.1 ± 0.5 Context: We introduce a new = .99) and inversion-eversion rotation years, mass= 69.3 ± 11.8 kg, height= technique for assessment of the three- (Measurement 1 = 62.51 ± 17.4° and 172.5 ± 10.7 cm) for a total of 94 dimensional passive support Measurement 2 = 62.49 ± 17.2°, ICC = ankle measurements. Interventions: characteristics of ankle braces. Brace .99). For internal-external loading, Strength was measured by using a effectiveness in combination with a rotation decreased 12° between the NB KinCom 125-AP isokinetic dyna- shoe has never been evaluated in vitro. (43.05 ± 18.4°) and braced (31.33 ± 14.9°, mometer (Chattanooga Group, With the use of a mechanical device, P = .017) ankles, and there was a non- Hixson, TN). PF and INV strength was ankle flexion and positioning and the significant increase of 2.6° rotation after assessed at a velocity of 120°/sec.

Journal of Athletic Training S-13 11F06FOCE Both concentric (CON) and eccentric Ankle Copers Demonstrate 125N of anterior force, and 1Nm (ECC) muscle actions were assessed Increased Anterior Stiffness intervals from 0 to 4Nm of inversion and then normalized to lean body mass Compared To Healthy And Unstable torque. A 2-way repeated-measures derived and SP groups. Main Ankles ANOVA was used to determine Outcome Measures: History of ankle Swanik CB, Needle AR: University of differences within each force level, and sprain served as the independent Delaware, Newark, DE between groups. The alpha level was variable, while the dependent variables set a priori at 0.05. Results: Group were the normalized average (AT) and Context: Ankle sprains are the most was observed to have a significant peak (PT) torque values (Nm/kg) from common injuries in athletics, with effect on anterior stiffness values concentric and eccentric PF and INV approximately 50% of patients (F2,56=5.9, p=.005), and post-hoc tests isokinetic strength. Results: complaining of repeated bouts of revealed that the PC group exhibited Isokinetic strength in the SP group was “giving way.“ (functional instability, significantly greater stiffness than HA significantly weaker than the NS group FAI). While extensive research has at 0-25N (p=.002), and greater across all variables including: CON- explored the mechanical and stiffness than AI ankles at each interval PF-AT (NS: 1.08 ± 0.30 vs. SP: 0.91 sensorimotor implications behind FAI, up to 100N (p<.05). The AI group ±0.26, p=0.006), CON-PF-PT (NS: the fifty percent of subjects that do not demonstrated increased anterior 1.44 ± 0.36 vs. SP: 1.27 ± 0.26, develop instability are lost to follow- displacement compared to HA and PC p=0.012), ECC-PF-AT (NS: 0.53 up. Understanding this group of groups (HA=7.9±2.0mm; AI=9.8±2.5 ±0.07 vs. SP: 0.50 ± 0.08, p=0.023), “potential copers” can provide insight mm; PC=7.8±2.3mm, p=.005). No ECC-PF-PT (NS: 3.48 ±0.96 vs. SP: into relevant interventions to prevent group differences were observed for 2.95 ±0.86, p=0.007), CON-INV-AT instability. Research has been inversion rotation (HA=32.3±4.6°; (NS: 0.18 ±0.05 vs. SP: 0.15 ±0.04, inconclusive in demonstrating changes AI=34.7±8.7, PC=31.2±9.0°, p=.29) p=0.003), CON-INV-PT (NS: 0.25 in ankle stiffness in patients with ankle or for inversion stiffness (F6,204= ±0.05 vs. SP: 0.22 ±0.05, p=0.011), instability; however, comparisons have 1.085, p=.37). Conclusions: The PC ECC-INV-AT (NS: 0.28 ±0.08 vs. SP: not been seen in a group of “potential group observed to have an increased 0.24 ±0.06, p=0.005), ECC-INV-PT copers”. Objective: To determine resistance to anterior displacement of (NS: 0.41 ±0.11 vs. SP: 0.36 ±0.11, changes in passive ankle stiffness that the ankle, despite seeing no changes p=0.021). Conclusions: Tradition- exist in “potential ankle copers” when in peak laxity. Previous investigations ally, clinicians have focused on compared to healthy and functionally on the neuromechanical contributors eversion and dorsiflexion strength in unstable ankles. Design: Post-test to joint stability have emphasized the the rehabilitation of a lateral ankle only with comparison group. Setting: importance of achieving optimal joint sprain. Although strength deficits in Human Performance Laboratory. stiffness. Our data suggests that these PF and INV appear to be novel, there Patients or Other Participants: 39 “potential copers” exhibit a mechanical is support in the literature for these subjects (23.0±2.9yrs, 171.5±10.3cm, adaptation that may assist in preventing findings. Strength deficits found in PF 69.7±13.2kg) provided 78 ankles for additional episodes of giving way in the and INV could be a result of persistent this study. Ankles were stratified into ankle joint. This adaptation is markedly reflex neuromuscular inhibition of the three groups using the Cumberland greater during the short range periarticular ankle muscles stemming Ankle Instability Tool (CAIT): healthy stiffness, where previous research has from a previous ankle sprain. Inhibition (HA, n=37), functionally unstable (AI, suggested the sensation of an of joint musculature after distention n=22), and potential copers (PC, impending roll-over incident is most and/or damage to a joint has been n=19). Interventions: Ankle laxity important. previously described in the literature. and stiffness was assessed using an The results of this study suggest a role instrumented ankle arthrometer (Blue for restoring both PF and INV strength Bay Research, Milton, FL). Three in the rehabilitation of a lateral ankle anterior translations to a force of sprain. 125N and three inversion rotations to a torque of 4200Nmm were applied to the ankle joint. Main Outcome Measures: Peak anterior displacement (mm) and inversion rotation (°) was assessed for between- group differences using univariate ANOVA’s. Passive ankle stiffness was assessed at 25N intervals from 0 to

S-14 Volume 46 • Number 3 (Supplement) May 2011 EBF: Concussion Monday, June 20, 2011, 10:45AM-11:45AM, Room 217

Free Communications, Oral Presentations: Concussion Issues Monday, June 20, 2011, 12:00PM-1:00PM, Room 217; Moderator: Ryan Tierney, PhD, ATC 11007FOSP 11177DOSP Prevalence Of Injurious Impacts In threshold represented (ie impacts in Influence Of Concussion Knowledge Interscholastic Football excess of 5580.0rad/s/s; 96.0g; and On Reporting Of Concussion In Broglio SP, Sabin MJ, Sosnoff JJ, impacts to the helmet front, back, or Games And Practices Among A Zimmerman J: University of Illinois top). Results: A total of 76621 impacts Sample Of High School Athletes at Urbana-Champaign, Neurotrauma were recorded throughout the data Register-Mihalik JK, Guskiewicz Research Laboratory, Urbana- collection period and 16 concussions KM, Linnan L, Marshall SW, Champaign, IL, and Carle Foundation were captured. The top 0.5% most Valovich McLeod TC, Mueller FO: Hospital, Division of Sports significant impacts included 383 hits The University of North Carolina, Medicine, Urbana, IL spread across the Offensive Line (52 Chapel Hill, NC, and A.T. Still impacts; 4.0 impacts/player), Offensive University, Mesa, AZ Context: Sport concussion has Skill (128 impacts; 6.4 impacts/player), received significant media attention as Defensive Line (163 impacts; 6.3 Purpose: Reporting of concussive of late. Despite growing awareness impacts/player) and Defensive Skill (40 injuries is one of the first steps in and research in this area, little is known impacts; 4.4 impacts/player) players. identification and management. It is about injury biomechanics. Objective: ANVOA results indicated no difference estimated that over 50% of these The purpose of this investigation was (p’s>0.05) between groups for linear injuries may go unreported. to describe and compare the highest acceleration (Offensive Line: Understanding the influence of magnitude impacts occurring in 91.6±16.2g; Offensive Skill: 98.4±20.1g; concussion knowledge on reporting interscholastic football across athlete Defensive Line: 95.5±17.5g, Defensive among high school athletes may help positions. Design and setting: Skill: 94.9±19.5), rotational acceleration direct education and awareness efforts Observational field study completed (Offensive Line: 8041.7±1285.5rad/s/s; in this population. Objective: To during the 2007, 2008, and 2009 football Offensive Skill: 8121.83±1477.4rad/s/s; examine the influence of concussion seasons. Participants: Interscholastic Defensive Line: 8109.0±1190.6rad/s/s, knowledge on concussion reporting football athletes (N=78, 16.8+.8yrs, Defensive Skill: 8101.2±1193.7rad/s/s), prevalence across games and practices 181.6+5.6cm, 89.4+13.9kg) volunteered or HITsp (Offensive Line: 61.2±21.6; among a sample of high school athletes. to participate in this investigation. Offensive Skill: 58.7±24.2; Defensive Design: A cross-sectional survey Interventions: Each athlete was Line: 59.9±20.0, Defensive Skill: design. Setting: The pre-validated equipped with the Head Impact 59.8±15.8). Additionally, 74 impacts survey instrument was completed at the Telemetry System (HITS) to monitor (0.1% of all impacts) exceeded the newly athletes’ home. Patients or Other and record all impacts occurring during proposed concussion threshold and Participants: A convenience sample of games and practices. Biomechanical included 7 of 16 recorded concussions 167 high school athletes (age=15.7±1.4) data recorded by the HITS mimics that (43.8%). Conclusions: The highest completed the questionnaire. of Hybrid III dummies for linear and magnitude impacts occurring in Interventions: Athletes attended a rotational accelerations (r=.98) and interscholastic football are equally school-based meeting and received a impact location (±.41cm). Main Outcome distributed among player positions. packet containing the questionnaire and Measures: Data from each impact The most severe impacts do not consent documents to take home, included linear acceleration (g), uniformly result in concussions, complete, and return via mail. The rotational acceleration (rad/s/s), and suggesting an inconsistent injury criterion variable was knowledge score, HIT severity profile (HITsp). Data were threshold between individuals. As which was calculated as the sum of the ranked based on rotational acceleration such, the variables analyzed here do correct responses from 35 knowledge and categorized based on player not provide an appropriate level of questions. The questionnaire was pilot position. Group differences in linear information for concussion diag- tested and Kappa Agreement across acceleration, rotational acceleration and nostics. Future work is needed test sessions was 0.6-0.9 for questions HITsp for the top 0.5% of impacts were to determine additional measures that (all yes/no) included in the knowledge evaluated using multiple Analyses of will improve diagnostic criteria and/or score. Main Outcome Measures: The Variance (ANOVAs). We further define more sensitive tolerance levels. definition of concussion reporting was investigated what percentage of indicating a recalled concussion or “bell impacts a newly proposed concussion ringer” event as reported to a coach or

Journal of Athletic Training S-15 11284FOSP medical professional. Concussion Impaired Gait Performance a significantly reduced gait velocity reporting measures included: 1) Following A Concussion (1.15 + 0.14m/s and 1.42 + 0.11m/s proportion of concussions and “bell Buckley TA, Munkasy BA: Georgia respectively, P<0.001), cadence (107.9 ringers” reported during practices, 2) Southern University, Statesboro, GA + 9.1 steps/minute and 119.7 + 8.3 steps/ proportion of concussions and “bell minute respectively, P=0.011), and spent ringers” reported during games, 3) Context: Impaired postural control is more time in stance (62.6 + 1.6% and overall proportion of reported a hallmark of concussion presentation; 60.6 + 1.2% of the gait cycle respectively, concussions as defined by the athlete, however the mechanisms related to P=0.03) than the healthy subjects. After and 4) overall proportion of reported these impairments are still largely Bonferroni correction, there was a non- “bell ringers” as defined by the athlete. unknown. During gait, the rhythmic significant 28% reduction in stride Binomial regression models [Prevalence muscle activation patterns are likely length in the concussion subjects Ratios (PR) and 95% Confidence controlled by central pattern generators compared to the healthy control Intervals (CI)] were used to analyze the in the thoracic and lumbar spinal cord, subjects (1.11 + 0.45m and 1.42 + 0.09m influence of a 10-point increase in however functional MRI studies have respectively, P=0.04). Conclusions: knowledge score on concussion suggested overriding supraspinal The results of this study suggest that reporting measures. Results: Increased control of gait, likely residing in the concussion acutely impairs knowledge score was significantly primary motor cortex. It is likely that spatiotemporal parameters of gait associated with higher reporting concussions do not adversely affect performance. The concussion subjects prevalence of concussions/”bell central pattern generators, but may in this study demonstrated a posturally ringers” during practices (PR=18.67; impair supraspinal control mechanisms. conservative gait pattern whereby they 95% CI:5.38-64.76; P<.001), and a higher Objective: To identify impairments in reduced their gait velocity and cadence reporting prevalence of “bell ringer” spatiotemporal parameters of gait as well as increased the amount of time events overall (PR=9.40; 95% CI:3.16- following a concussion. Design: Cross spent in stance. Further, these results 27.98; P<.001). No association was Sectional. Setting: Laboratory. support the recent findings suggesting observed between knowledge score Patients or Other Participants: A total overriding supraspinal control of gait; and reporting prevalence during games of 18 subjects were divided into two however, further investigation is (PR=1.46; 95% CI:0.51-4.21; P=.475) or groups, 9 subjects (5 Male, 1.73 + 0.09m required to more precisely identify brain concussion events overall (PR=0.98; ht, 80.8 + 20.4kg, 1.0 + 1.4 previous structures and networks associated 95% CI:0.35-2.76; P=.982). In games, concussions) who suffered Grade II with the impaired postural control. there were a total of 320 recalled (Cantu Evidence Based grading Finally, the Gaitrite portable gait concussions/”bell ringers” with only 73 system) concussions were matched to analysis system appears effective in (23%) of these events reported to a 9 healthy control subjects (5 Male, 1.71 identifying altered gait patterns coach or medical professional. In + 0.08m ht, 77.8 + 17.9kg) who had no following a sports-related concussion. practices, there were a total of 348 history of concussion. Intervention: recalled concussions/”bell ringers” All subjects completed 10 trials of self- 11235FOSP with only 40 (12%) of these events selected paced gait on a 4.9m Gaitrite Subconcussive Head Impacts Do Not reported to a coach or medical instrumented walkway, a reliable (ICC: Result In Short-Term Clinical professional. Conclusions: Increased 0.80 – 0.98) and valid (ICC: 0.92 – 0.99) Impairments In Youth Ice Hockey knowledge about concussion may instrument. Concussion subjects Players result in increased reporting of events completed their trials within 24 hours Mihalik JP, Guskiewicz KM, Register- athletes consider to be “bell ringers” post-injury and control data was Mihalik JK, Toler JD: The University and potential concussive events collected during preseason pre- of North Carolina, Chapel Hill, NC occurring during practices. This study participation physical examination. highlights that concussion education Main Outcome Measures: Spatio- Context: The long -term clinical may promote reporting of concussive temporal measures of gait per- impairments that have been identified events among high school athletes. In formance including stride length, stride in retired athletes have largely been conclusion, this study illustrates the velocity, and gait cadence were attributed to repeated subconcussive importance of context (game vs. compared between groups using a head impact exposures during their practice) on reporting behaviors. One-way ANOVA with Bonferroni earlier playing days. It is yet unknown corrections thus setting the alpha level whether repeated head impacts in a at 0.017. A paired sample T-Test young and vulnerable population may compared the gait cycle percentage in result in short-term clinical impairments stance phase between groups. Results: observed following a season of regular The concussion subjects walked with participation in collision sports.

S-16 Volume 46 • Number 3 (Supplement) May 2011 Objective: To study how the range=0 to 28 impacts), frequency of frequency, severity, location, and top-of-head impacts (median=35 cumulative magnitude of sub- impacts), and cumulative sum of linear concussive head impacts affects acceleration of head impacts neurocognitive function, balance (mean=5894.9g; sd=3300.8g) ob- performance, and symptomatology in served for each player. The multiple youth ice hockey players. We linear regressions for change scores hypothesized any changes in clinical in verbal memory (F4,78 =0.56; measures of concussion would be P=0.696; R2=0.028), visual memory 2 explained by measures of head impact (F4,78=1.14; P=0.343; R =0.055), exposure. Design: Quasi-experi- visuomotor processing speed 2 mental prospective repeated measures (F4,78=0.44; P=0.779; R =0.022), cohort. Setting: Clinical research reaction time (F4,78=0.38; P=0.823; 2 center and field settings. Patients or R =0.019), BESS (F4,78=0.84; Other Participants: A convenience P=0.503; R2=0.044), and PCSS 2 sample of 83 male ice hockey players (F4,78=2.01; P=0.102; R =0.093) did (age=14.5±1.1 years; height= not suggest that our independent 171.2±8.8 cm; mass= 64.0± 11.4 kg; variables of interest contributed in any experience=3.7±3.7 years). Inter- way to the changes we observed in our ventions: Preseason and postseason clinical measures of concussion. testing consisted of the following Conclusions: It does not appear that common clinical measures of any short-term changes in clinical concussion: Immediate Post- measures of concussions observed concussion Assessment and Cognitive over the course of a single playing Test (ImPACT), Balance Error Scoring season can be explained by the System (BESS), and 22-item measures of head impact exposure we Postconcussion Symptom Scale included in our analyses. Future work (PCSS). Head impact exposure, should prospectively study the including impact magnitude and potential long-term effects of head location, were collected for all players impact exposure on clinical over the course of the playing season impairments in young athletes. by using helmets customized to accommodate the Head Impact Technology System (HITS) instrumentation. Separate multiple linear regressions were employed for each outcome measure while including the following criterion variables: ≥10g, frequency of severe head impacts, ≥80g, frequency of top- of-head impacts, and cumulative sum of linear acceleration of all head impacts. Main Outcome Measures: Change scores (∆=postseason - preseason) were computed for the ImPACT composite indices (verbal memory, visual memory, visuomotor processing speed, and reaction time), the BESS total error score, and PCSS total symptom severity score. Results: Our analyses regressed change in clinical outcome against the frequency ≥10gof head (median= 270impacts impacts), frequency of severe ≥80g head (median=2 impacts;

Journal of Athletic Training S-17 Free Communications, Oral Presentations: Spine Injury Emergency Care Tuesday, June 21, 2011, 8:00AM-9:00AM, Room 217; Moderator: Laura Decoster, ATC 11257FOXX 11016SOEM Strapping Techniques May Influence the pelvis, a strap across the mid-thigh Radiographic Evidence Demonstrates Immobilization When Shifting A region, and a strap across lower leg. That Occipital Padding Maintains Patient To Clear The Airway Once the cadaver was properly Cervical Alignment After Football Horodyski MB, Conrad BP, Del immobilized, the spine board was rolled Helmet Removal Rossi G, DuBose DN, Horodyski to 90° by two researchers. A third Hernandez AE, Decoster LC, Burns N, Rechtine GR: University of researcher monitored an inclinometer MF, Swartz EE, Murthi DS, Vailas JC, Rochester, Rochester NY; attached to the spine board. For all Isham LL: NH Musculoskeletal Department of Orthopaedics and trials, an electromagnetic tracking Institute, Manchester, NH; University Rehabilitation, University of Florida, device registered motion at the C5-C6 of NH, Durham, NH; NH Orthopaedic Gainesville, FL; Department of level and the digital inclinometer Center, Manchester, NH Orthopaedics, University of South recorded spine board angle. All Florida, Tampa, FL; Department of procedures were completed three times Context: Minimizing head and neck Athletic Training, SUNY Brockport, on each cadaver. Main Outcome motion is a key principle in on-field Brockport, NY Measures: The primary measurements management of cervical-spine injuries. assessed were angular (flexion/ Therefore, recommendations for Context: When caring for the spine- extension, lateral flexion, axial rotation) managing football athletes with such injured athlete, it is necessary to restrict and linear (anteroposterior translation, injuries favor facemask removal to allow movement of the spinal column to avoid medial-lateral translation, and axial airway access. Maintaining cervical- exacerbating or creating neurological translation) motions occurring at the C5- spine alignment is another key injuries secondary to initial trauma, C6 level as the cadaver was rolled 90º principle; therefore, if helmet removal especially during the prehospital stages while immobilized to the spine board. becomes necessary, recommendations of patient care. The strapping Results: No significant differences call for simultaneous shoulder pad technique applied must prevent were noted between the head holder removal (all-or-none principle). excessive slipping motion in the event devices. The 3-Strap technique However, simultaneous removal of the immobilized patient must be rolled produced significantly more motion for: shoulder pads and helmet may cause to clear the airway. Objective: To flexion-extension [3-Strap: 1.67º ± 0.34º considerable movement especially if assess the effectiveness of current and SPIDER: 0.97º ± 0.25º, (p=0.001)]; adequate trained rescuers are not strapping techniques and two head lateral bending [3-Strap: 2.18º ± 0.29º available. Objective: To determine if immobilizers in minimizing spinal and SPIDER: 1.18º ± 0.22º, (p=0.049)]; occipital padding is an effective motions. Design: Repeated measures. axial rotation [3-Strap: 2.03º ± 0.30º and intervention to maintain cervical spine Setting: Cadaver laboratory. Patients 7-Strap:1.40º ± 0.25º, (p=0.009)]; and alignment after helmet-only removal. or Other Participations: Five lightly- medial-lateral [3-Strap: 2.86 mm ± Design: Quasi-experimental, repeated embalmed cadavers (3 males, 2 females; 0.39mm and SPIDER: 1.71 mm ± 0.48mm measures. Setting: X-ray suite of mass: 135 kg ± 31.2) with intact cervical (p=0.041)]. Conclusions: Although the orthopedic clinic. Participants: spines. Interventions: A global data shows the 3-Strap technique is Convenience sample of 20 males (age instability at C5-C6 was created by a significantly inferior in four of the six =23.6±2.7 years, height=181.1±8.7cm, spine surgeon. The cadavers were outcome measures, the measured weight=85.5±12.4kg). Interventions: positioned supine on the spine board. difference is small. While not IRB approval was granted for use of x- The head was stabilized using two significantly different, the SPIDER rays. Participants provided informed different devices: Ferno Universal Head technique resulted in less motion than consent and were fitted with football Immobilizer and Laerdal Speed Block. the 7-Strap. Our study shows that the helmet and shoulder pads. Helmets and Three strapping techniques were tested SPIDER technique results in less shoulder pads were altered to improve with each of the head immobilizers. The slipping motion in the event the radiographic visibility of the cervical 3-Strap technique involved the immobilized patient must be rolled to spine (helmets: metal rivets and placement of straps across the chest, clear the airway. chinstrap removed; shoulder pads: hips, and thighs. The SPIDER deltoid protection and metal rivets strapping technique has preset strap removed). After appropriate shielding locations determined by the with lead apron and lead throat manufacturer. The 7-Strap utilizes straps protection, four lateral radiographs placed in an X pattern at the chest and were taken. Participants were first across the shoulders, a third strap imaged wearing shoulder pads and across the chest, an X pattern across helmet. Investigators (certified athletic

S-18 Volume 46 • Number 3 (Supplement) May 2011 11211OOEM trainers) then removed the helmet The Effects Of Wet And Dry watch. The average time of each trial following recommended protocol. Conditions On The Time For Face was recorded to the nearest one- Calipers were used to measure the Mask Removal Using A Powered hundredth of a second. The average occipital thickness of the helmet; Screwdriver And Face Mask time of the three trials with each tool towels matching this thickness were slid Extractor and under each weather condition was under the subject’s head after helmet Carter AR, Shockey AK, Vonada ME, used for the analysis. A 2X2 repeated removal. Participants were imaged Hale SA: Shenandoah University, measures Analysis of Variance was immediately with occipital padding, Winchester, VA used to examine the effects of weather again 20 minutes later, and finally condition and tool on the time to without occipital padding. An Context: There is no published remove the face mask. Results: Means orthopedic spine surgeon blinded to the literature examining the effectiveness of and standard deviations for the removal study’s purpose, determined cervical face mask removal tools in inclement using the FME in wet and dry alignment via Cobb angle measure- weather conditions. Therefore, it is conditions were 82.46s+32.19s and ments of the posterior cervical cortices difficult to determine which removal 81.53s+36.58s respectively. Means and of C2-C6 vertebrae using angle method would be best, given current standard deviations for the removal measurement tools in the digital x-ray weather conditions. Objective: To using the SD in wet and dry conditions software (Stryker Office PACS, Version determine how wet and dry weather were 42.57s+14.89s and 35.41s+15.14s 4.1.35.2 Stryker Imaging, Kalamazoo, conditions affect face mask removal respectively. There was no significant MI). Intraobserver reliability was using a cordless powered screwdriver interaction between tool and condition determined a priori using intraclass (SD) and a Face Mask Extractor (FME). (p=0.684) and no significant main effect coefficient analysis. Measurements Analysis of speed and tool of condition (p=0.290). There was a were analyzed using a 1x4 RMANOVA effectiveness will help to determine an significant main effect of tool and post-hoc pairwise-comparisons appropriate face mask removal method (p<0.0005) on face mask removal time. with Bonferroni correction. Main given the environmental condition. The participants removed the face mask Outcome Measure: Cervical alignment Design: Repeated measures design. faster when using the SD. Conclusions: (C2-C6 Cobb angle). Results: Setting: Controlled grass field. This study supports the NATA position Intraobserver analysis showed Participants: A convenience sample statement of a screwdriver being an excellent reliability (ICC=1.0, 95% CI: of nine (3 male, 6 female) licensed athletic trainer’s primary means of face .999-1.0). RMANOVA detected athletic trainers participated in this mask removal, with a cutting tool significant differences (F=13.343,17, study. The participants had an average available as a backup. Our results P<0.001). Pairwise comparisons age of 32.11+6.72 years and an average suggest that regardless of weather revealed no differences in cervical of 8.39+7.42 years of experience as a condition, face mask removal can be alignment (all measurements reported licensed athletic trainer with an average completed more quickly using a SD. reflect lordosis) when comparing the of 4.39+2.93 years of football experience. baseline helmeted condition (10.1°±8.7; Interventions: All subjects were 11335FOPR 95% CI: 6.0-14.1) to the padded provided with rain suits for wet and dry The Effect Of Lacrosse Helmet Use conditions. Measurements taken after trials. Following a familiarization period, On Face Mask Removal With A removal of occipital padding (14.4°±8.1; each participant completed three trials Cordless Screwdriver 95% CI: 10.6-18.2) demonstrated a with each removal tool (SD, FME) under Bowman TG, Bradney DA: significant increase in cervical lordosis each weather condition (wet, dry). The Lynchburg College, Lynchburg, VA compared to the immediate padded order of weather condition and tool was measurement (9.5°±6.9; 95% CI: 6.3- counterbalanced to prevent order from Context: Timely and successful face 12.7; P=0.011) and the 20-minute affecting results. All trials were mask removal (FMR) is essential when padded measurement (6.5°±6.8; 95% CI: completed on a grass field. Wet catastrophic injuries occur in helmeted 3.4-9.7; P<0.001). Conclusions: These conditions were simulated by pre- athletes. Previous work on FMR of data provide quantitative evidence that soaking the ground and the participant football helmets has shown that the use of occipital padding after for eight minutes via a sprinkler system. cordless screwdrivers can be rendered helmet-only removal provides a safe One investigator, wearing a Schutt Air useless on helmets that have been worn alternative to the all-or-none principle helmet and shoulder pads simulated the for a single season. Research on of managing football equipment during injured athlete. Another investigator lacrosse helmets is lacking; however emergencies. If it becomes necessary provided in-line manual stabilization of catastrophic injury has occurred 13 to remove the football helmet in the the athlete’s cervical spine for the times over the last 26 years. Objective: field, occipital padding may be used to duration of each trial. Main Outcome To determine the frequency of FMR maintain cervical alignment until Measures: Two researchers indepen- failure for lacrosse helmets worn for at shoulder pads can be safely removed. dently timed each trial with a stop least one full season using a cordless

Journal of Athletic Training S-19 screwdriver. Design: Cross- recommend that athletic trainers sectional. Setting: Athletic training covering men’s lacrosse have a laboratory. Patients or Other secondary cutting tool immediately Participants: Helmets were obtained available in the event the cordless from two colleges (N = 55) and one screwdriver fails. We also recommend high school (N = 20) in the mid- routine maintenance checks of helmet Atlantic region. The mean seasons, hardware throughout the season. games, and weeks of practices the helmets were worn were 2.25±1.50, 35.25±22.91, and 30.75±19.36, respectively. None of the helmets had ever been refurbished. Interventions: A trial consisted of using a cordless screwdriver to remove all screws that secured the face mask to the helmet shell using standardized procedures. FMR required unscrewing either three (n = 30) or five (n = 45) screws depending on the helmet style. A model was positioned supine on the ground with each helmet fitted properly by an athletic trainer with 6 years of experience fitting lacrosse helmets. An athletic trainer trained in FMR techniques knelt down and put the helmet between their knees while attempting to remove all screws that secured the face mask to the helmet. Removal was attempted on a total of 75 helmets and 310 screws. Main Outcome Measures: The frequency of FMR failure was the dependent variable. Proportions of FMR failures for the helmets and individual screws with 95% confidence intervals (CI) were calculated. A removal attempt was considered a failure if the screw could not be removed with the cordless screwdriver because of t-nut spinning, the screw being stuck, the screw being stripped, or another reason. Results: FMR failure occurred on 12 of the 75 helmets (16.0%, 95% CI: 7.7%, 24.3%) while removal of 16 of the 310 individual screws failed (5.2%, 95% CI: 2.7%, 7.6%). Eleven of the 16 (68.8%, 95% CI: 28.1%, 100%) failed screws were unsuccessful because of t-nut spinning with the remaining being stuck in the t- nut (31.2%, 95% CI: 3.9%, 58.6%). Conclusions: Similar to the results reported on football helmets, we found the cordless screwdriver to be unreliable for FMR of used lacrosse helmets due to the 16% failure rate observed. Based on these results, we

S-20 Volume 46 • Number 3 (Supplement) May 2011 EBF: Heat or Hydration Tuesday, June 21, 2011, 9:15AM-10:15AM, Room 217

Free Communications, Oral Presentations: Heat Illness Prevention Tuesday, June 21, 2011, 10:30AM-11:30AM, Room 217; Moderator: Lindsay Eberman, PhD, ATC 11313DOEX

Examination Of Two Environmental based on Tr and HR, which were administration methods have on fluid Symptoms Questionnaire During 10- significantly greater on day 1 vs day 4 consumption, hydration status, and Days Of Exercise-Heat Acclimation (P=0.004, P=0.002) and all-subsequent perceptual variables (PV). Design: Stearns RL, Belval LN, Casa DJ, Klau days. 56-ESQ and 14-ESQ were Randomized crossover design. Setting: JF, Emmanuel H, Armstrong LE: significantly lower beginning on day Outdoor field study in warm University of Connecticut, Storrs, CT four compared to day one (P=0.004 and conditions(22.2±3.5pC). Participants: P=0.013 respectively) supporting Nineteen physically fit (>4x/wk) Context: The Environmental Symptoms evidence of heat acclimation. Pre- individuals (14M, 5F, 30±10y,176±8cm, Questionnaire (ESQ), while originally exercise ESQ scores across days 1-10 72.5±10kg) were recruited from the created for altitude-induced stress, has revealed no significant differences for university and local running clubs. been utilized in hot environments and 56-ESQ (P=0.998). Pre- and post- Interventions: The independent has been used in both its full (56-ESQ) exercise 56-ESQ scores were variable was fluid administration (EFA and a modified 14-question form (14- significantly correlated with Tr, and SA). EFA refers to when someone ESQ) however neither were validated (P<0.001, R=0.378) HR (P<0.001, else squirts water into the participant’s for heat stress or correlated with R=0.453), RPE (P<0.001, R=0.382). Post- mouth, whereas SA, the participant physiological data. Objective: The exercise 14-ESQ was significantly squirts water into their own mouth. The purpose of this study was 1) Validate correlated with Tr (P<0.001, R=0.529), water bottle(WB) was kept equal the 56-ESQ specifically for heat stress HR (P<0.001, R=0.591), RPE (P<0.001, distance from the mouth for both and heat acclimation 2) to compare a R=0.570). Conclusions: The 14-ESQ conditions. Participants weight (t-shirt modified version of the ESQ (14-ESQ) was significantly correlated with 56- and/or shorts only) and urine samples to the 56-ESQ over the course of a 10- ESQ during exercise heat acclimation. were collected prior to exercise. day exercise heat acclimation protocol All ESQs were significantly correlated Participants then completed a 10-min 3) Correlate all scales with with physiological variables and signs warm-up. Participants had a 2-min fluid physiological data. Design: 10-Day and symptoms of heat stress. Both ESQ break(FB) before the exercise exercise heat acclimation protocol. forms may be used during exercise heat protocol(EP), which included a series Setting: College University. Patients or acclimation as an efficient method to of five 15-minute stations. Exercises Other Participants: Eleven, non- indicate environmental heat stress and provided aerobic and anaerobic trained, non-heat-acclimatized males symptoms. demands, including hill jogging, push- (age 20±1y; height 183.7±8.4cm; weight ups, jumping jacks, ladder drills, and 81.7±12.2kg; percent body fat 11312MOEX intermittent rest. After completing each 10.1±2.9%). Interventions: Subjects Effect Of Fluid Administration On Ad station, participants received a 5-min FB followed 10 consecutive days of heat Libitum Fluid Consumption And where they drank ad libitum. Fluid acclimation (walking at 5.6 km·h-1, 5% Hydration Status variables and PV were collected during grade for 90 min duration; 33°C, 30-50% Finn ME, Yeargin SW, Eberman LE, every FB. Following the final FB, relative humidity). ESQ forms were Gage MJ, McDermott BP, Gray MT, participants provided a post-exercise completed on days 1,4,7 and 10 pre- and Niemann AJ: Department of Applied weight and urine sample. The order of post-exercise. During exercise, rectal Medicine and Rehabilitation, Indiana conditions and exercise stations were State University, Terre Haute, IN, and randomly assigned. Main Outcome temperature (Tr) Heart rate (HR) and Rating of Perceived Exertion (RPE) were Department of Health and Human Measures: Hydration status was recorded. Main Outcome Measures: Performance, University of Tennessee assessed via urine specific gravity Correlations were performed with HR, at Chattanooga, Chattanooga, TN (Usg) and body mass loss (BML). Fluid variables were total volume Tr, and RPE. A one-way ANOVA assessed mean differences across days Context: The use of an external fluid consumed(TVC), total number of 1-10 while a Pearson’s Bivariate administrator (EFA) to deliver fluids is squirts(TSq), and volume-per- Correlation was performed for a recent phenomenon in athletics. squirt(VSq). PV for thirst and fullness correlations between ESQ scores and However, this has yet to be compared were also recorded. Repeated-measures physiological data. An a priori alpha to the traditional method of self ANOVA was used for Usg and level of 0.05 was set. Results: administration(SA). Objective: To perceptual measures to analyze groups Verification of heat acclimation was examine the influence fluid across time. All other variables were

Journal of Athletic Training S-21 analyzed by group with a paired t- humid environment. Design: A was not significantly different test.P<0.05 a priori Results: With no randomized, counterbalanced, repeated (p=0.307, partial eta squared=0.115, difference between conditions (p=0.49), measures investigation with two power=0.163) between Cooling participants arrived hydrated (Usg conditions (Control, Cooling) during (147.6±2.6bpm) and Control SA=1.016±.009; EFA=1.019±.008) and exercise and recovery. Setting: (150.1±3.5 bpm). During recovery, remained (Usg SA=1.019±.008; Outdoors on artificial turf in a hot, humid HR was significantly (p=0.005) lower EFA=1.020±.007) hydrated throughout. tropical climate in the sun (WBGTo = for Cooling (95.3±2.6bpm) than There was no statistically significant 27.0±0.8 °C, range = 25.8-28.1°C) and in Control (102.4± 4.1bpm). between SA (26±9mL) and EFA the shade (WBGTo = 25.4±0.9 °C, range = Conclusions: Phase change cooling (20±10mL). A significant interaction 24.3-26.8°C). Participants: Purposefully was effective in reducing skin

(F1,5=2.037,p=0.05) of condition and time sampled 16 participants from a pool of temperature but core body for thirst was demonstrated; EFA volunteers meeting inclusionary criteria temperature and cardiovascular strain indicated more thirst at FB 3 and 6 as and 10 were included in data analysis were not sufficiently attenuated during compared to SA. A significant (age=22.6±1.6y; height=176.0±6.9 cm; exercise. Superficial cooling may be interaction (F1,5=4.783,p=0.001) for mass=76.5±7.8 kg; body fat=15.6±5.4%). useful in decreasing skin temperature fullness indicated SA felt more full Interventions: Participants wore one during exercise and facilitating during the last three FB. Conclusions: of the following: shorts and t-shirt recovery after exercise in the heat; SA promoted more TVC likely due to (Control) or cooling vest (Cooling) however, it should not replace ice greater VSq. Both conditions remained during 5-min rest breaks every 20 min water immersion in the treatment of euhydrated, but EFA consumed less during 60 min of intense, exercise in the EHI. fluids and felt thirstier. Euhydration may heat. Participants were monitored every have been maintained because of 5 min during 30 min of recovery in the 11311FOEX regularly spaced FB and when regular shade. Exercise sessions consisted of Effect Of Water Bottle Fluid Delivery FBs are unavailable, EFA may result in typical American football training and On Ad Libitum Fluid Consumption more BML and hypohydration. conditioning exercises at an average And Hydration Status heart rate of 85-95% of heart rate Yeargin SW, Finn ME, Eberman LE, 11104FOEX maximum. Participants consumed cold McDermott BP, Gage MJ, Niemann Thermoregulatory And water ad libitum. Meals, snacks, and AJ: Department of Applied Medicine Cardiovascular Responses To pre-exercise hydration status were and Rehabilitation, Indiana State Intermittent, Superficial Cooling controlled. Main Outcome Measures: University, Terre Haute, IN, and During Exercise In The Heat Department of Health and Human We assessed gastrointestinal (Tgi) and Cleary MA, Toy MG, Lopez RM: Performance, University of Tennessee skin (Tsk) temperature, and heart rate Department of Kinesiology and (HR) during intermittent rest breaks at Chattanooga, Chattanooga, TN Rehabilitation Science, Human during exercise and recovery. A 2-way Performance Research Laboratory, repeated-measures (condition x time) Context: Athletic Trainers commonly University of Hawaii at Manoa, analysis of variance (ANOVA) was used provide fluids during team athletic Honolulu, HI, and Department of and data are reported as mean ± SD. events with water bottles (WB). When Orthopedics & Sports Medicine, a minimal number of WB exist, the team Results: During rest breaks, Tgi was University of South Florida, Tampa, significantly (p=0.046) decreased in must share and avoid mouth-to-bottle FL Cooling (38.2±0.2°C) compared to contact, whereas individual bottles Control (38.5±0.1°C). The difference in eliminate this issue. Objective: To ∆ determine if fluid delivery, by allowing Context: Decreasing core body Tgi ( Tgi) between pre- and post- temperature during exercise in a hot, cooling breaks was significantly less mouth-to-bottle contact or not, humid environment may improve (p=0.033) in Cooling (-0.1±0.1°C) than influences fluid consumption and exercise tolerance, facilitate Control (-0.4±0.2°C). During recovery, hydration status. Design: Randomized crossover design. Setting: Outdoor acclimatization, and prevent exertional Tgi was not significantly different heat illness (EHI) from developing (p=0.450, partial eta squared = .028, field study in warm conditions during intense summer training. In power= .074) between Cooling (22.2±3.5°C). Patients or Other order to effectively cool athletes during (37.8±0.1°C) and Control (37.8±0.1°C). Participants: Nineteen physically fit (>4x/wk) individuals (14M, 5F, exercise, the cooling method must be During rest breaks, Tsk was significantly practical and easily worn during (p<0.001) decreased in Cooling independent variable was fluid delivery training or competition. Objective: (31.8±0.4°C) compared to Control with two levels; drinking with mouth- to-bottle contact (MOn) or drinking Evaluate the effect of intermittent, (34.4±0.5°C). During recovery, Tsk was superficial “phase change cooling” on significantly (p=0.001) lower in Cooling with the mouth 1-2in away from the WB thermoregulatory and cardiovascular (32.2±0.5°C) compared to Control top (MOff). Participants arrived at a responses during exercise in a hot- (32.8±0.4°C). During rest breaks, HR local park, weighed in wearing only t-

S-22 Volume 46 • Number 3 (Supplement) May 2011 shirt and/or shorts, and provided a with good hydration in a less amount urine sample. They warmed-up for of time during an event. MOff also 10min and then exercised for 75min. maintained euhydration but needed Each station involved aerobic and more TSq and drank less TVC. When anaerobic exercise such as hill jogging, possible, athletic trainers should ladder drills, and jumping jacks with employ personal WB for athletes and intermittent rest; each lasting 15min. provide regularly spaced FB to After the warm up, a 2min fluid encourage good hydration behaviors. break(FB) was given, and after every station, a 5min FB was given. Participants drank ad libitum, had their own 1L squeeze pop-top WB, and were provided a filled WB at each FB. All dependent variables were measured at each FB. After the last FB, participants weighed and provided a urine sample again. The order of conditions and the order of exercise stations were randomly assigned. Main Outcome Measures: Hydration status via urine specific gravity(Usg) and body mass loss was recorded. Fluid variables measured were total volume consumed(TVC), total number of squirts(TSq), and volume per squirt(VSq). Perceptual variables for thirst and fullness were also recorded. Repeated-measures ANOVA was used for Usg and perceptual measures to analyze groups across time. All other variables were analyzed by group with a paired t-test. P<0.05 a priori. Results: Participants arrived (Usg 1.017±0.009) and remained (Usg1.019±0.008) hydrated, with no difference between conditions (p=0.49). MOff lost (0.989±0.454kg) significantly more (p=0.05) body mass than MOn (0.778±0.567kg). MOn drank significantly (p= 0.05) more TVC (1.060±0.526L) than MOff (0.867± 0.312L). MOn and MOff significantly (p=0.009) differed in TSq; 30±14 and 35±16 respectively. MOn drank significantly (p=0.035) more VSq (37±24mL) than MOff (26±9mL). There was no interaction between condition and time for thirst

(F1,5=2.117,p=0.207). An interaction

(F1,5=3.013,p=0.014) for fullness demonstrated MOn felt more full during the second FB than MOff. Conclusions: MOn condition increased ad libitum TVC with fewer TSq needed and maintained euhydration. This may help athletes

Journal of Athletic Training S-23 Free Communications, Oral Presentations: Shoulder Girdle Adaptations In Overhead Athletes Wednesday, June 22, 2011, 8:00AM-8:45AM, 9:00AM-9:45AM, Room 217; Moderator: TBD 11324DOBI 11020FOMU Changes In Glenohumeral Rotational Athletes reported 13.4±3.1 years Dynamic Acromiohumeral Interval Range Of Motion In Collegiate experience and exhibited 43.3±13.0º Changes In Trained And Untrained Baseball Players: Predictive Factors of IR and 96.2±14.7º of ER during pre- Females With Differences In Dwelly PM, Tripp BL, Tripp PM, fall measurements. Athletes gained External Rotation Strength Eberman LE: University of Arkansas, 11.3±19.2º of total arc over the course Thompson MD, Landin D, Page P: Fayetteville, AR; University of of the season. Using the full Louisiana State University, Baton Florida, Gainesville, FL; Indiana State regression model: change in total arc Rouge, LA University, Terre Haute, IN = position + pre-season IR + pre- season ER + experience + division, Context: Previous research has Context: Understanding which investigators accounted for 78% of the demonstrated narrowing of the factors predispose overhead-throwers variance in change in total arc acromiohumeral interval (AHI) during 2 to changes in glenohumeral range of (F5,28=16.01, p<0.001, R =0.78). arm elevation. Weakness and fatigue of motion (ROM) may help clinicians Statistically, position (t28=-0.00, the external rotators may result in identify those susceptible to the p=0.99), experience (t28=1.63, further narrowing. Previous static AHI pathologies associated with p=0.12), and pre-fall IR (t=0.53, comparisons between trained and glenohumeral internal rotation deficit. p=0.60) were not significant untrained individuals are contradictory Objective: To observe overhead- contributors to changes in total arc and and no research has directly compared throwers’ range of internal and external were dropped from the model. The dynamic AHI differences between these rotation (IR, ER) over the course of refined regression model: total arc groups. Objective: To determine if an athletic season and to identify change = division + pre-fall ER dynamic AHI differences exist between predictors of ROM changes. Design: accounted for 74% of the variance in trained females with strong external Observational repeated-measures total arc changes (F2,28=37.6, rotators (ER) and untrained females with design. Setting: Collegiate Athletic p<0.001, R2=0.74). Division was a relatively weaker ER during loaded and Training Clinics. Participants: significant contributor to changes in unloaded scaption. Design: De- Twenty-nine healthy NCAA Division- total arc (t28=8.67, p<0.001) as was scriptive cohort study design. I (n=12) or Division-II (n=17) baseball pre-season ER (t28=3.89, p=0.002). Setting: Athletic training facility. athletes (13 pitchers, 16 fielders, Division-I athletes gained 7º IR and Participants: Fifteen, female, 19.9±1.5y, 179±14cm, 87.7±11.1kg). 21º ER and Division-II athletes lost 3º collegiate softball and volleyball Interventions: Investigators (PD and IR and gained 3º ER. Pre-season ER players (age = 19.5±0.6 years, mass = PT) measured ROM (inter-rater was 104º for Division-I athletes and 69.9±10.1 kg, height = 1.70±.06 m, reliability ICC range=0.79-0.96) for 90º for Division-II athletes. Con- ER strength = 13.4±1.6 kg) with no Division-I and-II athletes in their clusions: Division-I and Division-II history of surgery or current injury respective athletic training clinics athletes displayed similar pre-season involving their dominant arm. Fifteen, prior to the fall and after the spring total arc (137 and 140º, respectively). collegiate females with no history of baseball season. Main Outcome Division-I players increased their total regular overhead sport participation Measures: We measured bilateral arc of motion over the season, while (age =20.5±1.8 years, mass = passive glenohumeral IR and ER using Division-II players did not. Monitoring 63.6±13.3 kg, and height = 1.65±.09 a mechanical inclinometer (Sears, these changes throughout the season m, ER strength = 7.9±1.7 kg). Roebuck & Co, Chicago IL). should identify those athletes Interventions: Participants per- Maximum ROM was achieved at a firm developing the conditions associated formed three trials each of an capsular end-feel or just prior to with injury including any loss of IR that unloaded and loaded scaption exercise scapular motion. Using SAS 9.2 (SAS, is not met with an equal gain of ER. from 0°-90° while seated. Amount of Cary, NC), investigators conducted Clinicians should consider the effect load during the weighted scaption multiple regression analyses using pre-season ER and level of exercise was normalized based on independent variables: pre-season IR competition may have on the total arc anthropometric data for each and ER, years of baseball experience, when monitoring ROM throughout the participant. True anterior-posterior NCAA division, position (pitcher, non- season. fluoroscopic images of the gleno- pitcher) with the dependent variable of humeral joint were captured in real change in total arc (IR+ER) of motion time video during the last two trials of between pre-fall and post-spring each condition. Video was captured at measures (p<0.05 a priori). Results: 30 frames per second with a

S-24 Volume 46 • Number 3 (Supplement) May 2011 11195DOBI 1000x1000 pixel resolution, Association Between A History Of kneeling rotation test was performed to transferred via a digital video Upper Extremity Injury And measure the trunk rotation ROM recording device to a computer and Maximum Upper Torso-Pelvis towards the side of the throwing arm to analyzed using OsiriX software. A Separation Angle During Throwing calculate the normalized max-separation repeated measures ANOVA was used In Collegiate Softball Position (=max-separation/trunk rotation to detect dynamic AHI differences Players flexibility*100), which represents how based on load (loaded, unloaded), Oyama S, Aragon VJ, Oliaro SM, much of the available ROM a person position (0°, 30°, 60°, 90°), and group Padua DA, Myers JB: University of uses when throwing. Main Outcome (athlete, untrained). Post hoc t tests North Carolina at Chapel Hill, Chapel Measures: Mean of the variables from were performed as necessary. Main Hill, NC, and Duke University, the three highest self-rated trials were Outcome Measures: ER strength was Durham, NC used for analyses. Independent samples calculated as the average of three t-tests were used to compare the max- seated, maximal voluntary isometric Context: Throwing-related upper separation angle and the normalized contractions against a handheld extremity injuries are common among max-separation between groups with and dynamometer stabilized by the wall. competitive softball players. During without an injury history. Logistic AHI was measured as the smallest throwing, coiling/re-coiling of the trunk regression was used to calculate the vertical distance between the inferior is necessary to store and transfer odds ratio of having an injury history acromion and superior humeral head. energy to the upper extremity. between the participants categorized AHI values were recorded at 4 Therefore, excessive or insufficient (using tertiles) to demonstrate high and humeral-thoracic elevation positions coiling (separation between the upper low normalized max-separation. (0°, 30°, 60°, 90°). One investigator torso and the pelvis) may place the Results: While the max-separation was (MT) performed all measurements. anterior trunk and shoulder not significantly different between Results: Athletes had significantly musculature in suboptimal lengths groups (mean difference=3.4±7.6%, greater ER strength (P<.001) and a during the re-coil, and thereby lead to t1,63= 1.65, p=0.10), normalized max- significantly larger overall AHI than development of upper extremity injuries. separation was significantly greater in the the untrained females (P=.003). On However, whether the absolute amount group with an injury history compared average athletes had an AHI that was of maximum upper torso-pelvis to the group without (mean 2.05+.49 mm wider between 0°-30° separation (max-separation) and the difference=12.7±17.5%, t1,63=2.66, during unloaded scaption and 1.73+.64 max-separation relative to the available p=0.01). Participants with high mm wider between 0°-60° during trunk rotation range of motion (ROM) (>68.1%) normalized max-separation loaded scaption. Regardless of group, (normalized max-separation) are linked were 5.5 times (CI:1.3-23.7) more likely loaded scaption (4.7+1.6 mm) to the upper extremity injuries has not to have an injury history compared to resulted in significantly greater been investigated. Objective: To those with low (<50.6%) normalized (P<.001) AHI narrowing compared to investigate an association between the max-separation (X2=6.6, p=0.04). unloaded scaption (5.5+1.6 mm). throwing-related upper extremity injury Conclusions: The results indicate that Conclusions: Healthy female athletes history and the maximum upper torso- individuals who use a greater percentage with strong ER had a significantly pelvis separation angle during throwing of their available ROM are at greater risk wider AHI between 0°-60°. Regardless in softball position players. Design: for injury. Coiling/re-coiling of the trunk of differences in strength, both groups Cross-sectional design. Setting: is necessary for effective energy experienced an 11%-14% narrowing University softball fields. Patients or transfer to the upper extremity during of the AHI with the application of an Other Participants: Sixty-five throwing. Therefore, improvement of external load during scaption. Future collegiate softball position players (age the available trunk rotation ROM through research should attempt to determine =19.5±1.2years, height =165.4±7.0cm, combination of stretching and if external rotation strengthening mass =69.1kg). Interventions: Each neuromuscular training may allow protocols could improve dynamic AHI. participant completed a questionnaire to greater max-separation to occur within provide a recent (past 2 years) upper the optimal range of the trunk rotation extremity injury history, and performed ROM, and thereby help prevent the five maximum-effort throws development of the upper extremity (distance=25.9m), during which the injures. mechanics were captured using two video cameras. For each trial, the video footages were manually digitized, synchronized, and processed using a direct linear transformation to calculate the max-separation. Additionally, a half-

Journal of Athletic Training S-25 11343FOMU 11202FOMU Humeral Retrotorsion Is Associated ing sport were interpreted. Results: Predictors Of Dominant Limb With Decreased Shoulder Internal There was a significant main effect for Humeral Retrotorsion In High Rotation And Horizontal Adduction sport indicating that pitcher’s ER ROM School Baseball Players Range Of Motion In The Professional (Pitchers =130°± 9.5°;QB= 117.3± Myers JB, Oyama S, Marshall SW: Pitchers But Not Elite Quarterbacks 11°) was greater compared to QBs. Department of Exercise and Sport Thigpen CA, Shanley E, Kissenberth There were no significant interactions Science, Department of Epidemiology, MJ, Wyland DJ, Noonan TJ, Hawkins effects indicating that sport did not University of North Carolina at RJ, Schlegel TF: Proaxis Therapy, influence side to side differences in Chapel Hill, Chapel Hill, NC Greenville, SC; Steadman Hawkins HT, IR, or HA(p>.05). There were Clinic of the Carolinas, Greenville, SC, significant correlations between HT Context: Baseball players’ dominant and Steadman Hawkins Clinic – and IR(r=-.67; p<0.01), HA(r=-.50; limbs demonstrate greater humeral Denver, Denver, CO p<0.01), ER(r=-.27; p=0.01) for the retrotorsion compared to their non- T shoulder of pitchers. There were no dominant limb and the limbs of the non- Context: Humeral torsion(HT) is significant correlations between T arm overhead athletes. This increased thought to contribute to alterations in HT and IR(r=-0.33;p=0.11), HA(r= dominant limb humeral retrotorsion shoulder external(ER), internal(IR), and -.34;p=0.09), ER(r=-.24;p=0.17) (DLHR) in baseball players is believed horizontal adduction(HA) range of showing that HT was not associated to be a result of a combination of a motion(ROM) in the throwing(T) with ER, IR, or HA in QBs. Regression congenital contribution and the shoulder. Biomechanical differences are analyses revealed that both IR(R2=.45, retrotorsion acquired due to the documented between the pitcher’s and P<.05) and HA(R2=.25, P<.05) were torsional stress applied to the humerus quarterback’s(QB) throwing motion but significant predictors of HT in pitchers from throwing. It is considered that the it is unknown if these influence their but not QBs. The final regression greater the magnitude and cumulative respective osseous adaptations or model indicated IR and HA together frequency of the stress applied to the shoulder ROM. Objective: The purpose predicted HT(R2=.52,P<.05) inde- humerus, greater the retrotorsion of this study was to compare HT and pendent of gains in ER(R2 =.12,P=.14) acquired. Therefore, the amount of shoulder ROM between a group of for pitchers. Conclusions: Our results DLHT may be predicted from the professional pitchers and QBs show the T shoulder of pitchers congenital contribution, physical participating at the 2010 NFL Combine. displays greater overall ER but similar characteristics, and participation Design: Cross Sectional Setting: Field alterations in HT, IR and HA to QBs. factors that may affect the torsional Laboratory Patients: 50 (36 right; 14 Interestingly, HT influences clinical stress applied to the bone. Objective: left) professional pitchers (mean measures of shoulder IR and HA ROM To determine whether the congenital age=23;height=190cm;weight=88kg) in pitchers independent of gains in ER. contribution, physical characteristics, and 17(15 right;2 left) elite QBs(mean However, in this small sample HT did and participation factors are predictive age=22;height=189cm;weight=94kg) not influence clinical measures of of the amount of humeral retrotorsion were currently asymptomatic and shoulder ROM or account for the in the dominant limb of high school participating without restriction in observed differences in shoulder ROM baseball players. Design: Cross spring training or the NFL Combine in elite QBs. Therefore, changes in QB sectional design. Setting: High school respectively. Interventions: A digital ROM are likely the result of soft tissue sports medicine and/or baseball inclinometer was used to measure adaptations. Clinicians should carefully facilities. Participants: 312 varsity high bilateral ER, IR, HA ROM and HT in interpret ROM measures in QBs and school baseball players (age= supine with the scapula stabilized at 90° pitchers and in particular IR and HA 16.5±1.0years, mass= 77.5±12.6kg, of abduction. HT was measured via an ROM of the pitching shoulder. Future height=180.1±6.8cm). Interventions: indirect ultrasonographic technique. studies should examine a larger sample Subject demographic, height, and mass All measures displayed acceptable to confirm these results. were obtained. Bilateral humeral reliability (ICC(2,1 )=0.88-0.92) and 2 trials retrotorsion was measured using were averaged for analysis. Main ultrasonography and a digital Outcome Measures: A mixed-model inclinometer (ICC=.96-.98, SEM=2.0- ANOVA(sideXsport) was used to 2.3°). Shoulder rotation strength was compare the T and NT shoulder for ER, measured with a handheld IR, HA and HT between sports. Pearson dynamometer (ICC=.90-.92, SEM=.73- correlation coefficients and a stepwise .74%). Additionally, participants linear regression were then evaluated completed a survey regarding their to assess to what degree ER, IR, and baseball participation history. Main HA was influenced by HT for each Outcome Measures: Univariate linear sport(α = 0.05). Only effects involv- regressions were used to determine if

S-26 Volume 46 • Number 3 (Supplement) May 2011 11328DONE the congenital, physical char- Humeral Retroversion And Its measured with a Saunders Digital acteristics, and baseball participation Association With Posterior Capsule Inclinometer (The Saunders Group Inc. factors are predictive of DLHR in high Thickness In Collegiate Baseball Chaska, MN). A paired sampled t-test school baseball players. The amount of Players was performed to compare humeral non-dominant limb humeral Thomas SJ, Swanik CB, Kaminski TW, retroversion bilaterally. Separate retrotorsion (NLHR) is representative Swanik KA, Higginson JS, Nazarian L, pearson correlations were performed for of the congenital contribution Bartolozzi AR: University of Delaware, humeral retroversion, IR, ER, and PCT. affecting DLHT. The physical Newark, DE; Department of Main Outcome Measures: Humeral characteristic predictor variables Orthopaedic Surgery, University of retroversion was measured supine with included age, height, mass, humeral Pennsylvania, Philadelphia, PA; the arm abducted to 90° and elbow internal rotation(IR) and external Department of Health, Nutrition, and flexed to 90°. GH IR and ER were rotation(ER) strength normalized to Exercise Science, Human Performance measured supine with the scapula body mass, and ER:IR strength Laboratory, University of Delaware, stabilized. PCT was measured seated ratio(ER:IR). Baseball participation Newark, DE; Department of Nursing with the arm at the side in neutral predictor variables were years of and Heath Sciences, Neumann rotation. Results: The dominant arm baseball participation(YBP), seasons University, Aston, PA; Department of had significantly more retroversion played in the past 3 years(S3), years Mechanical Engineering, Spencer (15.6°, p=.0001) than the non-dominant of pitching experience(YPE), and Laboratory, University of Delaware, arm. A significant negative relationship seasons pitched in the past three Newark, DE; Department of was found between humeral years(SP3). Results: NLHR Radiology, Thomas Jefferson retroversion and GH IR (-0.472, p=0.001) significantly predicted DLHR University Hospital, Philadelphia, PA; and a significant positive relationship (n=312,r2=.347, p<.0001). Age(n Department of Orthopedic Surgery, between humeral retroversion and GH =311,r2=.004, p=.27), height(n=308, Pennsylvania Hospital, Philadelphia, ER (0.295, p=0.042). A significant r2=.003, p=.37), mass(n=312,r2=.009, PA positive correlation was also found p=.11), IR strength (n=292,r2=.004, between humeral retroversion and PCT 2 p=.25), ER strength (n=291,r =.005, Context: Baseball players commonly (0.427, p=0.003). Conclusions: This was 2 p=.23), and ER:IR (n=291,r =.002, present with decreases in internal the first study to identify a relationship p=.50) were not predictors. YPE was rotation (IR) and concurrent increases between humeral retroversion and PCT a statistically significant predictor of in external rotation (ER) motion. Several in addition to GH IR & ER. The 2 DLHR(n=250,r =.031, p=.01), yet glenohumeral adaptations have been identification of these multiple only explained 3.1% of the variance in theorized to cause these changes in correlations appears to suggest that 2 DLHT. YBP(n=311,r =.000, p=.85), motion including humeral retroversion the loss of IR caused from humeral 2 S3(n=312,r =.010, p=.07), YPE(n and posterior capsule thickness (PCT). retroversion may be placing additional 2 =250,r =.031, p=.01), and SP3(n= However, limited data exists examining stress on the posterior capsule during 2 242,r =.000, p=.03) were not the interrelationship between humeral the deceleration phase of the throw significant predictors. Conclusions: retroverson and posterior capsule thereby causing a fibroblastic healing The results indicate that 35% of the thickness. Objective: To measure response. Humeral retroversion has variance in DLHR can be explained by humeral retroversion, glenohumeral previously been identified as a positive NLHR, which represents the (GH) IR and ER rotation, and posterior adaptation due to the increase in congenital contributor influencing the capsule thickness. Design: A single external rotation without anterior DLHR. None of the physical group post test only. Setting: This capsule attenuation. However, the characteristics or the participation study was performed in a controlled current study suggests that humeral variables individually explained more laboratory setting. Patients or Other retroversion may be contributing to the than 3% of the variance in DLHT. Participants: Twenty four division one negative adaptation of posterior Factors not accounted for in the collegiate baseball players (age = 19.6± capsule thickness. Additional research current study that need to be examined 1.3 years, mass = 89.2± 5.8 kg, height = should prospectively evaluate baseball in future studies include throwing 186.3± 4.9 cm) with no current injury or players to identify the sequential mechanics, skeletal maturity, and more surgery in the past eight months. development of these adaptations and detailed participation factors Interventions: Independent variables how they contribute to injury. (exposure, competitive level, and were arm (dominant and non-dominant). participation/pitching volume Humeral retroversion and posterior variables). Further research using capsule thickness was measured with prospective designs are needed given an ultrasound system (Sonosite Titan, the limitations of cross-sectional Sonosite Inc., Bothell, WA) and GH studies. internal and external rotation (IR) was

Journal of Athletic Training S-27 EBF: Knee Wednesday, June 22, 2011, 10:00AM-11:00AM, Room 217

Free Communications, Oral Presentations: Knee Injury Prevention Strategies Wednesday, June 22, 2011, 11:15AM-12:45PM, Room 217; Moderator: Grace Golden, PhD, ATC 11F10FOBI Variability of Hip and Knee Joint also participated. All participants ran study to determine whether PFPS Biomechanics During Running for a minimum of 20km per week. patients exhibit MV changes following Patients With Patellofemoral Pain Interventions: Baseline measures of rehabilitation. Funded by the NATA Syndrome three-dimensional (3D) knee and hip Foundation. Ferber R, Bolgla L, Earl-Boehm J, kinematics were recorded using a Vicon Emery CA, Hamstra-Wright KL: 8-camera system (200 Hz) for 25 11145FOBI Faculty of Kinesiology, University consecutive footfalls for the PFPS A Comparison Of Lower Extremity of Calgary, Calgary, AB, Canada; involved limb and matched control limb Muscle Strength Between Individuals Department of Physical Therapy, while running at 2.55 m/s on a treadmill. With Patellofemoral Pain Syndrome Medical College of Georgia, Augusta, As part of a larger RCT protocol, PFPS And Individuals At Risk For Future GA; Department of Human Movement and control subjects were randomized Development Of Patellofemoral Pain Sciences, University of Wisconsin- into a 6-week hip- or knee-focused Syndrome Milwaukee, Milwaukee, WI; rehabilitation protocol. Both groups Boling MC, Padua DA, Marshall SW, Department of Kinesiology & were tested at baseline and at 6-weeks. Beutler AI: University of North Nutrition, University of Illinois- Main Outcome Measures: 3D frontal Florida, Jacksonville, FL; University Chicago, Chicago, IL and transverse plane knee and hip joint of North Carolina, Chapel Hill, NC; angles (degrees) were derived, relative Uniformed Services University of the Context: Most research studies to the lab coordinate system. MV (mm2) Health Sciences, Bethesda, MD suggest that reduced movement was defined as the total area of joint variability (MV; the ability to produce motion, in both planes, calculated using Context: Previous research indicates a consistent and controlled movement custom-written a Matlab program for weakness of the lower extremity pattern) may be associated with running the 25 footfalls. Between- and within- musculature in individuals with injuries, such as patellofemoral pain group differences were determined patellofemoral pain syndrome (PFPS); syndrome (PFPS). To date, researchers using 2 (group) x 2 (time) repeated however, it is not known if this have not determined if MV changes may measures ANOVAs and a priori post- weakness is present prior to or occur following rehabilitation. hoc testing (P<0.05). Results: At following the development of PFPS. Objective: To determine the effect of a baseline, PFPS exhibited significantly Objective: To compare baseline 6-week rehabilitation protocol on knee greater (P=0.02) involved knee MV measures of lower extremity isometric and hip joint MV for patients with (254.91±96.15mm2) compared to strength between individuals who PFPS. At baseline, we hypothesized that controls (190.38±74.98mm2) and currently have PFPS and individuals PFPS patients would exhibit reduced significantly greater (P=0.05) involved who later develop PFPS. Design: involved limb MV compared to controls hip MV (357.32±94.84mm2) compared to Prospective cohort. Setting: US and that MV would increase after controls (309.71±92.54mm2). After 6- Military Academy. Patients or Other rehabilitation compared to baseline weeks, PFPS showed significantly Participants: The cohort consisted of values. We expected no change for the reduced knee (P=0.03; 214.44± 1,525 cadets (606 females, 919 males; control group knee or hip MV following 83.26mm2) and hip (P=0.04; height=172.46±8.87cm, mass= 71.31 the protocol. Design: Cohort 305.22±83.27mm2) MV compared to ±11.54kg) who were freshmen at the intervention, repeated measures design. baseline. Controls showed no change time of enrollment in the current Setting: Clinical research laboratory. in MV after 6 weeks (knee: investigation. Inter-ventions: Each Patients or Other Participants: Twenty 195.38±57.66mm2, P=0.73; hip: participant underwent a baseline PFPS patients, assessed by an AT and 298.73±97.45mm2, P=0.55). Con- assessment of isometric strength of meeting inclusion criteria based on clusions: Contrary to the hypotheses, the hip and thigh musculature. Boling et al. (2006), volunteered to baseline MV was higher for the PFPS Participants performed two trials for participate (5 males, 15 females: age= involved knee and hip joints compared each strength test and all strength data 32.2±10.1 years; mass= 66.3±9.7kg; to controls. Also contrary to the were normalized to body mass. A height=155.3±8.8cm) Twenty age, limb, hypotheses, regardless of intervention baseline questionnaire was completed and mileage-matched controls (5 males, assignment, PFPS demonstrated at the time of strength testing to 15 females: age= 30.8±9.8 years; mass= reduced knee and hip MV following a determine if individuals had a history 70.6±11.3kg; height= 153.3±6.2cm) 6-week intervention. This is the first of PFPS that currently limited their

S-28 Volume 46 • Number 3 (Supplement) May 2011 11071FOBI ability to participate in physical Neuromuscular Factors obtained for the knee extensors, knee activity. Individuals reporting yes to Influencing External Knee flexors, hip abductors, hip extensors, this question were included in the Valgus Moment In Males And hip internal rotators, and hip external “injured” group. Following baseline Females rotators. Multivariable linear data collection, participants who did Padua DA, Boling MC, Goerger regression (backward elimination) was not report a history of PFPS were BM, Beutler AI, Marshall SW: performed for the criterion variable of followed prospectively for a maximum Sports Medicine Research external KVM. The predictor variables of 4 years to determine those diagnosed Laboratory, University of North included hip and knee joint angles with PFPS. Individuals who developed Carolina, Chapel Hill, NC; (deg) at IC, PK and DSP; peak internal PFPS during the 4-year follow up University of North Florida, hip and knee joint moments period, which was determined by a Jacksonville, FL; Uniformed (normalized to body weight x height); manual review of medical records by the Services University of the Health peak VGRF (normalized to body principal investigator, were included in Sciences, Bethesda, MD weight); and strength values for all the “at risk” group. Main Outcome muscles (normalized to body weight). Measures: Normalized mean and peak Context: Preliminary evidence Analyses were performed using all isometric strength of the knee flexors, indicates external knee valgus moment participants and stratified by sex. knee extensors, hip extensors, hip (KVM) is a risk factor for ACL injury. Results: The most parsimonious abductors, hip internal rotators, and hip External KVM is also greater in regression model using all participants external rotators were averaged across females, who are at increased risk of included internal hip adduction the two trials and included in the data ACL injury, compared to their male moment (.12±.06), internal hip analysis. Independent t-tests were counterparts. Thus, it is important to internal rotation moment (.06±.03), performed to compare isometric understand mechanisms associated VGRF (3.02±.93), and knee valgus strength between the “injured” and “at with increased external KVM. DSP (3.80±4.45) (R2 adjusted=.559, ≤ risk” groups ( 0.05). Results: Sixty Modifiable factors associated with P<.001). The same predictor cadets (31 females, 29 males) reported external KVM are likely multifactorial variables were included in the most a history of PFPS that currently limited and may be sex-specific. Objective: parsimonious regression models for their ability to participate in physical To determine the association between males (R2 adjusted=.583, P<.001) and activity (“injured” group). Sixty-three external KVM and lower extremity females (R2 adjusted =.523, P<.001), cadets (34 females, 29 males) were biomechanics and strength in males separately. Conclusions: There were diagnosed with PFPS during the follow- and females. Design: Cross-sectional. no sex differences in factors up period (“at risk” group). The “at Setting: Research laboratory. predicting external KVM. Greater risk” group had significantly weaker Patients or Other Participants: external KVM was associated with average (0.248±0.057%BW vs. 0.273± 2,662 healthy, physically active increased internal hip adduction and 0.075%BW; P=0.03) and peak (0.308 participants (males=1,640; females internal rotation moments, VGRF, and ±0.072%BW vs. 0.342±0.097%BW; =1032; age=18.6±0.6 yrs, ht=173.5 knee valgus DSP. Internal hip P=0.04) isometric strength of the hip ±9.2 cm, wt=71.9±12.9 kg). Inter- adduction and internal rotation extensors. While differences in the ventions: Three-dimensional knee and moments were the strongest other lower extremity muscle strength hip joint kinematics and kinetics were predictors of external KVM for both measures were not statistically quantified using an electromagnetic males and females. Muscle strength significant between groups (P>0.05), motion analysis system and force plate was not included in the regression the “at risk” group displayed lower while participants performed a jump- models and does not appear to be a strength values for all muscle groups landing task (3-trials). Strength was major factor associated with external compared to the “injured” group. measured using a hand-held KVM. These findings provide insight Conclusions: While lower extremity dynamometer during a 5-second into mechanisms associated with strength training is common in treating maximal voluntary isometric external KVM, which may have those with PFPS, strengthening of the contraction (2-trials). Main Outcome implications on understanding ACL lower extremity muscle groups Measures: Joint angles at initial injury risk factors and designing injury (especially the hip extensors) is an contact (IC), peak (PK), and prevention programs. important component that should be displacement (DSP) were identified. incorporated in injury prevention Peak joint moments and vertical programs aimed at reducing the risk of ground reaction force (VGRF) were future development of PFPS. also determined. Kinematic and kinetic variables were measured during the first 50% of the stance phase. Separate strength values were

Journal of Athletic Training S-29 11083DOPR non-effused knees but investigators during their competitive seasons. The Effects Of Compliance With should evaluate correlations between Likewise, 205 high school female Neuromuscular Training On normalized and raw concentrations to volleyball, soccer and basketball Anterior Cruciate Ligament Injury ensure the data are representative of athletes were evaluated for landing Risk Reduction In Young Female raw concentrations. This technique biomechanics prior to their com- Athletes: A Meta-Analysis may be valuable for examining post- petitive season and monitored for ACL Sugimoto D, Myer GD, Bush HM, traumatic osteoarthritis onset and injury during their competitive Klugman MF, Medina McKeon JM, progression. seasons. Interventions: Logistic Hewett TE: Cincinnati Children’s regression analyses determined Hospital Medical Center, Cincinnati, 11138FOBI threshold knee abduction moment cut- OH; University of Kentucky, Quantification of Knee Load scores that provided the maximal Lexington, KY; Ohio State University, Associated with Increased Risk sensitivity and specificity for Columbus, OH for Specific Knee Injury Incidence prediction of PFP and ACL injury risk. Myer GD, Ford KR, Hewett TE: Incidence rates were expressed per Context: Although neuromuscular Cincinnati Children’s Hospital 100 athlete competitive seasons. Main training (NMT) programs are often Medical Center, Cincinnati, OH; Outcome Measure: Positive PFP and prescribed to reduce the incidence rates University of Cincinnati, Cincinnati, ACL injury status. Results: The of noncontact anterior cruciate ligament OH; Ohio State University Sports cumulative incidence rate for new PFP injuries (ACL) in young female athletes, Medicine, Columbus, OH incidence was increased 2.2 (95% CI the influence of compliance to these 1.11 to 4.34) relative to ACL injury programs on ACL injury outcome Context: Patellofemoral dysfunction when normalized per 100 athlete remains unclear. Objective: To and the resultant pain symptoms (PFP) seasons (PFP 9.7 vs ACL 4.4). systematically review and synthesize affects up to 30% of people aged 13- Regression analysis indicated that PFP previously published studies to 19 years. PFP symptoms lead three- risk increased in athletes who determine the effect of NMT quarters of affected patients to limit demonstrated >15.4 Nm of knee compliance on reduction of ACL injury recreational activities or to cease abduction, while ACL injury risk incidence. Data Sources: A physical activity altogether. Injuries to increased with peak landing knee computerized search was performed the Anterior Cruciate Ligament (ACL) abduction torque >25.3 Nm. using PubMed, SPORT Discus, result in the greatest time lost from Conclusions: Females who demon- CINAHL, and Medline(1995-2010) in sport and recreational participation by strate >15 Nm of knee abduction February, 2010. Key words were young athletes. Interestingly, there is during landing may be at increased risk “anterior cruciate ligament prevention”, a similar sex disparity in both for the development of PFP and those “ACL prevention”, “knee prevention”, conditions, as adolescent females and who demonstrate >25 Nm of knee “neuromuscular training”, “neuro- young women are affected with PFP abduction during landing may be at muscular intervention”, and “pro- and ACL injury 2-10 times more often increased risk for both PFP and ACL spective knee prevention”. Study than their male counterparts. Altered injury. The increased incidence of PFP Selection: Criteria for inclusion required or reduced motor control during relative to ACL injury is likely that 1) actual number of ACL injury physical activities result in excessive associated with the reduced threshold incidents were reported, 2) a NMT knee abduction joint load in females. of knee abduction associated with program was utilized, 3) studies This neuromuscular dysfunction increased risk of PFP. Focused pre- included females, 4) studies were appears to increase risk of acute ACL season exercise intervention may be prospective, controlled trials, and 5) injury and chronic PFP in females. warranted for females who land with compliance to programs were Objectives: The purpose of this study greater than 15 Nm of knee abduction, documented. Data Extraction: Study was to compare incidence rates and while those females who land with >25 quality was assessed using the PEDro threshold knee abduction load during Nm of knee abduction may benefit scale. Extracted data included: the landing associated with increased risk from increased treatment dosage number of ACL injuries (#ACL), total of PFP and ACL injury. Design: gained from both pre-season and in- numbers of subjects in each group Prospective cohort study. Setting: season neuromuscular training (#Total Subjects), observation time Controlled laboratory. Patients or protocols aimed to reduce knee periods (Months), number of subjects Other Participants: Middle and high abduction and PFP/ACL injury who completed each session, number school female athletes (n=145) were incidence. of sessions completed by an entire evaluated by a physician for PFP and team, and number of total sessions. for landing biomechanics prior to their ACL injury incidence rates (ACL-IR) basketball season and monitored by were calculated [#ACL / #Total Subjects certified athletic trainers for PFP x Months]. The variable Athlete

S-30 Volume 46 • Number 3 (Supplement) May 2011 11326SOIN Attendance Rate (Attendance) was The Effects Of A Comprehensive followed by dynamic stretching of the calculated as the reported number of Soccer Specific Warm Up Program lower extremity. Main Outcome subjects who completed each session On Lower Extremity Injury Rates Measures: The number of lower converted into a percentage of the total Grooms D, Palmer T, Grindstaff TL: extremity injuries over each season was number of subjects in the intervention College of Mount Saint Joseph, the outcome variable of interest and group. The variable Session Completion Cincinnati, OH; Northern Kentucky was defied as an injury which required Rate (Completion) was calculated as the University, Highland Heights, KY; at least one day time loss from activity reported number of sessions completed Creighton University, Omaha, NE (practice or game). Athlete exposures by an entire team converted into a were defined as participating in one percentage of the total number of Context: Soccer is a popular sport, but practice or game situation. Injury rates training sessions in the intervention has a risk of lower extremity injury were calculated for each season to period. These data were used to including thigh muscle strains and determine the odds ratio (OR) and the calculate Overall Compliance Rate ligamentous injuries to the knee and relative risk reduction (RRR) between (Compliance) [Compliance = Attend- ankle. A number of injury prevention seasons. Results: There were 8.1 ance x Completion]. Compliance was programs have been developed, but injuries per 1000 exposures in the initially dichotomized into high or low many are not sport specific or are control group (2009 season) and 2.2 using the mean Compliance as the performed outside of practice settings. injuries per 1000 exposures in the cutoff. Compliance was further broken A soccer specific program known as intervention group (2010 season). In down to high (>66%), moderate (33- “the 11” was developed by an expert the intervention season (2010) the risk 66%), or low (<33%). Incident rate ratios group in association with FIFA of lower extremity injury was (IRR) were used to compare ACL-IRs (Federation Internationale de Football significantly reduced compared to the among the binominal and tertiary Association) Medical Assessment and control season. There were 13 lower Compliance categorizations. The quality Research Centre (F-MARC) to require extremity injuries during the control of evidence was assessed using the minimal equipment and implementation season and 4 during the intervention Centre of Evidence Based Medicine as part of regular soccer training. “The season (OR=.28, 95% CI=.09-.85; RRR= (CEBM)–Levels of Evidence. Data 11” program has shown the potential .99, 95% CI= .989-.999; P= .014). Synthesis: Six of 205 studies were to reduce injury risk in youth female Conclusions: This study demonstrated included. The average PEDro score was soccer players but has not been studied that “the 11” soccer specific exercise 5/10(range: 4 to7). Results are presented in an American male collegiate warm up program reduced the overall as IRR [95%Confidence Intervals]. The population. Previous studies utilizing risk of lower extremity injury compared IRR analysis with dichotomous “The 11” program have suffered from to the control season. An exercise compliance categorization demon- non-compliance issues, minimal exercise based soccer specific warm up maybe strated statistically lower ACL supervision and the lack of exercise more effective than a general dynamic incidence rates in high compliance progression. Objective: To assess the warm up for the prevention of soccer studies compared to the ACL incident effect of “the 11” program on incidence lower extremity injuries. rates in low compliance studies (IRR of lower extremity injuries in male 0.27:[0.07, 0.80]). The IRR analysis with collegiate soccer players. Design: tertiary break down indicated Retrospective cohort study. Setting: statistically lower ACL incidence rates Male soccer team: Division III NCAA. in high compliance studies compared Participants: Forty-one Division III to moderate and low compliance studies collegiate male soccer players (age= 20 (IRR 0.18:[0.02, 0.07]). The CEBM ±2.3 years, mass= 73.6±11 kg, height= recommendation reached evidence level 177.4 ±6 cm). Interventions: A 2a. Conclusions: Results of this meta- comprehensive warm-up program analysis demonstrated a potential dose- (“The 11”) with exercise progressions response relationship between NMT was used to improve strength, body compliance rates and ACL incidence awareness, and neuromuscular control rates. Attending and completing during static and dynamic movements. prescribed NMT sessions appears to The program was implemented into the be an important component for 2010 soccer season and included preventing ACL injuries in young exercise progressions and ATC female athletes. supervision at each session to ensure proper exercise technique. In the 2009 season (control) the team completed a warm up that consisted of light jogging

Journal of Athletic Training S-31 Free Communications, Oral Presentations: Shoulder Diagnoses and Outcomes Monday, June 20, 2011, 8:00AM-9:00AM, Room 218; Moderator: Kelly Blivens, PhD, ATC 11088MOIN 11116FOIN New Vs. Recurrent Shoulder Injury frequencies for new and recurrent Item Reduction And Factor Time To Return-To-Play Timelines shoulder injury frequencies were Distribution Of The Functional Arm For Interscholastic Sports From documented and used for analyses. For Scale For Throwers (FAST) 2007-2009 the survival curve analyses, variables Bay RC, Huxel Bliven K, Snyder Valier Hagedorn EM, Uhl TL, Bush HM, included frequency of those who AR, Lam KC, Sauers EL: Post- Medina McKeon JM: University of returned to play versus those who did Professional Athletic Training Kentucky, Lexington, KY not (return, no return) at specified time Program, A. T. Still University, Mesa, points (next day return, 3-days, 7-days, AZ Context: Epidemiological 10-days, 22-days, no return by information that focuses on upper season’s end[censored]). Results: Context: Upper extremity injuries in extremity (UE) injuries in high school During the 2007-2009 school years throwers may result in diminished athletics is extremely limited. there were a total of 1536 injuries health-related quality of life. The Objective: To examine the effect of recorded; these occurred during Functional Arm Scale for Throwers injury history on time to return-to- 188,925 AE. There were 135 shoulder (FAST) is a region-specific patient self- play (T-RTP) timelines for new vs. injuries documented, with 21 that were report scale currently under recurrent shoulder injuries in high reported as recurrent. Out of the 21 development using a three-stage scale school athletes. Design: Descriptive, recurrent injuries reported, 1 athlete development process. During stage I, a retrospective, epidemiology study. had 2 recurrent shoulder injuries, so 54-item scale was developed that Setting: Data were collected from 20 athletes with recurrent injuries reflects aspects of the disablement seven high schools of Central were included in the analysis. There model (pain, impairment, functional Kentucky during the 2007-08 and were 5 medical disqualifications for limitations, disability and societal 2008-09 academic years by ATs new shoulder injuries, whereas for limitations). Purpose: To complete employed at each high school. recurrent injuries there was 1. stage II of scale development, including Patients or Other Participants: Comparison of the survival analyses item reduction, factor distribution and High school athletes (freshman, junior revealed that recurrent injuries discriminability assessment, thereby varsity, or varsity level) who required significantly longer T-RTP reducing the scale to less than 25 items, participated in at least 1 of the timelines compared to new injuries while preserving the variance following interscholastic sports (p=0.04). For new injuries, T-RTP characteristics and factor structure of (football, soccer, volleyball, cross- survival estimates for probability of the 54-item scale. Design: Cross- country, basketball, cheerleading, return were: next day: 48.7% [37.0, sectional. Setting: Paper-based survey swimming/diving, wrestling, baseball, 59.2]; 3-day: 69.9%[57.3, 80.5] 7- in athletic training facilities. Patients or softball, track, tennis, golf) during the day:78.8%[62.3, 89.3], 10-day: Other Participants: Convenience 2007-08 and/or 2008-09 academic 89.4%[73.0, 97.3], and 22- sample of 267 injured (n=122) and non- years. Interventions: Incidence of day:94.7%[73.5, 99.8]. For recurrent injured (n=145), male baseball (n=192) shoulder injury was documented and injuries, T-RTP survival estimates for and female softball (n=75) players reported per 10,000 athlete-exposures probability of return were: next day: (age=19.5±1.1 years, 11.9±4.8 years of (AEs). Kaplan-Meier survival analyses 30.0 [12.8, 58.1]; 3-day: 55.0%[28.9, experience) from multiple levels of using censored data were used to 77.0] 7-day:60.0%[29.9, 86.3], 10- competition (high school, college, examine T-RTP curves for new and day: 70.0%[34.2, 91.5], and 22- professional). Interventions: Parti- recurrent shoulder injuries. If one day:80.0%[54.1, 99.6]. Conclusions: cipants completed a demographic athlete had multiple recurrent injuries, Evidence from this study suggests that questionnaire and the original 54-item only the most recent injury was used recurrent shoulder injuries have a FAST. Pitchers (n=117) also completed for analysis. Statistical comparison of slower RTP compared to new injuries. a 9-item module. Main Outcome differences between these survival This indicates that injury prevention Measures: FAST item response curves were evaluated by log-rank and appropriate rehabilitation after distributions, along with subscale and analysis. Estimated survival injury to prevent recurrence are total scale Cronbach’s alpha, inter-item probabilities for T-RTP was imperative for improving outcomes of correlations, factor structure, cor- determined by Kaplan-Meier sports-related shoulder injuries in this respondence with the 54-item version Estimator using censored data. population. and association with known groups Statistical significance for log-rank (injured vs non-injured). Items were analysis was set at P<.05. Main selected from each subscale based on Outcome Measures: Shoulder injury distributional characteristics (mean,

S-32 Volume 46 • Number 3 (Supplement) May 2011 11F22FOTE variance, non-missing). Remaining Clinically Important Difference- respectively). The GROC, a 13-point items were examined with respect to Success (CID-Success): Defining transitional scale ranging from a ‘very inter-item correlation and item-to-scale Success With Patient-Rated great deal worse’ to ‘a great deal better,’ correlations. Cronbach’s was Outcome Tools For Patients With was used to ascertain the patient- calculated for each subscale and items Shoulder Impingement Syndrome perceived magnitude of change in that lowered alpha were considered for Michener LA, Snyder AR, McClure health status. Means, standard exclusion. Discrimination of injured vs PW: Virginia Commonwealth deviations and percent change from non-injured athletes was also tested. University, Richmond, VA; A.T. Still initial to discharge for the DASH and Results: Exploratory factor analysis University, Mesa, AZ; Arcadia PSS were calculated. Patients were (maximum likelihood, varimax rotation) University, Glenside, PA dichotomized into two groups: of the original 54-item scale yielded 4 Successful outcome (Success) and non- factors: Throwing (21 items), Activities Context: The minimal clinically successful outcome (Non-Success); of Daily Living (10 items), important difference (MCID) defined for Success= GROC ‘quite a bit better’ or Psychological Effects (7 items) and the Disabilities of the Arm, Shoulder higher at DC and again at the 12-week Advancement (9 items). Following item and Hand (DASH) and Pennsylvania follow-up, and Non-Success= GROC reduction, 22 items were retained. The Shoulder Score (PSS) patient-rated less than ‘quite a bit better’ at either number of items retained and outcomes (PRO) are used to determine time point. CID-success for the DASH Cronbachs were: Throwing (10, α=.95), if minimal meaningful change has and PSS was determined through Activities of Daily Living (5, α=.84), occurred. However, meaningful change receiver operator characteristic curves Psychological Effects (4, α=.85) and associated with a successful treatment by identifying the point of maximum Advancement (3, α=.94). A Pain outcome, the clinically important sensitivity and 1-specificity. Area under subscale, crossing factor dimensions, difference-success (CID-success), has the curve (AUC) determined was also tested (6 items, α=.85). not been defined. Objective: To discriminative ability of the cut point, Receiver operating characteristic determine the percent change in the with values >0.70 considered curves were calculated, using known DASH and PSS associated with a satisfactory. Results: Patients were group (injured vs non-injured) as the successful treatment outcome, the CID- seen for an average of 9 visits over 5 state variable. Areas under the curve success, in patients undergoing care weeks. There were 42 patients were (AUC) were: Throwing (.92), Activities for shoulder subacromial impingement defined as Success (DASH: IE- of Daily Living (.85), Psychological syndrome (SAIS). Setting: Outpatient 26.3±11.6; DC-8.5±7.9; PSS: IE- Effects (.79) Advancement (.93) and clinics. Participants: Consecutive 58.6±11.8; DC-86.1±10.5), and 32 Pain (.91). For the full 22-item scale, patients (n=74: female=52.7%; patients as Non-Success (DASH: IE- AUC=.93. The factor structure was age=50.2±14.2 years) recruited for a 31.4±13.0; DC-20.1±14.1; PSS: IE- preserved and the 22-item scale clinical trial. Intervention: Standardized 56.6±10.9; DC-68.4±18.4). CID-Success accounts for 98% of the variance in the treatment of manual therapy and percentage cut points for the DASH and original scale. The 9-item pitching exercise for 6 weeks. Main Outcome PSS were 40% and 20% with AUC of module was retained (α=.98, AUC=.89). Measure: The DASH and PSS were 0.79 and 0.76 respectively. Conclusion: Conclusions: The FAST was reduced completed at initial evaluation (IE) and CID-success is a different metric of from 54 to 22 items using an empirical discharge 6-weeks post-initial visit change than the MCID. The CID- item-reduction process. The shortened (DC). The Global Rating of success values for the DASH and PSS scale will be more efficient to administer Change(GROC) was completed at of 40% and 20% change can be helpful and score, has preserved the factor discharge and again 12-weeks post- to define success, interpret change structure of the original scale and initial visit. The DASH is a region- over the course of care and inform shows excellent discriminability for specific PRO for upper extremity treatment decision-making. upper extremity injury in throwing disability with 30 questions rated on a athletes. Stage III of the scale 5-point Likert scale; scores range 0-100 development process will evaluate the and higher scores indicative of less measurement properties of the FAST. disability and fewer symptoms. The PSS is a region-specific PRO consisting of 3 subscales: pain, satisfaction, and function; total score range 0-100 with higher scores indicative of less pain and greater satisfaction and function. The DASH and the PSS have excellent reliability (ICC=0.96 and 0.94

Journal of Athletic Training S-33 11F18MOTE Early Phase Shoulder Rehabilitation phases using an electrogoniometer Exercises: Activation Of Scapular (Noraxon USA). The average of 3 Muscle Ratios Between repetitions for each exercise was used Glenohumeral Pathology Patients for analyses. Statistical tests included And Healthy Controls 3-way analyses of variance, multivariate Cayton SJ, Huxel Bliven K, Valovich approach, with repeated measures, McLeod TC, Bay RC: Athletics alpha = 0.05. Main Outcome Measures: Department, University of Alabama Electromyography (EMG) was used to in Huntsville, Huntsville, AL; Post- collect muscle activity from the UT, LT, Professional Athletic Training MT, and SA during exercises. Ratios Program, A. T. Still University, Mesa, were calculated by dividing normalized AZ mean EMG values of the UT by normalized mean EMG values of the MT, Context: Alterations in scapular LT, and SA to generate ratios UT/MT, muscle [i.e. upper trapezius (UT), UT/LT, and UT/SA, respectively. Ratio lower trapezius (LT), middle trapezius values were multiplied by 100 to obtain (MT), serratus anterior (SA)] relative activity of the UT (%) compared activation commonly occur in patients to the other muscles. A high value with glenohumeral (GH) pathology. corresponds with increased UT Addressing muscle imbalances activity; a low value represents less UT collectively as ratios (UT/LT, UT/MT, activity with respect to MT, LT, and SA. UT/SA) is imperative for restoring Results: For the UT/LT ratio, a functional shoulder stability. significant exercise x phase interaction Recommendations for early phase was found (p=0.012). The UT/LT ratio exercises to correct scapular ratios are was higher during the eccentric phase currently based on research in healthy of prone horizontal abduction with subjects. Objective: To determine if external rotation (concentric = scapular ratios (UT/MT, UT/LT, UT/SA) 145.61±173.61%; eccentric =162.04 differ between exercise type and ±188.10%). No significant differ- exercise phase in patients versus ences were found for UT/MT (p=0.08 healthy controls. Design: Mixed to 0.44) and UT/SA (p=0.09 to 0.79) crossover design. Setting: Laboratory. ratios. Conclusions: The higher UT/ Participants: Twenty-nine subjects LT ratio during the eccentric phase of [Control: n=14 (6 males, 8 females), age the horizontal abduction with external =23.5±11.6 years, height =170.2±11.05 rotation exercise indicates an imbalance cm, mass=62.3±15.45 kgs; GH patients: of high UT and corresponding low LT n=15 (8 males, 7 females), age=24± 5.7 activation, which is undesirable. years, height=170.2±12.5 cm, mass Therefore, it is recommended that, if =78.2±22.1 kgs]. Interventions: All used to address UT/LT imbalances, the measures were compared between eccentric phase of this exercise be control and GH patient groups. modified or eliminated. Overall, no Inclusion criteria for GH patients group differences exist, suggesting the required shoulder pain ≥1 week that exercises tested elicit similar activation interfered with daily activities and for regardless of injury. Examining the which patients sought medical effect of performing exercises over time attention. Two exercises for each on ratios is warranted. Funded by the scapular ratio were examined: exercises Master’s Grant Program of the NATA for UT/LT: prone horizontal abduction Research & Education Foundation. with external rotation and sidelying forward flexion; UT/MT: sidelying forward flexion and prone extension; and UT/SA: standing forward flexion and sitting diagonal. Each exercise was separated into concentric and eccentric

S-34 Volume 46 • Number 3 (Supplement) May 2011 EBF: Shoulder Monday, June 20, 2011, 9:15AM-10:15AM, Room 218

Free Communications, Oral Presentations: Finalists Doctoral Oral Presentations Monday, June 20, 2011, 10:30AM-11:45AM, Room 218; Moderator: Brian Ragan, PhD, ATC 11179DOSP Identifying Acute Impairments injury as part of an ongoing clinical decisions. Athletic trainers without the Following Concussion: Is There A program. Impairments for each outcome resources necessary to complete Case For Baseline Testing? measure were determined by calculating baseline testing may consider utilizing Toler JD, Mihalik JP, Register-Mihalik two standardized test scores for each normative neurocognitive and postural JK, Guskiewicz KM: The University of concussed athlete. The first control data for comparison in a North Carolina, Chapel Hill, NC standardized score compared the multifaceted evaluation of concussion. athlete’s post-injury score to their Context: Many athletic trainers are preseason baseline measures 11282DOSP A Survey$Of Knowledge challenged to complete preseason [ZBL=(post-injury score-baseline baseline testing with limited financial, score)/SD]. The second compared their Differences Of Sport-Related physical, and personnel resources. post-injury score to normative data Concussion Between Contact And Non-Contact Sports In Some believe identifying post- [ZNORM=(post-injury score-normative concussion impairments may be mean)/SD]. Standardized scores lower South Korea difficult without individual baselines. than 1.50 SD below the mean Lee HR, Brown CN, Resch JE, Miles The utility of using normative data for represented an “impaired” state. All JD, Ferrara MS: University of Georgia, clinical decision-making during a others represented an “unimpaired” Athens, GA, and University of Texas multifaceted post-concussion eval- state. Main Outcome Measures: at Arlington, Arlington, TX uation has not been fully studied. Standardized test scores (ZBL, ZNORM) Objective: To compare the agreement were computed for the SOT composite Context: While much research has between acute impairments identified score, GSC total symptom severity been conducted concerning using individual baselines compared to score, and the following ANAM concussions in the United States, there normative data in concussed athletes. throughput scores: Simple Reaction have been few studies about Design: Prospective longitudinal study. Time-1, Simple Reaction Time-2, Math individuals’ knowledge of sport- Setting: Clinical research center. Processing, Memory Search, Match-to- related concussions reported in South Patients or Other Participants: 1,204 Sample, Procedural Reaction Time, Korea. Objective: To examine male and female collegiate student- Code Substitution, and Spatial knowledge differences of sport- athletes completed preseason baseline Processing. A McNemar test for paired related concussion between contact testing as part of an ongoing clinical proportions was employed for each pair and non-contact sports athletes in program. Sport- and gender-matched of standardized test scores with an a South Korea. Design: Cross-sectional normative data (means and SD) were priori alpha level of 0.05. Results: survey. Setting: High schools and obtained from the original baselines of Disagreements were observed for total Colleges in South Korea. Patients or a smaller subset of 678 athletes with no symptom scores (Χ2(1)=10.00; P=0.002) Other Participants: Participants history of self-reported concussions, and ANAM Match-to-Sample were from Seoul Physical Education learning disabilities, and attention (Χ2(1)=5.33; P=0.039). No other High School (n=141, 91 male:18.3 deficit disorders. Athletes diagnosed disagreements were observed. Ten ±0.76 years, and 48 female:18.2 with concussion in our sample (n=100) percent of our sample was considered ±0.74years), and Korea National completed their first post-injury symptomatic relative to baseline, yet Sports University athletes (n=269, assessment within 4 days. These asymptomatic relative to normative 225 male:20.9±1.12 years, and 42 athletes had preseason baseline data data. Conclusions: Comparing post- female:20.9±1.13years). Valid surveys available. Interventions: Our injury outcomes to normative data were returned by 34.6% of the high multifaceted preseason concussion test appears effective in identifying acute school athletes and 28.8% of for battery consisted of a computerized impairments following concussion. collegiate athletes. Interventions: A neurocognitive test (ANAM; However, we recommend baseline survey was developed based on Automated Neuropsychological evaluations should include a GSC at a previous studies and an expert Assessment Metrics), postural control minimum because comparisons of post- committee provided content validity. assessment (SOT; Sensory injury symptom severity scores to The survey consisted of 22 self- Organization Test), and a 17-item normative data may incorrectly identify administered items and was graded symptom checklist (GSC). This an athlete as unimpaired and promote administered to athletes prior to or test battery was repeated following premature return-to-participation following practice. Athletes were

Journal of Athletic Training S-35 categorized by contact sports (n=332) knowledge of South Korean medical evoked potentials (MEP) were and non-contact sports (n=78). The personnel, coaches and athletes to assessed bilaterally with electro- survey consisted of two domains 1) improve their understanding of sport- myography over the vastus medialis signs and symptoms and 2) return-to- related concussions along with return during a standardized isometric play criteria. Chi Square analyses were to play guidelines. quadriceps contraction at 5% of their performed to ascertain the difference maximal contraction. Active motor of concussion knowledge between 11219DONE thresholds, defined as the lowest TMS groups with = .05. Main Outcome Cortical Excitability Of The intensity to elicited a measurable (> Measurement: Knowledge differ- Quadriceps Is Decreased In 100µV) MEP in 5 of 10 consecutive ences in recognition of specific signs Individuals With Unilateral Anterior trials, were used to determine the TMS and symptoms of concussion and Cruciate Ligament Reconstructions intensity for peak to peak outcome knowledge of return to play criteria Ericksen HM, Lepley AS , Gribble PA, measures. A 2 by 2 (Group, Side) post-injury between contact and non- Pietrosimone BG: The Joint Injury and ANOVA was performed to assess the contact athletes. Results: Contact Muscle Activation Laboratory, difference in cortical excitability of sports athletes reported significantly University of Toledo, Toledo, OH the quadriceps. Alpha level was set a increased concussion knowledge for priori at P<.05. Main Outcome amnesia (Χ2 (1, N = 410) = 3.365, Context: Lower extremity neuro- Measures: Amplitudes for five peak p=0.043), nausea (Χ2 (1, N = 403) = muscular control alterations are to peak MEPs at 120% of each 4.046, p=0.028), and “drowsiness” common following Anterior Cruciate subject’s active motor threshold were (Χ2 (1, N = 406) = 3.756, p=0.033) Ligament Repair (ACLr). While averaged and normalized to muscle than non-contact sports athletes. quadriceps dysfunction is often responses (MEP:M ratio) derived from However non-contact sport athletes reported following ACLr, the neural electrically evoked stimuli from over the reported significantly more origin of these of these deficits is not femoral nerve. Results: MEP: M ratios knowledge about the concussion completely understood. Previous were significantly lower in the ACLr symptom “feeling in fog” (Χ2 (1, N = hypotheses suggest that spinal level injured (0.016±0.007) and uninjured 406) = 3.903, p=0.03) than contact neural modulation plays a significant (0.016±0.008) limbs, compared to their sports athlete. Non-contact athletes role in altering neuromuscular function matched control injured (0.029±0.014) also considered concussion as a more following joint injury, but little is known and uninjured (0.023±0.012) limbs serious head injury than contact sports about how higher brain centers, like the (F1,16= 6.71, P=0.02). There was no athlete (Χ2 (1, N = 408) = 17.002, motor cortex are affected in those with significant main effect for Side p<.001). Of respondents, 8.9% ACLr. Objective: To determine if a (F1,16=1.0, P=0.33) or Side by Group reported a history of sport-related difference in cortical excitability of the interaction (F1,16=0.77, P=0.39). concussion. Of that 8.9%, 50% did not quadriceps exists in those with Conclusion: Lower MEP:M ratio in report their post-concussion signs and unilateral ACLR compared to a healthy ACLr subjects supports a decrease in symptoms to anyone and 36.1% of matched controls. Design: Case control. cortical excitability of the quadriceps athletes reported their post- Setting: A controlled research muscle bilaterally in individuals with concussion symptoms to the coaching laboratory. Patients or Participants: ACLr. It is unknown if these bilateral staff. Furthermore, 63.3% of the Nine unilateral ACLr (3 males, 6 females; deficits are caused by the unilateral athletes who reported concussions age=24.3±5.27years; height = 173.9 injury or if the deficits may have made return-to-play decisions by ±10.8cm, mass=70.45±14.8kg, 67.5± contributed to the ACL injury. This data themselves, while 22.2% of the cases 42.6 months post surgery) and nine is fundamental in understanding the the coaching staff made return to play healthy matched control partici-pants genesis of neuromuscular deficits decisions. Conclusions: Our study (3 males, 6 females; age= 25.0±5.20 following ACLr. Future research should reflects limited knowledge regarding years; height= 171.9±10.4cm, mass= focus on the cortical aspect of concussion management procedures 68.1±11.9kg) were included in this neuromuscular control to determine in South Korea. The limited study. Interventions: Measures of appropriate prevention and rehabil- knowledge of concussion signs and cortical excitability were tested itation programs following ACLr. symptoms and making return-to-play bilaterally (injured, uninjured leg) decisions is of greatest concern. The among both groups (ACLr,Control). lack of medical staff in athletic The order of leg tested was facilities, coupled with unreported randomized. Limbs of the healthy group signs and symptoms may increase the were matched as “injured” to an ACLr risk of cumulative or catastrophic counterpart. Cortical excitability was effects from recurrent concussions. measured in a seated position in 90° of Concussion education should be knee flexion using Transcranial implemented to increase the Magnetic Stimulation (TMS). Motor

S-36 Volume 46 • Number 3 (Supplement) May 2011 11246DONE 11135DOPE Pain And Associated Neuromuscular a priori at P<0.05. Effect sizes Perceptions Of Approved Clinical Alterations During Stair Ambulation (Cohen’s d) were calculated with 95% Instructors: Strategies For In Those With Patellofemoral Pain confidence intervals. Results: The Overcoming Barriers In The Syndrome symptomatic leg demonstrated Implementation Of Evidence-Based Aminaka N, Pietrosimone BG, significantly shorter VMO activation Practice Armstrong CW, Gribble PA: duration compared to the Hankemeier, DA, Van Lunen BL: University of Toledo, Toledo, OH asymptomatic leg, regardless of the Old Dominion University, Norfolk, group (Symptomatic =782.90- VA Context: Hip abductor muscle ±279.47 ms, Asymptomatic= 936.27 weakness has been implicated as a ±340.49ms, F1,35=6.247, P= 0.017, Context: Approved Clinical contributing factor for patellofemoral d=-0.48 [-1.11,0.15]). There was no Instructors (ACIs) are in a position to pain syndrome (PFPS). However, little group difference for AL duration or teach and mentor athletic training evidence exists for how hip adductor, onset (P>0.05). The PFPS participants students in their clinical experiences. vastus medialis and gluteus medius demonstrated significantly later As evidence-based practice (EBP) muscle function is affected in those GMed onset (PFPS =33.13± 76.85ms, becomes more prevalent in athletic with PFPS. Objective: Determine if hip Healthy=-60.43±90.66 ms, F1,35= training education there is a need to and quadriceps muscle activation and 18.835, P<0.001, d=1.12 [0.43, understand the barriers ACIs self-reported pain differ between those 1.76]), and shorter GMed duration experience in implementation of EBP with and without PFPS during stair (PFPS= 295.61± 133.21ms, Healthy with their students. Objective: The decent. Secondarily, we assessed the =518.54 ±229.41ms, F1,35=18.127, P< purpose of this study was to investigate relationship between pain and muscle 0.001, d=-1.19 [-1.84,-0.49]). The the barriers ACIs face when activation in those with PFPS. Design: VAS scores were significantly implementing EBP concepts in their Case-control. Setting: Research different between groups (PFPS= clinical practice and in teaching EBP laboratory. Patients or Other 2.24±1.83, Healthy = 0.00±0.00, t= to professional athletic training Participants: Twenty PFPS (13F/7M, -5.471, P<0.001, d=1.73 [0.97,2.42]). students. In addition to the barriers, 21.45±3.90years, 169.96±10.47cm, There was a strong negative correlation information on how best to address the 71.30±14.50kg) and twenty healthy between VAS and VMO onset on the barriers from an ACI perspective was participants (13F/7M, 21.35± 3.76years, symptomatic leg (r=-0.611; P=0.007). investigated. Design: Emergent design 172.21±9.24cm, 69.68± 9.78kg). There was a strong positive correlation interviews with phenomenological and Interventions: Participants descended between VAS and AL duration on the modified grounded theory per- four-step stairs while surface symptomatic leg (r=0.607; P=0.010). spectives were used for this inquiry. electromyography was collected on the There was a moderate negative Setting: Individual phone interviews vastus medialis oblique (VMO), correlation between VAS and were conducted with all participants. adductor longus (AL), and gluteus asymptomatic leg AL onset (r=-0.496; Participants: Sixteen ACIs (11 males, medius (GMed). Participants rated the P=0.043) and a moderate positive 5 females; 10±4.66 years AT maximum pain on the symptomatic knee correlation between VAS and experience; 6.81±3.94 years ACI during the task using a 10-cm visual asymptomatic leg GMed duration experience) with at least one year of analog scale (VAS). Healthy (r=0.472; P=0.048). Conclusion: ACI experience were interviewed to participants’ legs were matched to the Pain was associated with earlier determine the barriers faced and PFPS participants by side. Main activation onset of VMO and longer potential strategies to overcome these Outcome Measures: Bilateral activation duration of AL on the barriers. Criterion and snowball activation onset and duration of VMO, symptomatic leg. Also, pain on the sampling were used to identify AL, and GMed, and VAS score on the symptomatic leg was correlated with potential participants. Data collection symptomatic limb were collected during earlier onset of AL and longer duration ceased when saturation of the data was stance phase of the second step of stair of GMed on the asymptomatic leg. obtained due to repetition of descent. An independent-samples t-test The study suggests caution when participant responses. Data assessed the group difference on the implementing rehabilitation exercises Collection and Analysis: Telephone VAS score. A separate two-way that promote excessive activation of interviews were conducted by the ANOVA was utilized to detect group the hip adductors, as it may be a researcher and transcribed verbatim by and side differences for each contributing factor for painful a professional transcriptionist. dependent variable. Pearson product- symptoms of PFPS. Interview data were analyzed and coded moment correlations assessed for common themes and sub-themes relationships between muscle regarding barriers and educational activation measures and VAS in the emphases to improve the barriers. PFPS group. Significance level was set NVivo 8 software (QSR International,

Journal of Athletic Training S-37 Cambridge, MA) was used to manage the data and develop codes. Peer review, member checking, and transcript verification were conducted to triangulate and ensure trustworthiness of the data. Results: ACIs reported barriers related to both resources and personnel when it came to implementing EBP within their own clinical practice. Time, equipment, and access to current literature were all sub-themes that emerged from the resource barriers discussed by the ACIs. Unwillingness to accept evidence regarding advancements in treatment in co-workers, clinicians, and coaches respectively were personnel barriers expressed by the ACI. These challenges in the ACIs’ own clinical practice therefore affect their ability to utilize EBP while mentoring students. Education or emphasis on EBP within the ACI workshops was only experienced by three of sixteen ACIs (18%). ACIs reported the need for better integration between the clinical setting and the classroom, and also expressed the need for EBP to be integrated throughout the athletic training education program. Conclusions: Integration of the classroom and clinical experience is important in advancing ACIs’ use of EBP with their students. A collaborative effort within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could result in a positive effect of the ACIs ability to implement EBP within their own clinical practice.

S-38 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Master’s Oral Finalist Presentations Monday, June 20, 2011, 12:00PM-1:15PM, Room 218; Moderator: Kristin Kucera, PhD, ATC 11140MOSP 11186MOXX Baseline Self-Report Symptoms And headache-related symptoms (head- Effects Of Kinesio Taping On Health-Related Quality Of Life In ache, pressure in head) and the HIT-6 Endurance Ratio And Circulation High School Athletes Differ With total score. Main Outcome Of The Gastrocnemius Muscle Prior Concussion History And Sex Measures: Dependent variables Haynes HL, Kroskie RW, Docherty Leach CA, Bay RC, Valovich McLeod included the total symptom score (TSS) CL: Indiana University, TC: A.T. Still University, Mesa, AZ and the HIT-6 total score. Higher scores Bloomington, IN indicate greater symptom severity on Context: Due to enhanced monitoring the symptom scale and a greater impact Context: Kinesio Tex Tape® (KT) is a and recognition of sequelae, of headache on HRQOL as measured new therapeutic taping method that is concussion during adolescence is of by the HIT-6. Results: A significant being used in orthopedic and sports growing concern. Concussions may interaction was noted for TSS (p=0.014) medicine settings. One of the potential manifest not only through immediate with POS females reporting a benefits of using KT is that the tape physical and cognitive symptoms, but significantly higher score (18.3±18.5) increases blood circulation to the also through enduring changes in the than NEG females (10.2±13.5), POS muscle and subsequently improves athlete’s health-related quality of life males (11.8±13.7) and NEG males muscle function. To date, there has (HRQOL). Recurrent headaches, in (6.6±9.9). POS males also reported a been very little research done on how particular, may negatively affect an significantly higher TSS than NEG KT affects muscle performance. individual’s HRQOL. Objective: To males. The interaction between Objective: To determine the effect of determine if history of prior concussion history and sex was not Kinesio Tex® on the endurance ratio of concussions is related to self-reported significant for the HIT-6 (p=0.11), but the gastrocnemius muscle. A secondary symptoms and HRQOL, and if this significant main effects were noted for purpose was to evaluate how KT may relationship is moderated by sex. A group (p<0.001; POS=46.6±7.8, affect lower leg blood flow, secondary objective was to assess the NEG=43.8±6.8) and sex (p<0.001; circumference, and volume measures. relationship between headache-related female=46.4±8.1 > male=44.9±7.2). Design: Repeated Measures. Setting: symptoms and headache-specific Significant correlations (p<0.01) were Research laboratory setting. Patients HRQOL. Design: Cross-sectional. found between the HIT-6 total score or Other Participants: Sixty-one Setting: High school athletic facilities. and headache (r=.52), HIT-6 total score healthy, active subjects, (38 female, 23 Patients or Other Participants: and pressure in head (r=.46), and male; 23.0±5.2years; 170.8±22.2cm; Interscholastic athletes with a positive between headache and pressure in 78.4±30.0kg) volunteered to participate. (n=1665, 1416 males, 249 females, head (r=.68) among the entire sample. Subjects were randomly assigned to age=15.6±1.6 years, grade=10.3±1.1) or Conclusions: Female adolescent one of three groups, these included: negative (n=1633, 1132 males, 501 athletes reported higher TSS and HIT-6 proper KT, sham KT, no tape. females, age=15.6±1.5, grade=10.3±1.1) scores than males, indicating that they Interventions: Subjects were tested self-reported concussion history. are more symptomatic and have lower over three days: Day 1(Baseline), Day Interventions: Participants completed headache-specific HRQOL, when 2 (24 hours after baseline), and Day 3 a concussion history questionnaire, the otherwise healthy. Athletes with a (72 hours after baseline). On each day Sport Concussion Assessment Tool-2 concussion history reported more of testing blood flow, circumference, (SCAT2) symptom scale and the symptoms and higher HIT-6 scores than volume, and endurance ratio were Headache Impact Test (HIT-6) during those without prior concussions. recorded. A laser doppler (LDF 100C, preseason baseline assessments. The Concussions may have an enduring Biopac Systems) was used to evaluate symptom scale and HIT-6 have impact on an athlete’s physical health blood flow. Maximum circumference of published reliability and validity. and HRQOL and should be considered the gastrocnemius was determined by Subjects were grouped as positive during administration and inter- a spring circumference measuring tape. (POS) or negative (NEG) according to pretation of baseline assessments. Volumetric water displacement was their self-reported concussion history. Baseline testing should include used to measure leg volume. Lastly, a The independent variables were group symptom checklists and HRQOL Cybex NORM dynamometer (Cybex (POS vs. NEG) and sex (male vs. female). assessments to assure adequate post International Inc, Ronkonkoma, NY) Separate 2x2 analyses of variance were concussive care. was used to evaluate the endurance conducted for each dependent variable. ratio of the gastrocnemius. Depending Significance was set at ≤.05, two- on group assignment, tape was applied tailed. A Pearson correlation was used after Day 1(baseline) data were to assess the relationship between two obtained. Subjects in the proper KT

Journal of Athletic Training S-39 group received the ankle tape the star excursion balance test (SEBT) 64.8% was associated with a technique as described in the KT may provide strong predictive sensitivity of 0.56 and a specificity of manual. Subjects in the sham group capabilities for lower extremity 0.74(+LR=2.17, -LR=0.59). For PM, received one strip of KT around the injury, more information is needed to there was no statistically significant circumference of the proximal further substantiate the predictive Group difference (t1,64=0.94, P=0.35; gastrocnemius. Subjects in the no tape outcomes that have been suggested. Injured:75.12±11.21%; Non-Injured: group did not receive any tape Objective: To determine if the SEBT 78.14±11.23%). A %MAXD of application. Main Outcome can be used as a lower extremity injury 72.95% was associated with a Measures: The dependent variables prediction tool for adolescent sensitivity of 0.44 and a specificity of were blood flow (BPUs), volume (ml), basketball players. Design: Pro- 0.72(+LR=1.56, -LR=0.78). For PL, circumference (cm), endurance ratio spective cohort Setting: High school there was no statistically significant

(J). Separate Repeated Measures athletic training rooms. Patients or Group difference (t1,64=1.52, P=0.13; Analysis of Variance (RMANOVA) Other Participants: Sixty-six boys’ Injured:65.74±11.16%; Non-Injured: with one within subject factor (day at and girls’ basketball players (42 boys; 70.34±10.30%). A %MAXD of 3 levels) and one between subjects 24 girls; 15.71±1.18yrs; 176.13 67.45% was associated with a factor (group at 3 levels) were ±10.66cm; 70.98±14.96kg) were sensitivity of 0.56 and a specificity of conducted on each dependent variable. recruited from three high schools. 0.64(+LR=1.74, -LR=0.59). For CS, The alpha level was set at p <0.05. Interventions: Prior to the season, all the Group difference approached

Results: For endurance ratio, results athletes performed maximal reaches on statistical significance (t1,64 =1.93, of the RMANOVA revealed no the SEBT in three directions: anterior P=0.058; Injured: 67.52±9.42%; Non- significant main effect for group (F2, (ANT), posteromedial (PM), and Injured:72.31±8.41%). A %MAXD of

58=2.61, p=.08), main effect for day posterolateral (PL). Certified Athletic 69.53% was associated with a

(F2,116=2.22, p=.11) or day by group Trainers at the schools recorded acute sensitivity of 0.75 and a specificity of interaction (F4, 116=1.99, p=.10). lower extremity injury occurrences 0.64(+LR=2.08, -LR=0.39). Con- Specifically, when evaluating the during the competition season. After clusion: While no significant Proper KT group we found no the season, players were stratified into differences in SEBT reach distances differences between testing prior to an injured or non-injured group were found between subjects that tape application (Day 1=55.8±20.0J) depending on the recordings by the incurred a lower extremity injury and compared to following tape application ATC’s. Main Outcome Measures: The those that did not, the CS did (Day 2=64.6±21.4J or Day 3=61.6 average of three reaches (cm) were demonstrate good sensitivity (0.75) ±16.2J). Blood flow, volume, and normalized to leg length (cm) and and moderate specificity (0.64). circumference measurements also reported as a percentage for each Clinicians can consider using the SEBT yielded no significant differences reaching direction(%MAXD). as predictor of lower extremity (p>.05) between groups or test days. Additionally, a composite score (CS) of injuries for high school basketball Conclusions: KT does not enhance the average of the three normalized players if a composite score is muscle endurance of the gastroc- reach scores was calculated. employed. nemius muscle in a healthy population. Independent samples t-tests were used Furthermore, we found KT did not to detect differences between the 11268MOPE affect blood circulation, circum- groups (injured, non-injured) for ANT, Student Retention in Undergraduate ference, or volume of the gastroc- PM, PL and CS. Significance was set at Athletic Training Education nemius muscle. P<0.05. Receiver-operator character- Programs within NATA District Four istic curves were used to determine Young AM. Klossner JC. Docherty 11216MOIN %MAXD for each of the four SEBT CL. Dodge TM, Mensch JM: The Star Excursion Balance measures that maximized specificity and Indiana University, Bloomington, Test As A Predictor Of Lower sensitivity. Additionally, positive and IN; Springfield College, Springfield, Extremity Injuries In High negative likelihood ratios (+LR and MA; University of South Carolina, School Basketball Players -LR) were calculated. Results: Columbia, SC Sato A, Aminaka N, Pfile KR, Sixteen subjects (24.24%) exper- Pietrosimone BG, Shinohara J, ienced acute lower extremity injuries. Context: A better understanding of Webster KA, Gribble PA: University Fourteen injuries (87.5%) were why students leave an undergraduate of Toledo, Toledo, OH, and Boston inversion ankle sprains, and two athletic training education program University, Boston, MA injuries (12.5%) were muscle strains. (ATEP), as well as why they persist is For ANT, there was no statistically critical in determining the future Context: Prevention of injury is membership of our profession. significant Group difference (t1,64=1.15, vitally important to the clinician. P=0.26; Injured: 65.84±8.13%; Non- Objective: To understand how clinical While limited investigation suggests Injured: 68.36±7.44%). A %MAXD of experiences affect student retention.

S-40 Volume 46 • Number 3 (Supplement) May 2011 Design: Descriptive study using ANOVAs revealed that the persisters injuries over the course of one qualitative and quantitative mixed and dropouts differed significantly on baseball season. Design: A single methods. Setting: ATEPs across AF (persisters =11.63±.41, dropouts group, repeated measures design was NATA District Four. Participants: We =13.35±.72, p=.04), CI (persisters employed. Setting: All measurements used purposeful criterion sampling =45.76±1.45, dropouts =38.01±2.55, were ascertained in a climate- methods. Criteria for selection p=.01), and M (persisters =28.90±.53, controlled laboratory, while the included those senior students in a 3- dropouts =21.91±.93, p=.01) scales. stretching protocol was performed on year ATEP within NATA District 4 as Qualitative themes suggested time a collegiate baseball field. Patients well as those who have dropped out of commitment was a retention barrier or Other Participants: Thirty-five the ATEP. Program directors who for both groups. Support networks, male collegiate baseball players (age: participated sent us a list of names and authentic experiential learning, and 19.0±2.0 yrs; height: 181.6±6.4 cm; email addresses for senior students role identity facilitated retention for mass: 85.3±13.1 kg) from a single and students who voluntarily left the persisters, however a lack of authentic NCAA Division I institution. program. Identified students were sent experiences was a barrier for dropouts. Interventions: The SS protocol, the an email explaining the study as well Major or career change also led to experimental intervention, was as a link to an on-line survey. Seventy- attrition for dropouts. Conclusions: incorporated into each participant’s one persisters (27 males, 44 females, There is a perceived difference in how daily routine. All participants received age=21.81±1.17 years) and 23 athletic training students are integrated standardized training in the proper dropouts (10 males, 13 females, into their clinical experiences between stretching mechanics. Upon demon- age=20.25±0.90 years) representing those students who leave an ATEP and stration of the correct technique, each 24 ATEPs participated. We achieved a those who stay. Results suggest athlete was instructed to utilize the SS 42% and 26% response rate from educators may improve retention by on every day of athletic participation persisters and dropouts, respectively. emphasizing authentic experiential for 12 weeks. Following data Interventions: The independent learning opportunities rather than reduction, differences in R-O-M were variable was matriculation status at two hours worked, allowing students to explored with repeated measures levels: persisters and dropouts. take on more responsibility and by analysis of variance (RM-ANOVA) Students completed the Athletic facilitating networks of support within across sessions, where P<.05. For all Training Education Program Student clinical education experiences. statistically significant main effects, Retention Questionnaire (ATEPSRQ), post hoc paired t-tests were used to which has been previously utilized and 11315MOXX elucidate significant differences published in the AT literature. The The Sleeper Stretch: Effects On between sessions. The Fisher Exact ATEPSRQ included questions which Range Of Motion And Injury In Test was conducted to identify any measured responses on a 6 point likert Baseball Players disparities of shoulder injury scale within 5 construct areas. The Grow KK, Butryn TM, Plato PA, frequency between past and present constructs included: anticipatory Brown HL, Douex AT: Athletic baseball seasons. Main Outcome factors (AF), academic integration Training Research Laboratory, San Measures: Using a universal 2-armed (AI), clinical integration (CI), social José State University, San José, CA goniometer (Baseline, Irvington, NY), integration (SI), and motivation (M). a single researcher obtained 3 The ATEPSRQ also included Context: Glenohumeral internal dominant shoulder IROT measure- qualitative questions. Main Outcome rotation deficit (GIRD) may be an ments per session, across 4 sessions Measures: The responses to each underlying cause of shoulder (pretest, week 4, 8, and 12). question were summed and the total for pathology in overhead athletes. The Additionally, the number of time-loss each construct was used as the Sleeper Stretch (SS) is popular among (≥8 days or 4 games) shoulder injuries dependent variable. Multivariate clinicians to prophylactically increase incurred during the 2010 baseball Analysis of Variance (MANOVA) was shoulder internal rotation (IROT) season was compared to the number performed on the quantitative data range of motion (R-O-M). If increased of injuries per season for the previous followed by univariate ANOVAs on any IROT deters the development of 3 baseball seasons (2007-2009). significant findings. A priori alpha level GIRD, perhaps overhead athletes can Results: Overall, participants gained was set at p<.05. Qualitative data were utilize the SS regimen to decrease the approximately 9° of shoulder IROT analyzed through inductive content incidence of shoulder injuries. over 12 weeks (pretest =46.78°±9.64, analysis. Trust-worthiness was ensured Objectives: To examine the effects of week 12= 55.23°± 7.23; P=.001); the through peer debriefing. Results: The a SS protocol on glenohumeral IROT most clinically significant gain MANOVA identified a significant R-O-M over the course of 12 weeks. (6.05°) occurred between weeks 8 and difference between the persisters and Secondly, to determine the efficacy of 12 (49.18°±7.49 vs. 55.23°±7.23; dropouts, (Pillai’s Trace=.42, a SS regimen for reducing the P=.001). Important-ly, there were no incidence of non-traumatic shoulder F(1,92)=12.95, p=.01). The follow-up shoulder injuries in 2010 which, when

Journal of Athletic Training S-41 compared to low injury frequencies in previous seasons (4, 3, 1), rendered a trend towards significance (P=.057). Conclusions: Meaningful gains in shoulder IROT can be obtained over a 12-week period when utilizing the SS; however, it may take up to 8 weeks for significant increases to occur. The resultant increase in motion, coupled with the absence of shoulder injury is clinically important. This suggests that the SS could be a promising preventative measure for overhead athletes to utilize.

S-42 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Rehabilitation Techniques Tuesday, June 21, 2011, 8:00AM-9:00AM, Room 218; Moderator: John Miller, PhD, ATC 11040MOTE 11F11DOTE Comparison Of The Effects Of main effect for time was found for the The Effect Of A 4-Week BAPS Aquatic And Land-Based Balance left foot/eyes open condition (p=.030). Rehabilitation Program On Subjects Training Programs On The The center of pressure sway velocity With Functional Ankle Instability Postural Control Of College- improved significantly (p=.013) Linens SW, Ross SE, Arnold BL: Aged Recreational Athletes between pre- and posttest in the land Georgia State University, Atlanta, Spiers SN, Greenwood LD, Boucher group (pre=.855±.157°/s, post GA, and Virginia Commonwealth AM, Barnard-Brak L, La Bounty P, =.661±.118°/s) while no improve-ment University, Richmond, VA Greenwood M: Baylor University, was found for the aquatic group Waco, TX (pre=.783±.152°/s, post=.817±.63°/s). Context: Rehabilitation protocols Between-group effects for this using multiple exercises have been Context: Land-based balance training condition were not significant (p=.549). shown to improve balance and decrease has been shown to improve postural No other conditions associated with the ankle sprain incidence in individuals control in healthy individuals. An US test revealed significant time or with functional ankle instability (FAI). aquatic environment contributes between-group differences (left-foot While these outcomes are desired, several properties that may increase the eyes closed, p=.851; right foot eyes evidence is lacking on how each effects of balance training on postural open, p=.820; right foot eyes closed, specific exercise in rehabilitation control. Objective: To determine if p=.660). In the LOS test, a significant programs contribute to improving aquatic and land-based balance training (p=.033) time by group interaction was clinical outcomes. Objective: To programs created significantly different present for maximum excursion. The quantify improvements in clinical improvements in levels of postural aquatic group improved significantly impairments using a single ankle control measured among college-aged (p=.003) between pre- and posttest rehabilitation exercise as a therapeutic recreational athletes. Design: A two- (pre=94.44±6.41%, post=97.69 ±5.23%) intervention. Design: Prospective, group pretest-posttest study. Setting: while no differences were found for the randomized controlled experimental Testing was performed in a laboratory land group (pre=98.97±5.09%, design. Setting: Research laboratory. setting and the interventions took place post=97.73±4.63%). No other findings Patients or Other Participants: Thirty- in the university student athletic center. were significant for the LOS test four subjects with “giving way” and a Participants: Eighteen healthy, (reaction time, p=.156; movement history of ankle sprains (i.e. FAI) were recreationally active males (n=6) and velocity, p=.431; directional control, participants. Subjects had to score ≤27 females (n=12), (age=20.56±2.59 years, p=.137). In the SOT, no significant on the Cumberland Ankle Instability height=167.6±7.2 cm, mass=66.66±7.90 differences were found between pre- Tool (CAIT). Seventeen subjects kg) with no history of vestibular or and posttest scores for either balance (170.22±8.71 cm, 75.57±13.55 kg, other balance-influencing disorders group (p=.054). No significance was 22.94±2.77 yrs; CAIT=16.94±5.08) were were recruited for participation. found between groups (p=.973). randomly assigned to a rehabilitation Interventions: Subjects were randomly Conclusions: While the current study group (REH) and seventeen subjects assigned to an aquatic (n=12) or land- was limited by a small sample size and (168.57±9.81 cm, 77.19±19.93 kg, based (n=6) balance-training group. unevenly numbered intervention 23.18±3.64 yrs; CAIT=17.18±4.43) were These groups performed a preset groups, it appears that neither the randomly assigned to a control group program of balance exercises three days aquatic nor land-based training (CON). Interventions: Pretests were a week for six weeks. Main Outcome environment was superior to the other administered in a counterbalanced Measures: Pre- and posttest when attempting to enhance postural order. The foot lift test (FLT) required measurements of postural control were control in healthy, active individuals subjects to close their eyes and stand made using three tests available using a 6 week balance program. quietly on their limb with FAI for 30 through Neurocom’s Smart Equitest seconds. Subjects were asked to Balance System. The testing batteries minimize both foot wobbles and included the Limits of Stability (LOS) touching their contralateral limb to the test, the Unilateral Stance (US) test, and floor. The posteromedial reach test the Sensory Organization Test (SOT). (PMR) required subjects to stand on A 2(group) x 2(pretest-posttest) mixed their limb with FAI and reach with their analysis of variance was performed to contralateral limb as far as possible determine statistical significance, while maintaining stability. The side which was set a priori at (p<.05). hop test (SHT) required subjects to hop Results: In the US test, a significant 0.3 m side-to-side on their limb with FAI

Journal of Athletic Training S-43 for 10 repetitions. Pretesting was ligament injuries and patellofemoral the squat and ankle ROM. A group (2- either followed by 4 weeks with no pain. Knee valgus can be caused by levels) by phase (6-levels) repeated intervention for controls or wobble muscle imbalances throughout the measures ANOVA was used to analyze board rehabilitation, consisting of 3 lower extremity, including the ankle and knee valgus angle. Independent sessions per week. Subjects performed lower leg. Exercise interventions that samples t-tests were used to compare 5 wobble board repetitions, with each alter these muscle imbalances could change scores in ankle ROM repetition consisting of 20 seconds of improve knee valgus and potentially (P<0.05). Results: The intervention clockwise circles and 20 seconds of reduce injury risk. Objective: To group significantly improved knee counterclockwise circles on the limb determine if an exercise intervention valgus angle (P=0.001, F(1,150) with FAI. Both groups were posttested targeting ankle and lower leg muscle =4.43). Tukey post hoc testing 4 weeks after their pretest. Two by two imbalances can improve knee valgus revealed a reduction in knee valgus repeated measure ANOVAs were used alignment and ankle dorsiflexion range angle from 30% (Control: PRE= for data analysis (α=.05). Tukey’s HSD of motion (ROM). Design: Randomized -1.9±5.0º, POST=-2.8±6.1º; Inter- post-hoc tests were conducted on Control Trial. Setting: Laboratory. vention: PRE=-8.0±7.2º, POST= significant interactions. Main Outcome Patients or Other Participants: -3.7±8.4º) to 50% squat phase. Ankle Measures: Dependent measures Participants must have displayed visual DFKE increased the intervention included average number of foot lifts evidence of knee valgus during a group (P=0.009, t(1,30)=2.8) (FLT), average reach distance (cm) double leg squat that was corrected (Control: PRE =5.0±4.6º, POST= normalized by leg length (PMR), and when performed on a 2” heel lift. Visual 3.5±5.2º; Intervention: PRE= time (s) to complete testing (SHT). evidence of knee valgus was defined 6.9±4.7º, POST= 10.5±4.6º) while Fewer foot lifts, longer reach distances, as the midpoint of the patella moving DFKF (P=0.64) did not. Con- and shorter times indicated improved medial to the great toe. Participants clusions: In this population, knee performance. Results: Main effects for meeting these criteria were randomly valgus is at least somewhat attributable time were significant for all measures assigned to a control (n=16, to a lack of ankle motion. This (P<0.05), but main effects for groups 168.2±6.7cm, 62.6±9.3kg, 20.5±2.8yrs) or exercise program could benefit were not (P>0.05). Significant intervention group (n=16, 169.8±6.3cm, clinicians attempting to correct interactions were found for FLT 66.2±12.1kg, 20.7±2.8yrs). Interven- dynamic postural alignment and

(REHpre=5.61±2.59, REHpost=3.82±2.25, tions: The intervention group potentially limiting injuries.

CONpre=5.00±1.73, CONpost=4.61±1.77; completed 10 directed exercise sessions F =4.55, P=0.041), PMR (REH over a 2-3 week period. The program 11261FOTE (1,32) pre Cardiovascular Outcomes Of =0.85±0.12, REHpost=0.98±0.12, CONpre= consisted of common rehabilitation 0.88±0.08, CON =0.86±0.09; F =23.79, exercises implemented according the Active Gaming: Applying The post (1,32) Wii To Athletic Training Rooms P<0.001), and SHT (REHpre=19.55±9.54 s, National Academy of Sports Medicine REH =12.40±6.15 s, CON =16.20±7.95 guidelines: 1) inhibit tight muscles, 2) An YW, Hedderson W, Naugle KM, post pre Wikstrom EA, Naugle KE: s, CONpost=15.18±7.95 s ; F(1,32)=8.37, stretch tight muscles, 3) strengthen P=0.007). Post-hoc testing showed that weak muscles, and 4) perform University of Florida, Gainesville FL, the REH group improved performance integrative exercises with proper form. and University of North Carolina, on all measures at posttest, whereas the The control group did not undergo Charlotte, NC CON group did not. Conclusions: training and returned for testing 2-3 Wobble board rehabilitation improved weeks later. Participants had Content: Active gaming has become clinical impairments. We suggest dorsiflexion range of motion assessed a trendy rehabilitation tool in athletic utilizing this program to improve and performed 5-trials of a double leg training settings; with devices such as balance and performance deficits squat before (PRE) and after (POST) the the Nintendo Wii suggested to produce associated with FAI. Funded by the intervention period. For the double leg cardiovascular responses similar to Doctoral Research Grant Program of squat, participants started with their traditional physical activity. One the NATA Foundation. feet shoulder width apart and hands appealing aspect of Wii games is the overhead and squatted to 90º of knee potential enjoyment of athletes using 11099DOTE flexion. An electromagnetic tracking these systems to combine enter- Directed Exercise Improves Knee system assessed knee valgus alignment tainment with aerobic fitness, allowing Valgus And Ankle Range Of Motion during the double leg squat task. Ankle for potential increases in rehabilitation Bell DR, Padua DA: University of dorsiflexion ROM was measured with compliance. However, the aerobic Wisconsin-Madison, Madison, WI, the knee extended (DFKE) and knee capability of Wii games in athletic and University of North Carolina at flexed (DFKF) using a standard training settings is yet to be Chapel Hill, Chapel Hill, NC goniometer. Main Outcome Measures: substantiated. Objective: To determine Change scores (POST-PRE) were the cardiovascular effects of selected Context: Knee valgus is theorized to calculated for knee valgus angle at the Wii games compared to traditional increase the risk of anterior cruciate 0, 10, 20, 30, 40, and 50% phases of cardiovascular activities (treadmill S-44 Volume 46 • Number 3 (Supplement) May 2011 walking and stationary biking). (31.43bpm±4.03) lead to a Hypothesis: Wii games will provide significantly greater increase in HR equal cardiovascular training compared to aerobic-step (25.71bpm outcomes as treadmill walking and ±3.62) and tennis (22.57bpm±4.93). stationary biking at moderate intensity. Participants’ enjoyment was Design: A cross-sectional study significantly greater for boxing (8.13 design determined the relationships cm±1.63) compared to walking between Cardiovascular Intensity (5.76cm±2.21) and stationary biking (HR), and Perceived Exertion (RPE (5.51 cm±2.48). Conclusions: scores) of multiple Wii games. Results suggest that these Wii games, Setting: University Fitness Center when played at a beginner level, (field setting). Participants: produce a slightly lower cardio- Fourteen college-aged volunteers vascular response than the traditional (M=6, F=8). Interventions: Partici- exercises performed at a moderate pants completed multiple exercises intensity. Wii boxing produced the sessions, with two exercise activities greatest increase in HR among the Wii performed during each session for 20 games and was rated more enjoyable minutes each. During session one, than traditional exercises. Future participants walked briskly on a studies are needed to determine Wii’s treadmill and rode a stationary bike at effectiveness as a cardiovascular a light to moderate pace. During rehabilitation tool in athletic training sessions two and three participants settings. performed a total of four Wii games, including tennis, boxing, step- aerobics, and cycling. The order of the Wii games was randomized and counterbalanced across the two sessions. Participants reported their RPE and level of enjoyment following each exercise activity. Main Outcome Measures: Change in HR from resting (bpm), Borg scale of Perceived Exertion (RPE), and rating of enjoyment on a 10cm visual analog scale. Each outcome measure was analyzed with a separate repeated measures one-way ANOVA (p<05). Results: Differences existed between the exercise activities on RPE, HR, and level of enjoyment (p’s < .001). Follow-up tests revealed significantly greater RPE on the stationary bike (12.79±.89) compared to all other exercise activities except for walking. Additionally, RPE was significantly greater for walking (12.43±1.22), boxing (11.21±2.25), and cycling (11.43±2.21) compared to tennis (9.57±2.06) and aerobic-step (9.64±2.10). All activities increased HR at least 20 bpm. Stationary biking (57.43bpm±5.51) and treadmill walking (56.93bpm±4.60) lead to significantly greater increases in HR compared to Wii Games. Boxing (39.71bpm±5.52) and cycling

Journal of Athletic Training S-45 Free Communications, Oral Presentations: Tissue Response to Damage and Treatment Tuesday, June 21, 2011, 9:15AM-10:15AM, Room 218; Moderator: Chad Starkey, PhD, ATC 11278FOTE 11045DOTH The Effect Of Antihistamine On The Each variable’s change from baseline Skeletal Muscle Blood Flow And Signs And Symptoms Of Eccentric was compared between groups using Volume Are Not Reduced In The Muscle Damage repeated measures ANOVA followed by Gastrocnemius After Ice Application Jutte LS, McIntosh ID: Ball State Tukey-Kramer post-hoc testing when Selkow NM, Day C, Quinn J, Liu Z, University, Muncie, IN appropriate. A priori significance was Saliba S: University of Virginia, set at P-value <.05. Results: Increases Charlottesville, VA Context: Eccentric exercise causes in pain were significant post muscle damage and induces (1.9±2.2cm), 24hr-post (2.6±2.1cm), and Context: Ice is commonly applied 48hr-post (2.4cm±2.3cm; F =14.60, inflammation via chemical mediators. 4,88 after acute injury with the expectation Histamine is a chemical mediator P<.001). Increased creatine kinase that intramuscular cooling decreases responsible for pain and edema. levels were significant 48hr-post blood flow to help reduce edema and (1248±2668µ/L; F =5.19, P<.001). Objective: The purpose was to 4,88 secondary hypoxia. Contrast-enhanced determine the effects of antihistamine Decreased knee range of motion was ultrasonography (CEU) is an innovative ° on the signs and symptoms of eccentric significant 24hr-post (-8.5±10.7 ; method to measure microvascular F =2.52, P=.025). Decreased isometric muscle damage. Design: Double- 4,88 perfusion using microbubbles as a blinded, randomized controlled strength was significant post contrast agent. CEU has not been laboratory study Setting: Bio- (-0.23±0.34NM/kg) and 24hr-post previously used to assess the effect of (0.19±0.31NM/kg; F =5.19, P<.001). mechanics Laboratory Subjects: 4,88 modalities on skeletal muscle Twenty-four sedentary males Group had no effect on changes in pain; microvascular perfusion. Objective: To (age=20.5±2.6yrs) participated. range of motion; strength, or creatine assess skeletal muscle blood flow and Individuals with loratadine allergies or kinase levels after eccentric exercise. volume of the medial gastrocnemius using any type of medication were However, leg girth changes were during ice application. Design: excluded. Interventions: Signs and significantly greater in the antihistamine Crossover. Setting: General Clinical symptoms of eccentric muscle damage group (post= 0.98±1.45cm, 24hr post= Research Center. Patients and Other were assessed 24 hours prior, 0.95±1.07cm, 48 hrs post= 1.15±1.46cm, Participants: Sixteen healthy adults immediately after (post), 24, 48, & 72 72 hr post= 0.82±1.33cm) compared to (Age: 22.8±2.8 years; Height: hours post-eccentric exercise bout. the placebo group (post= 0.09±0.55cm, 165.9±12.0 cm; Mass: 65.9±15.5 kg) The exercise bout consisted of 6 sets 24hr post= 0.22±0.40cm, 48 hrs post= participated. Interventions: ECG was of 10 repetitions of eccentric hamstring -0.18±0.96cm,72 hr post= -0.03± used to monitor heart rhythm, and was 0.62 cm; F =3.58, p =.009). Con- curls on an isokinetic device. 4,88 used as a trigger for the CEU Participants were randomly selected to clusions: Although, leg girth measurements. The participant was either a 10mg loratadine (active increased more with antihistamine, positioned prone and a thermocouple ingredient in Claritin®) or placebo this increase was not associated with was inserted 1cm into the medial group (N=12/group). Dosing occurred changes in pain or function. Therefore, gastrocnemius based on skinfold twice, 12 hours before and after the over-the-counter dose of measure. The participant rested 10 exercise. Main Outcome Measures: Loratadine had minimal effect on the minutes then a solution of Dependent variables were change signs and symptoms of eccentric microbubbles was infused intra- scores for pain, leg girth, knee passive muscle damage. Future research veniously at a rate of 1.5mL/min for 3 range of motion, knee flexion isometric should investigate other types of min. CEU measurements were obtained strength (expressed relative to body antihistamine, dosing, and timing of with continuous infusion of weight), and serum creatine kinase (CK) dosing. Loratadine at over-the-counter microbubbles at baseline and levels from 24 hours pre-exercise. Pain dosing is not an effective treatment for immediately post treatment. The was measured with a 10-cm visual the signs and symptoms of eccentric treatment condition was randomized to analog scale. Leg girth was measured muscle damage. Funded by GLATA ice (750g crushed ice) or sham (750g using a standard measuring tape at the Research Assistant. candy corn) and application time was femur’s midpoint. A goniometer was dependent on the medial gastroc- used to measure knee range of motion nemius skinfold thickness, which with 90° of hip flexion. Isometric ranged from 10-60 minutes. The strength was determined by an investigator recording CEU measures isokinetic device. Serum CK levels were was blinded to the treatment condition. measured from venous blood samples. The opposite treatment condition was

S-46 Volume 46 • Number 3 (Supplement) May 2011 11091FOTH administered at least 48 hours later. Preliminary Investigation Of and femoral diameter were used to Main Outcome Measures: Three Quadriceps Intramuscular calculate FBF. Measurements were 2x2 repeated measure ANOVAs were Temperature And Femoral Artery taken at predetermined time points used to determine the effect of Blood Flow And Vascular from both the cryotherapy treated leg cryotherapy on blood flow (dB/sec), Conductance During The and the non-treated leg. Main volume (dB) and intramuscular Application Of Cryotherapy Outcome Measures: Change from temperature (°C) immediately And Compression baseline in TIM and TSK (°C). Total following the treatment condition. Trowbridge CA, Holwerda SW, percent change in FBF and FVC (ratio Results: There was no difference in Keller DM: The University of between leg blood flow and mean blood flow following cryotherapy Texas Arlington, Arlington, TX arterial pressure). Repeated measure treatment (2.79±0.28 dB/sec) ANOVA with four levels of time (30, compared to baseline (3.14±0.21 dB/ Context: Cryotherapy and 60, 90, 120 minutes) investigated TIM sec) (p=.293). Following the sham compression are recommended for and TSK. A repeated measures ANOVA condition, blood flow increased after reduction in tissue temperature and with leg (Treated and Non-treated) treatment (3.43±0.25 dB/sec) control of hemorrhage and edema. investigated overall percent changes in compared to baseline (2.59±0.23 dB/ However, limited information exists FBF and FVC. Alpha set a priori at Results: sec) (p=.003). There was no related to the amount and duration of 0.05. TIM was colder at 90 difference in blood volume following vaso-constriction and reduced blood minutes compared to 30 minutes (p = cryotherapy treatment (7.55±0.75 dB) flow that accompanies cryotherapy 0.02), but no further cooling occurred compared to baseline (9.47±0.92 dB) treatment. Objective: To examine the at 120 minutes. TIM maximum change (p=.10). Following the sham effect of 30 on/30 off/30 on/30 off Game was -10.5±1.9°C (occurring at condition, blood volume increased Ready® with medium compression 93.4±5.4 minutes). Thirty-minute TSK after treatment (10.42±0.98 dB) applied to thigh/knee on intramuscular change was significantly greater than compared to baseline (7.32±0.81 dB) other time points (p<0.001) with a temperature (TIM), skin surface (p=.01). Intramuscular temperature maximum change of -21.7±0.5°C. During temperature (TSK), femoral artery blood was significantly different following flow (FBF) and femoral vascular the 2-hour treatment, the average cryotherapy treatment (27.0±5.1°C) conductance (FVC). Design: Within change in FVC was significantly compared to baseline (36.4±1.8°C) repeated measure designs. Setting: different (p=0.015) between Treated (- (p<.001). Following the sham Controlled laboratory setting. 47.9±8.8%) and Non-treated (0.3±3.2%) condition, intramuscular temperature Participants: Four males (age=22±1 yr, legs. Additionally, the average change was not different after treatment mass=88±9 kg, height=184±7 cm, thigh in FBF was significantly different (39.09±1.39°C) compared to baseline skinfold=14.2±4.2 mm) volunteered for (p=0.01) between Treated (-46.2±10.9%) (36.64±.70°C) (p=.171). Con- study. All had no current injury and Non-treated (2.1±2.0%) legs. clusions: This study is the first to involving their thighs or knees and Conclusions: Our preliminary examine microvascular perfusion of were not taking prescription investigation demonstrates that cycled skeletal muscle with therapeutic cold. medications. Interventions: Game cold and compression produces lower Although cryotherapy did not reduce Ready® with ice water (3-11°C) was blood flow and increased vaso- blood flow and volume in the muscle, used with standard knee sleeve. constriction, which may provide as was previously theorized, the Treatment used manufacturer preset in protection against excessive cooled muscle maintained micro- two successive cycles of 30 minutes of hemorrhage, edema, and secondary vascular perfusion character-istics cooling with medium compression (5- metabolic injury. However, more similar to those at baseline, suggesting 50 mmHg) followed by 30 minutes research is warranted to clarify the time that cryotherapy may attenuate blood passive recovery (knee sleeve left in course of and magnitude of these flow and volume increases with acute place). A thermocouple inserted 1.5cm changes in relation to changes in tissue inflammation. below the subcutaneous adipose layer temperature.

sampled TIM and a surface thermo-

couple sampled TSK. Thermocouples were interfaced to a computer through an Isothermex®. Heart rate and blood pressure were collected using a 3-lead ECG and automated blood pressure device. A hand-held probe was placed on the skin over the common femoral artery where Doppler ultrasound measures of femoral blood velocity

Journal of Athletic Training S-47 11F04MOCE The Magnitude Of Applied Cyclic immuno-histochemistry. Stereo- Compressive Load Influences logical point-counting techniques Inflammatory Cell Infiltration But were used to quantify cell nuclei, and Not Lymphangiogenesis In Healthy differentiate to muscle nuclei. Larger Skeletal Muscle sections of tissue were used for Waters CM, Abshire SM, Dupont- Western Blot analysis to identify Versteegden EE, Butterfield TA: markers of lymphangiogenesis using University of Kentucky, Lexington, antibodies VEGF-C and LYVE-1. KY Main Outcomes: Leukocyte in- filtration and lymphan-giogenic Context: Muscle trauma initiates an markers were quantified with standard inflammatory response, often resulting stereology and western blot analyses. in secondary hypoxic injury and Dependent variables were leukocyte prolonged reduction in force. Massage number and protein abundance. therapy is a commonly utilized manual Results: Four days of CCL resulted modality for the treatment of in a disparate cellular infiltration inflammation and muscle pain. The response in all 3 groups, with no application of massage as a modality differences found in lymphan- includes a variety of techniques, each giogenic markers: The 1.4N load varying in the magnitude, duration and exhibited less cellular infiltration frequency of the applied load. Recently, when compared to the contra-lateral we have shown that muscle damaged control (14.2±1.4cells/0.60mm2 vs through repetitive eccentric exercise 24.8±3.2cells/0.60mm2, p=0.005); exhibited significant improvements in the 4.5N load exhibited greater form and function following cyclic infiltration compared to contra-lateral compressive loading (CCL) as an control (41.3±4.7cells/0.60mm2 vs analogue to massage, when compared 22.6±3.2cells/0.60mm2, p=0.003); to damaged control muscles. However, and the 11.0N load exhibited greatest the mechanisms of the improved cellular infiltration compared to function and reduced damage following contra-lateral control (61.9±9.7cells/ CCL remain unknown. Objective: 0.60mm2 vs 20.8±2.4cells/0.60mm2, Investigate the influence of various p=0.001). There were no systemic magnitudes of CCL on inflammatory cell effects of CCL on lymph vessel infiltration and lymph vessel growth in growth and inflammation. Simple healthy skeletal muscle. Design: Cross- linear regression indicated magnitude over control design, with three pure- of load was an excellent predictor of controls analyzed for possible systemic the difference in cellular infiltration effects. Setting: This experiment took (R2=0.99). Conclusions: Our place within a controlled basic science findings indicate the inflammatory laboratory setting. Participants: response to CCL in skeletal muscle is Twenty one Male Wistar Rats (200g). associated with the magnitude of load Interventions: Rats were placed in applied. Interestingly, at optimal load one of 4 groups based on load: 0.0N, (1.4N in this study) there is a potential n=3; 1.4N, n=6; 4.5N, n=6; and 11.0N, anti-inflammatory response to n=6. Rats receiving treatment massage. There was no evidence of underwent CCL to one tibialis anterior increased lymphangiogenesis at any for 30 minutes per day for 4 CCL load or a systemic effect. Funded consecutive days, with the by the Master’s Grant Program of the contralateral limb serving as control. NATA Research & Education On day five, rats were euthanized and Foundation. muscles were harvested, and frozen for further analyses. Tissue samples were sectioned at 0.08mm and stained for cellular infiltration via hemotoxylin and eosin staining and

S-48 Volume 46 • Number 3 (Supplement) May 2011 EBF: Modalities Tuesday, June 21, 2011, 10:30AM-11:30AM, Room 218

Free Communications, Oral Presentations: Patient Oriented Outcomes Tuesday, June 21, 2011, 4:30PM-6:00PM, Room 218; Moderator: Luzita Vela, PhD, ATC 11114MOMU Comparison Of Health-Related included the PedsQL total score (TS) and whether differences are due to Quality Of Life In Interscholastic and 5 subscale scores [physical certain sports. Adolescent Athletes Participating functioning (PF), psychosocial In Fall, Winter, Or Spring Sports functioning (PSF), emotional 11338FOIN Califano KM, Snyder AR, Lam KC, functioning (EF), social functioning Changes In Health Related Quality Valovich McLeod TC: A.T. Still (SOF), school functioning (SCF)], and Of Life In Active Females One Year University, Mesa, AZ 3 subscale scores of the MFS [general After ACL Tear fatigue (GF), sleep fatigue (SF), Carr KE, McGuine TA, Winterstein Context: Due to increased emphasis on cognitive fatigue (CF)], with higher AP, Hetzel SJ, Sigl J: University of evidence-based practice and whole scores indicating better HRQOL. One- Wisconsin, Madison, WI person healthcare, attention has been way ANOVAs were conducted to given to the evaluation of health- compare total and subscale scores Context: Anterior cruciate ligament related quality of life (HRQOL) in between the athlete groups and alpha (ACL) tears occur with higher adolescent athletes through the use of was p<0.05, two-tailed. Means and frequency in female athletes and limit patient-rated outcome measures standa rd deviations (SD) were their ability to fully participate in (PROMs). However, little is known calculated for all scale scores and data athletics for 6 to 8 months. However, about HRQOL in this population, are reported as (mean±SD). Results: there are limited data about how health including whether HRQOL differs Spring athletes reported significantly related quality of life (HRQOL) is throughout the school year. Knowledge higher scores than fall athletes for TS affected following an ACL tear. regarding representative values of (p=.003, spring: 91.2±9.0; fall: 88.8±10.2) Objective: To identify changes in HRQOL obtained through PROMs is and GF (p=.001, spring: 89.3±13.0; fall: HRQOL in female athletes one year after important for accurate scale 85.2±15.8), winter and spring athletes an ACL tear using the SF 12 v2.0, a interpretation following injury. reported significantly higher scores widely accepted self report survey used Objective: To compare preseason (p<.001) for PF than fall athletes (winter: by healthcare providers and HRQOL of adolescent athletes who 92.7±10.4; spring: 94.1±7.8; fall: researchers to measure HRQOL. participate in either fall, winter, or spring 89.9±11.9), and spring athletes scored Design: Prospective cohort. Setting: interscholastic athletics. Design: significantly higher (p=.04) than winter Data were collected at a sports medicine Cross-sectional. Setting: Athletic athletes for SCF (spring: 85.4±14.8; clinic and university health service. training facilities. Patients or Other winter: 82.5±15.5). There were no Patients or Other Participants: Participants: A convenience sample of differences (p>.05) between athlete Participants were a convenience sample single-sport interscholastic adolescent groups and PSF, EF, SOF, SF, and CF. of 90 high school and college females athletes participating in either fall Conclusions: Our results indicate that (age = 16.8 ±1.7 years) who sustained (n=413; male=354, female=59; spring single sport adolescent an ACL tear while participating in a age=15.5±1.2 years), winter (n=422; interscholastic athletes report better sport or regular fitness activity and male=313, female=109; age=15.9±1.2 health status than single sport athletes subsequently underwent ACL years), or spring (n=282; male=162, participating in fall and winter season reconstruction surgery. Interventions: female=120; age=15.9±1.2 years) sports. sports on several measures of HRQOL, Each subject completed the SF12 v2.0 Interventions: Athlete group (fall, including school functioning, general at multiple intervals over the course of winter, or spring) was the independent fatigue, and overall health. These one year. The Physical Composite variable. Participants completed the findings suggest that adolescent Score (PCS) and the Mental Composite Pediatric Quality of Life Inventory athlete HRQOL may vary depending on Score (MCS) of the SF12 v2.0 measure (PedsQL) (internal consistency=.68-.88) sport season, with better HRQOL eight domains of physical and and the PedsQL Multidimensional reported later in the school year. As a emotional health and are recognized as Fatigue Scale (MFS) (internal result, it may be necessary to evaluate valid measures of patient outcomes consistency= .75-.92) during one HRQOL at the start of each new sport after treatment of orthopedic injuries. testing session at the start of their season. Future research is warranted The test-retest reliability of the SF12 respective sport season. Main Outcome to determine if multi-sport athletes v2.0 has been reported to be good to Measures: Dependent variables exhibit similar differences in HRQOL excellent (0.760 to 0.890) in patients

Journal of Athletic Training S-49 with various orthopedic injuries. Main Web-based. Patients or Other and interpret (28.8%). The most Outcome Measures: Dependent Participants: 1469 randomly sampled frequently endorsed problems of use variables included the paired ATs (age=36.8±9.8 years; 48% female; reported by AT-NON were that differences in the composite scores 76% practice >5 years) working in the outcomes instruments are time (PCS and MCS) between the pre-injury college/university, two-year institution, consuming for clinicians to score and and 12 months post injury intervals. secondary school, clinic, hospital, or interpret (31.2%), time consuming Differences were assessed with the industrial/occupational setting. Non- (46.3%) and irrelevant to patients Wilcoxon Signed-Rank Test (p< 0.05) practicing ATs were excluded. (28.0%), and require a support reported as the median (inter-quartile Intervention: An email invitation was structure that clinicians do not have ranges [IQR]: 25th and 75th). Results: sent to the random sample of ATs asking (29.3%). Conclusions: These results The paired PCS scores (-1.61[-5.3, 0.87]) them to complete a validated survey, suggest that while there are benefits were significantly lower (p= 0.001) 12 through Survey Monkey, regarding the to using patient-rated outcomes, there months post ACL tear (pre-injury = use, benefits, and barriers of outcome are also barriers (eg, completion and 56.61 [56.61, 58.53]; 12 months post measures in athletic training. The scoring time) to their use. Barriers are injury = 55.78 [52.82, 57.55]). The paired survey consisted of 86 questions split similar between AT-PR and AT-NON. MCS scores (-2.19 [-5.82, 2.95]) were into two question sets. ATs who Future research should investigate significantly lower (p= 0.013) 12 months indicated they used patient-rated strategies to decrease barriers and post ACL tear (pre-injury = 58.9 [53.65, outcome measures (AT-PR) completed facilitate use of patient-rated outcome 61.85]; 12 months post injury = 65 Likert-style (5pts: 1=strongly agree, measures in athletic training practice. 56.6:[51.04, 55.66]). Conclusions: 5=strongly disagree) questions about Female athletes who sustained an ACL the benefits and barriers to the use of 11199OOMU tear rated their physical and emotional these instruments. ATs who indicated Identifying Differences In Health- health to be worse 12 months after their no use of patient-rated outcome Related Quality Of Life Between knee injury as measured by the Physical measures (AT-NON) completed 21 Adolescent Athletes And A General, Composite Score and Mental questions about the barriers of use. Healthy Adolescent Population Composite Score of the SF12 v2.0. Internal consistency was high for each Lam KC, Snyder Valier AR, Bay RC, Understanding that HRQOL is lower survey factor (Cronbach’s alpha=.89, Valovich McLeod TC: A.T. Still one year after this major knee injury may .90, and .71, respectively). A reminder University, Mesa, AZ enable healthcare providers to better email was sent to all potential subjects affect the physical, psychological and at 2-weeks post-initial invitation. Main Context: Patient-rated outcome social health outcomes of their female Outcome Measure: Dependent measures (PROMs) are important for athletes. variables were the endorsements for the assessing health-related quality of life benefits and barriers to the use of (HRQOL) and providing patient- 11293FOMU patient-rated outcome measure centered, whole person healthcare. Benefits And Barriers To The Use Of questions. Likert questions were Normative values established for a Patient-Rated Outcome Measures In classified as endorsed when a rating of general, healthy population are often Athletic Training “agree” or “strongly agree” was used as a frame of reference when Snyder AR, Vela LI, Chaffee A, selected by a participant. Data are utilizing generic PROMs for patient care Parsons JT: A.T. Still University, reported as percentage endorsed (%). and clinical decisions. However, Mesa, AZ, and Texas State Results: 458 ATs initiated the survey previous studies have indicated that University, San Marcos, TX (response rate=31.2%) and 398 ATs athletes tend to report significantly (AT-PR=26.1%, AT-NON=73.9%) better HRQOL than a general, healthy Context: Evaluation with patient-rated completed the survey (response population, which may decrease the outcome measures is important for rate=27.1%). The most frequently utility of these normative values when driving treatment decisions and endorsed benefits of use reported by providing medical care for athletes. determining effective interventions. AT-PR were enhancing communication Objective: To identify differences in However, athletic trainers (ATs) rarely with patients (89.7%) and other health HRQOL, as measured by a commonly use them. Understanding the reasons care professionals (80.4%), directing used generic PROM [Pediatric Quality for disuse of patient-rated outcomes in patient care (86.9%), and increasing of Life Inventory (PedsQL)], between athletic training may assist in exam efficiency (80.4%). The most adolescent athletes and a general, constructing strategies that facilitate frequently endorsed problems of use healthy adolescent population. Design: routine collection of these important reported by AT-PR were that patient- Cross-sectional. Setting: Athletic outcomes. Objective: To identify the rated measures are time consuming training facilities. Patients or Other benefits and barriers to the use of (44.2%), difficult (35.6%), and Participants: The athlete group (ATH) patient-rated measures in athletic confusing (30.8%) for patients and was a convenience sample of 1955 training. Design: Survey. Setting: time consuming for clinicians to score (male=1526, female=429; age=

S-50 Volume 46 • Number 3 (Supplement) May 2011 15.1±0.8 years) interscholastic peers. Our findings also suggest that required leg or shoulder pain ≥1 week adolescent athletes. The general, adolescent athletes may constitute a that interfered with daily activities and healthy group (GEN) was represented unique patient population that requires for which patients sought medical by values extracted from a previously its own set of normative values related attention. Interventions: The published normative dataset by Varni to generic PROMs. Healthcare independent variable was group et al. (2007) for 14, 15, and 16 year- practitioners should be cognizant of membership (Con & Exp). Scapular old (y/o) healthy adolescent these differences and account for them dyskinesis was examined using three individuals (n=729). Interventions: when providing care for adolescent special tests: 10 repetitions each of Group was the independent variable. athletes and when utilizing the PedsQL unweighted and weighted flexion Participants completed the PedsQL GCS and other PROMs for patient bilaterally, and scapular flip sign. These Generic Core Scale (GCS) (internal care. tests performed in combination produce consistency=.68 - .88) during one 81-85% agreement, k=0.51-0.59. The testing session. Main Outcome 11291OOMU Disabilities of the Arm, Shoulder and Measures: Dependent variables The Relationship Between Clinical Hand (DASH) (MDC=12.75pts, scale included the total PedsQL GCS score Tests For Scapular Dyskinesis And range:0-100; higher scores represent (TS) and 5 subscale scores [physical Health-Related Quality Of Life diminished HRQOL) and American functioning (PF), psychosocial Assessed Via Two Upper Extremity Shoulder and Elbow Surgeons (ASES) functioning (PSF), emotional Self-Report Scales In Patients With (MCID=6.4pts, scale range:0-100; functioning (EF), social functioning Shoulder Versus Lower Extremity higher scores represent better HRQOL) (SOF), school functioning (SCF)], with Pain self-report scales were administered to higher scores indicating better VonHolten SL, Sauers EL, Huxel assess HRQOL. Both scales have been HRQOL. Independent-samples t-tests Bliven K, Bay RC: St John’s Sports reported to be reliable and valid were conducted to compare total and Medicine, Springfield, MO, and Post- measures of disability in populations subscale scores between ATH and Professional Athletic Training with a broad range of shoulder injuries. GEN. Groups were matched by age Program, A.T. Still University, Mesa, Main Outcome Measures: The (14, 15, 16 y/o) and alpha was set at AZ dependent variables for aim 1 were the p<0.05, two-tailed. Data are reported scapular special test findings, classified as (age group: mean±SD for ATH, Context: Scapular dyskinesis may be as positive or negative, based on the mean±SD for GEN) Results: ATH a contributing factor to shoulder pain visible presence of excessive or reported significantly higher scores and disability, and numerous clinical asymmetric scapular winging and/or (pd”0.02) than GEN across all age tests purport to assess scapular failure to control scapular motion. The groups for TS (14y/o: 89.4±9.6, dyskinesis. However, relationships dependent variables for aim 2 were 85.7±12.0; 15y/o: 89.8±9.6, 84.7± between scapular dyskinesis and self- patient self-report scores for the DASH 12.7; 16y/o: 89.6±10.1, 85.8±11.4), reported, health-related quality of life and ASES. The Fisher’s exact test was PF (14y/o: 91.1±10.6, 89.0±13.2; (HRQOL) in patients with shoulder pain used to compare scapular special test 15y/o: 91.5±11.2, 88.6±13.6; 16y/o: and dysfunction are unknown. findings between groups and Mann 91.8±10.4, 89.1±12.7), PSF (14y/o: Objective: Assess whether three Whitney-U tests were used to analyze 88.6±10.6, 84.0±13.3; 15y/o: 88.9± standard clinical tests for scapular differences between groups on DASH 10.7, 82.7±14.2; 16y/o: 88.5±11.5, dyskinesis differentiate between and ASES scores. Alpha was p=0.05, 84.0±13.0), EF (14y/o: 88.8±13.9, patients with shoulder pain and lower two-tailed. Results: Groups did not 81.0±17.8; 15y/o: 88.8±14.6, 79.7± extremity pain (Aim 1), and establish the differ significantly on the scapular 18.6; 16y/o: 88.4±15.6, 80.2±18.0), relationship between these tests and special tests (unweighted flexion, and SOF (14y/o: 92.6±11.0, self-reported HRQOL in patients with p=1.00; weighted flexion, p=0.07; 89.8±14.7; 15y/o: 94.0±10.0, 89.1± shoulder pain (Aim 2). Design: Cross- scapular flip sign, p=0.68). Significantly 14.5; 16y/o: 93.6±11.2, 90.3±12.6). sectional. Setting: Outpatient clinic. lower HRQOL was observed between For SCF, 14 and 15 y/o ATH scored Patients or Other Participants: 15 groups for the DASH-Total (Exp significantly higher (p<0.02) than their patients being treated for lower =23.7±13.5pts, Con=0.7±1.1pts, p=0.02) GEN counterparts (14y/o: 84.1±14.8, extremity pain served as a control group and ASES-ADL (Exp=34.8±10.1pts, 81.2±17.1; 15y/o: 83.9±15.0, 79.3± (Con) [(male=11, female=4); Con=49.4±1.4pts, p=0.04). Patients with 17.9), but the difference between the age:19.3±4.6yrs; height:176.1±8.8cm; a positive weighted flexion test 16 y/o groups was not significant mass:74.7±15.0kgs] and 15 patients displayed significantly different (p=0.23; 16y/o: 83.4±15.9, 81.5± being treated for shoulder pain served scores on the DASH-Total (positive 17.4). Conclusions: Our results as the experimental group (Exp) =12.2±15.0pts, negative=6.6±11.1pts, support previous findings indicating [(male=9, female=6); age: 29.8± p=0.017) and ASES-ADL (positive that adolescent athletes report better 13.7yrs; height: 174.9±10.4cm; mass =39.3±11.1pts, negative =45.4 HRQOL than a general population of :73.4±13.1kgs]. Inclusion criteria ±8.5pts, p=0.038), indicating lower

Journal of Athletic Training S-51 HRQOL. Conclusions: The three variable was created based on the tests for scapular dyskinesis in this minimum acceptable criteria for FAI. study did not differentiate between Based on current literature this criterion shoulder pain and lower extremity pain was established as at least one ankle patients. A positive weighted flexion sprain and at least one episode of test for scapular dyskinesis was giving way (MC_FAI). Data were correlated with lower self-reported modeled using chi-square and HRQOL in both groups. The multinomial logistic regression. 95% relationship between scapular confidence intervals (CI) were dyskinesis and HRQOL warrants calculated for the resulting odds ratios. further study. Results: 53.30% of participants experienced a dominant limb ankle 11242DOIN sprain, and 48.22% of participants with Critical Review Of Self-Reported a dominant ankle sprain reported at Functional Ankle Instability least an episode of giving way. The Measures model revealed that all questionnaires Donahue M, Simon J, Docherty CL: were better at determining when a Indiana University, Bloomington, IN participant did not meet the minimum criteria for FAI (no MC_FAI=95.7%, Context: Functional Ankle Instability MC_FAI=55.6%). Backwards stepwise (FAI) lacks a gold standard measure or reduction of the model revealed in the universally accepted inclusion criteria. final step that only the CAIT (X2= 8.22, As a result, a wide variety of self- odds ratio= 0.31, CI 0.14-0.69, p=.004) reported ankle instability measures with the AII (X2= 29.70, odds ratio= 0.10, have been developed for use in FAI CI 0.04-0.23, p<0.001) had a significant research. Objective: Determine which relationship with the dependent ankle instability measure identifies variable (MC_FAI). Conclusions: The subjects who meet the minimum model illustrates that no single measure accepted criteria for FAI. Design: Cross- was able to predict if an individual met sectional study Setting: University the minimally accepted criteria for FAI. classroom settings. Participants: Two However, the model identified that the hundred and forty-two college aged combined use of the CAIT and AII subjects (104 males, 138 females, and produced a significantly accurate 21.38 ± 1.40 years) volunteered from a prediction of ankle stability status. large Midwestern university popu- Based on the results of this model we lation. Interventions: The inde- strongly recommend that the CAIT and pendent variables were the seven ankle AII be used in conjunction to determine instability questionnaire: Ankle ankle stability status. Instability Instrument (AII), Ankle Joint Functional Assessment Tool (AJFAT), Chronic Ankle Instability Scale (CAIS), Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM), Foot and Ankle Instability Questionnaire (FAIQ), Foot and Ankle Outcome Score (FAOS). Subjects were asked to complete all questionnaires in one testing session. The order of the questionnaires was randomized and subjects were instructed to complete each questionnaire for their dominant limb. All seven of these questionnaires are currently used or appear in the FAI literature in the past five years. Main Outcome Measures: The dependent

S-52 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Issues in Teaching and Learning Wednesday, June 22, 2011, 8:00AM-9:00AM, Room 218; Moderator:Tim Spiecher, PhD, ATC 11234FOPE The Perceptions Of Clinical saturation occurred. The data was to understand and demonstrate during Reasoning Skills And Abilities In transcribed verbatim and checked for the clinical education experience. One Students Who Learned A Student- accuracy. Two investigators indepen- way for students to express clinical Centered Clinical Reasoning dently used a framework analysis reasoning skills is through their case Technique method to create a thematic framework presentations. However, the time Vela LI, Heinerichs S, Drouin J: and interpret the data. Peer review pressured environment of the clinical Texas State University, San Marcos, strategies were used to establish setting may inhibit clinical instructors TX; West Chester University, West trustworthiness and accuracy of the (CIs) from engaging in a teacher Chester, PA; Lock Haven University, themes. Results: Participants’ centered approach. Learner centered Lock Haven, PA comments on SNAPPS centered on approaches have been utilized areas where SNAPPS improved clinical successfully in medical education for Context: Clinical reasoning (CR) is the reasoning and clinical education assessing this skill. Objective: To process by which knowledge, experiences. Participants commented on determine the feasibility of utilizing a cognition, and metacognition are the improved ability to process learner centered technique (SNAPPS) combined into the clinical decision thoughts during an orthopedic injury for assessing a student’s ability to making process. Teaching CR enables evaluation with an emphasis on the express clinical reasoning skills in students to make better clinical analysis of a differential diagnosis. athletic training. Design: Feasibility decisions during clinical education Participants also remarked on the study Setting: Three undergraduate experiences. SNAPPS is an acronym for notable improvements in organization, CAATE accredited athletic training a student-centered clinical reasoning detail and communication of the clinical programs. Participants: As part of a and case presentation method used in examination findings. The education larger study 13 CIs (6 males, 7 females) clinical education. Objective: To process was also augmented by clinical were randomly assigned based on sport investigate entry-level athletic training instructor feedback and self-directed coverage, year’s experience, and students’ (ATS) perceptions of the learning experiences required in the number of students supervising. CIs SNAPPS technique on clinical SNAPPS procedure. Participants did were involved in a 4 week study utilizing reasoning skills and abilities. Design: comment that time constraints and the a learner centered technique (SNAPPS) Descriptive qualitative method using detailed nature of SNAPPS were two with 15 undergraduate students. Eight focus groups (FG) Setting: Two cons of the technique particularly participants (62%) had e”10 years undergraduate, entry-level, CAATE during busy clinical days. Conclusions: experience as a CI and 5 (48%) had <10 accredited athletic training education Perceptions of students using SNAPPS years experience. All CIs and students programs. Patients or Other were positive indicating that the attended a training session that Participants: Thirteen participants (age integration of SNAPPS into clinical demonstrated the technique, addressed = 21.62±1.19; GPA = 3.27±0.25; gender education is worthwhile. In addition to the concept of clinical reasoning, and = 8 female, 5 male) were purposively improving clinical education allowed for questions and answers. selected based on years of clinical experiences, the vocabulary, concepts Interventions: Thirteen CIs listened to education experiences (>1 year) and and deployment of SNAPPS appeared their assigned students utilize the completed coursework (completed to aid students in the construction of SNAPPS technique for all authentic orthopedic evaluation series) to meaning in clinical reasoning. orthopedic case presentations over a 4 participate in one of two FGs. FG week period. Following the 4 week 11241FOPE participation was limited to participants intervention CIs were asked to complete Clinical Instructor’s Perceptions who were assigned to learn and apply an online survey, the SNAPPS Of A Learner Centered Technique the SNAPPS procedure in a clinical Perception Survey (Cronbach’s = .862). To Express Clinical Reasoning education setting over a 4-week period. Main Outcome Measures: The Skills In Athletic Training Data Collection and Analysis: After SNAPPS Perceptions Survey consists Students learning and employing the SNAPPS of 8 likert scale items for which 1= Heinerichs S, Vela L, Drouin J: West technique for all authentic orthopedic strongly disagree, 5= strongly agree Chester University, West Chester PA; case presentations over a four-week and four open ended items centering Texas State University, San Marcos, period, participants took part in one of on the effectiveness of the technique. TX; Lock Haven University, Lock two (n=4 and n=9), 25-30 minute FG Data was analyzed using descriptive Haven, PA interviews. The FGs were guided by a statistics while trends were ascertained structured interview guide consisting in open ended questions. Results: of 6 open-ended questions. The focus Context: Clinical reasoning skills are Twelve of 13 (92.3%) CIs completed the group interviews continued until data valuable for athletic training students online survey. Twelve (100%) of the

Journal of Athletic Training S-53 participants strongly agreed or agreed undergraduate sports medicine reinforce what they already do or to that SNAPPS improved the quality of students were randomly selected from teach new strategies. Participants in presentations. Ten (83%) of the a sports medicine laboratory course. the PAF training found it beneficial, participants strongly agreed or agreed Data Collection and Analysis: The which may improve the acceptance of that SNAPPS enabled the students to participants practiced skills in groups feedback and their wiliness to provide be more concise in their case of four, they were instructed to assess feedback. Conclusions: The results of presentations. Ten (83%) of the and provide feedback to their peers. this study indicate that PAF training can participants strongly agreed or agreed There were three sets of laboratory improve certain aspects of the feedback that SNAPPS improved the students skills with two days of practice for each that students provide to each other ability to clinically reason during the set. Eight participants received a two- while practicing procedures to enhance evaluations. Ten (83%) of the day PAF training after the first set of skill practice. participants strongly agreed or agreed labs; eight participants served as the that SNAPPS enabled students to control group. The training consisted 11093FOPE formulate a differential diagnosis. None of discussion of the background/ Standardized Patient Encounters of the participants reported any purpose of PAF, reflection of past peer And Case-Based Simulations disagreement or strong disagreement interactions, discussion of feedback Improve Students’ Confidence with any statements on the survey. tips, analysis of videotaped scenarios And Evaluation Skills Eight (66%) of the participants and role playing exercises. The Walker SE, Weidner TG, Armstrong described that SNAPPS enabled their participants were videotaped and audio KJ: Ball State University, Muncie, students to think more critically and taped. The feedback was transcribed IN, and Georgia College & State allowed for a more organized case verbatim and actions that provided University, Milledgeville, GA presentation. Conclusions: It is feedback were recorded in Excel. feasible to utilize a learner centered Content and quality of the feedback Context: Athletic training student’s technique to express clinical reasoning were evaluated with the feedback clinical skills are evaluated via many skills in athletic training students quality scale (descriptive, general, methods, such as role play, case during their clinical experiences. CIs incorrect or missing). The videotaped studies, case-based simulations (CBS), felt the technique was thought feedback was also categorized by the and standardized patients (SP). No provoking, allowed for organization, type of feedback (reaffirming or research has examined the longitudinal and effective in student’s expression of corrective). Content, quality and type effects of these evaluation experiences, clinical reasoning skills. of feedback were qualitatively coded particularly on future clinical decision- for themes using deductive content making. Objective: To explore athletic 11302DOPE analysis to determine differences in the training students’ perceptions Peer Assessment/Feedback Training feedback given by the experimental regarding a small group SP encounter Has A Positive Effect On The group when compared to the control versus an individual CBS on their Feedback That Students Provide group. Independent analysis yielded clinical decision-making abilities. Marty MC, Henning JM, Vetter AM: 96.30% agreement and 100% agreement Design: Descriptive qualitative method The University of North Carolina at after discussion. Independent analysis, of inquiry with a grounded theory Greensboro, Greensboro, NC, and member checking and peer debriefing approach. Setting: Individual Ashland University, Ashland, OH were used to ensure accuracy and interviews at one Midwestern trustworthiness. Results: The University. Patients or Other Context: Peer assessment/feedback videotaped data analysis suggests that Participants: Eleven athletic training (PAF) is clearly occurring in athletic PAF training potentially shaped the students (4 males, 7 females; 20 + 0.894 training education programs. However, consistency of descriptive feedback, years old) who were enrolled in a Lower it remains unclear whether students use of strategic questioning, staying Extremity Orthopedic Evaluation course would improve their ability to assess on task and the amount of reaffirming during their first or second semester in their peers and provide corrective feedback provided. Findings also the athletic training education program feedback if they received formal suggest that other factors shaped the (ATEP) participated in this study. All training in how to do so. Objective: peer feedback, such as baseline ability participants received the same Determine if a PAF training program to provide quality feedback, difficulty classroom and laboratory instruction. affected the quality and type of of the skill and the number of errors Participants’ were randomly assigned feedback students provided to their performed while executing the skills. to one of two groups (Group A peers. Design: Descriptive quasi- Some of the strategies discussed in the completed a CBS, then small group SP experimental repeated measures. PAF training were used by the control encounter; Group B completed a small Setting: Undergraduate sports groups even though they did not group SP encounter then a CBS) to medicine class. Patients or Other receive training. The training could be control for different semesters in the Participants: Sixteen upper-level beneficial for all students to either ATEP. Individual interviews took place

S-54 Volume 46 • Number 3 (Supplement) May 2011 4 weeks following the final evaluation experience. Data Collection and Analysis: Semi-structured interviews were recorded, transcribed verbatim and analyzed using open coding, axial and selective coding (i.e., develop themes/ threads). To ensure trustworthiness, member checks and peer de-briefing were employed (performed by a qualitative research expert in athletic training). Results: Three themes emerged from the participants’ responses: 1) increased confidence towards future evaluations, 2) improved organization throughout the evaluation process, and 3) enhanced value of group members during small group SP encounter. Overall, students’ perceived that as a result of both the CBS and small group SP encounter they were more confident and felt better prepared realizing they possessed the knowledge and skills to perform future evaluations. Students also perceived that both experiences improved their clinical decision-making skills. Students felt they would perform future evaluations in a more organized manner. Lastly, students reported that they valued interacting with their peers and sharing ideas about questions and evaluation methods during the small group SP encounter. However, students reported a lack of confidence regarding their verbal and non-verbal communication with each other in a group. Overall, students reported difficulty navigating and understanding their role within a group. Conclusions: Both the small group SP encounter and CBS increased students’ confidence and improved their clinical decision-making skills for future patient evaluations. The small group SP encounter also allowed students to interact with their peers in forming a patient’s diagnosis, a necessary aspect of functioning as part of a health care team.

Journal of Athletic Training S-55 EBF: Education Wednesday, June 22, 2011, 9:15AM-10:00AM, Room 218 Free Communications, Oral Presentations: Gender Issues In Athletic Training Wednesday, June 22, 2011, 10:30AM-11:15AM, Room 218; Moderator: Ashley Goodman, PhD, ATC 11273FOHE Gender Bias In The Athletic Training training. Ten certified ATs provided investigated. Objective: To identify Profession feedback on the survey to establish differences among genders between Mackey T, Kamphoff C, Armentrout S: face validity, and several questions occupational settings and across the Minnesota State University, Mankato, were clarified based on their feedback. occupational life span. Design: We MN Main Outcome Measures: A series of used a non-experimental, descriptive chi-square analyses were calculated to research design to observe the trends Context: Research regarding gender in determine gender differences in of the National Athletic Trainers’ athletic training is limited; however, the perceived treatment. A multiple linear Association (NATA) membership data studies that have been published regression analysis was calculated to in regard to gender, occupational suggest that female athletic trainers determine the relationship between setting, and age. Setting: We obtained (ATs) experience gender bias. Even gender, salary, age, and years of NATA membership demographic data though the majority of NATA members experience. Results: Chi-square (October 27, 2009). Participants: The are females, evidence suggests that analyses indicated that compared to population of athletic training members female ATs are less likely to work in males, females were more likely to included both full-time and part-time supervisory positions, earn a lower indicate differences in how they are ATs but excluded graduate assistants, salary, experience gender bias as treated or perceived by coaches (61.1%; retired and non-employed individuals. mothers, and have less opportunity to p=.001), athletes or patients (33.7%, The sample of ATs has 12,277 female work in professional sports compared p=.001), athletic administrators (32.5%; ATs and 13,255 male ATs with an age to male ATs. Objective: The primary p=.001), parents (27.8%; p=.001), and range of 22 to 66 years old. A majority purpose of this study was to examine physicians (17.0%, p=.001). A multiple of Athletic Trainers (70.4%, N=18571) gender differences in perceived linear regression analysis indicated that were employed in the college/ treatment of male and female ATs. The gender, age and experience were related university, clinic, and secondary school secondary purpose was to examine the to salary (p=.001; r2=.276). More setting. The frequencies of the relationship between gender, salary, specifically, females at the same age and individuals in the other settings were age and years of experience. Design: years of experienced as males earned too small for any meaningful statistical Cross-sectional survey design. Setting: on average of $3,664 less than males (p analysis. Intervention: We calculated An on-line survey sent via email using =.001). Conclusions: Findings suggest frequencies and percentages to Survey Monkey. Patients or Other gender bias exists in the athletic training determine demographic and descriptive Participants: A total of 3300 ATs were profession. Females report perceived data. We analyzed the data using an randomly selected from the NATA differences in treatment and a lower ANOVA to identify the differences membership database. Male and female salary regardless of age and years of between genders across age and ATs who work with patients were sent experience. More education is needed setting. Main Outcome Measures: We a link to an on-line survey that focused to increase awareness and promote observed trends in occupational setting on perceived gender issues in athletic equality for females within athletic and gender between the ages of 22 and training. Approximately 32% (n=1040) training. 67 years old. Results: We identified of the members contacted completed significant differences between 11150FOHE some component of the survey; genders across the ages (F1,18569= however 127 participants did not Labor Force In Athletic Training: 110818.080, P<.001, η2=.068). complete the entire survey and their Age, Gender And Setting Factors Although women account for 42.9% of responses were not included. The final Eberman LE, Kahanov L: Indiana the total sample population, women sample included 913 athletic trainers State University, Terre Haute, IN occupy a large majority of the (Males = 421, Females = 489, 3 did not profession between ages of 22-28, but indicate gender) with a mean age of 36.2 Context: Gender related occupation then drastically decline between the (SD = 9.76). The participants had or occupational setting shifts may be ages of 28-35. The male population size worked in the athletic training occurring in Athletic Training. To remains relatively consistent between profession for an average of 12.32 years better understand the labor force and the ages of 27-42 years old and (SD = 8.67). Interventions: The survey distribution of gender among settings, eventually dissipates. We identified was developed based upon the limited a comparison of male and female significant differences between research regarding gender in athletic employment patterns should be genders across the occupational

S-56 Volume 46 • Number 3 (Supplement) May 2011 settings (F1,18569=61.908, P<.001, structured phone interviews. Setting: female AT students seek out mentors η2=.003). The male population declines Division I clinical setting Patients or in their industry while they complete in the college/university and clinic Other Participants: 14 female ATs their coursework and practica. The ATs settings, but then increases in the using both criterion and snowball in the current study indicated a mentor, secondary school setting during their sampling techniques were included in regardless of gender, helped them feel mid- to late-forties. We also observed the study. The mean age was 27 ± 2 empowered to navigate the male-centric significance at the intercept between with 5 ± 2 years of experience. Criteria terrain of athletic departments by setting and gender (F1,18569=63529.344, included employment at the Division I encouraging them to be assertive and P<.001, η2=.845) which is enhanced clinical setting, full-time assistant AT, not second-guess their decisions. across the ages (F1,18569=23566787.642, and at least three years of working P<.001, η2=.939). The intercept of experience but no more than nine years setting and gender accounts for 85% to avoid role continuance. Participants of the variability in occupational setting represented 5 NATA districts. Data change and the addition of age recruitment was guided by data increases the accounting for variability redundancy. Data Collection and in occupational setting change to 94%. Analysis: Analysis of the interview Conclusions: We identified significant data followed inductive procedures as differences among genders between outlined by a grounded theory settings and across the ages in addition approach. Credibility was established to an overall decrease among all by member checks, multiple analyst professionals. A marked decline in triangulation, and peer review. Results: female athletic trainers occurs at the age Eleven of the 14 participants described of 27, yet the male population increases experiences of gender bias, while at the secondary school suggesting a thirteen of the fourteen encountered setting shift. Burnout, fatigue, pay issues regarding their age. Two themes scale and a misunderstanding of emerged to explain experiences of professional culture and job duties may gender bias: 1) gender role influence the exodus or shifting in stereotyping, and 2) negative past athletic training. experiences with female ATs. Coaches served as the primary source of gender 11156DOHE bias. Participants indicated experiences Is It About Respect? Using Role in which their ability to make clinical Congruity Theory To Explore The judgements were questioned by male Challenges Faced By Young, Female coaches, regardless of their past Athletic Trainers performance as ATs. Other experiences Pagnotta KD, Mazerolle SM, Borland of bias were encountered due to JF, Burton LJ: University of coaches’ perceptions of negative Connecticut, Storrs, CT, and experience with previous female ATs, Springfield College, Springfield, MA which influenced future relationships with other female ATs. Clear Context: Athletic training is communication with both coaches and experiencing an increase in the number players on expectations and of women entering the profession with philosophies regarding medical care, a female ATs representing 46.5% of ATs supportive head athletic trainer within the NATA. Despite this increase regarding clinical competence, and the collegiate setting appears to only having and serving as a role model were retain one-quarter of these ATs and a cited as critical tools to alleviate gender limited number assume the role of Head bias in the workplace. Conclusions: AT. Role congruity theory has been The female ATs in this study stressed proposed to understand why women the importance of being assertive with are under-represented in leadership the coach early on in the season with positions. Objective: To understand regard to their role on the team. They challenges and obstacles faced by reasoned that these actions brought young, female athletic trainers working forth a greater perception of congruity in Division I athletics. Design: between their roles as ATs and their Exploratory study using semi- gender and age. It is suggested that

Journal of Athletic Training S-57 Free Communications, Oral Presentations: Evidence Based Practice in Athletic Training Wednesday, June 22, 2011, 11:30AM-12:45PM, Room 218; Moderator: Bonnie Van Lunen, PhD, ATC 11226DOPE Athletic Training Education Program validity of the ATECQ. Reliability of likely to spend time preparing students Directors’ And Athletic Trainers’ the ATECQ was 0.933, and 0.929 with in this area. Therefore, ATEP curriculum Perceptions Of The Psychosocial item deletion. Main Outcome should be reevaluated for the Intervention And Referral Variables: Importance (essential to inclusion/exclusion of the psychosocial Competencies job performance), criticality (degree competencies, potentially creating Seiler BD, Gentner NB, Wehring SP, of adverse effects), and preparedness additional space for instruction in more Joyner AB: Georgia Southern (perceived preparation) were the applicable areas of practice. University, Statesboro, GA, and dependent variables. One-tailed t-tests University of South Carolina, were completed to determine 11164FOPE Columbia, SC importance, criticality, and prepared- Program Evaluation Of The Evidence- ness of the psychosocial com- Based Teaching Model In Undergraduate Athletic Training Context: Education of the petencies. Alpha was set at a more α Education: Student Outcomes psychosocial intervention and referral conservative level ( =0.017) after Manspeaker SA, Van Lunen BL, (PS) content area is required to be completing a Bonferroni adjustment. Hankemeier D: Old Dominion taught within all Athletic Training Participant demographics and NATA University, Norfolk, VA, and Texas Education Programs (ATEPs). content rankings were expressed as Christian University, Fort Worth, TX Research has evaluated athletic frequencies and percentages. Results: trainers’ (AT) perceptions of the PS No significant results were found content area, but not ATEP directors’ between ATs and ATEP directors within Context: While research recommends perceptions of this area. Objective: To the importance (P=0.14), criticality that health professions expand the evaluate ATEP directors’ and ATs’ (P=0.38), and preparedness (P=0.38) of instruction and use of evidence-based perceptions of the importance, the psychosocial competencies. practice (EBP) due to its individualized criticality, and preparedness of the PS However, ATEP directors rated the approach to patient care, few examples competencies, and evaluate partici- roles/function of community based of strategies aimed at teaching the EBP pants’ ranking of the National Athletic healthcare providers competency as process, or the effects of such Trainers’ Association (NATA) content more important (Mean= 1.98±0.80) than strategies on students, exist in athletic areas. Design: Descriptive survey. ATs (Mean=1.65±SD=0.77) (P=0.008), training. Objective: To evaluate the Setting: Web-based survey including the signs/symptoms of eating disorders effectiveness of the Evidence-Based non-collegiate, NAIA, and NCAA competency as more important Teaching Model (EBTM) in increasing Division I, II, and III institutions. (Mean=2.62±SD=0.56) than ATs student knowledge, attitudes, and use Patients or Other Participants: A (Mean=2.38±SD=0.63) (P=0.01), the of evidence-based concepts. The convenience sample of 88 (8.8%) ATs basic counseling principles com- EBTM presents the EBP process: 1) and 53 (15.4%) ATEP directors. petency as more important (Mean= formulating a clinical question through Interventions: The independent 2.09±SD=0.77) than ATs (Mean= Patient (P), Intervention (I), Comparison variable consisted of ATs and ATEP 1.83±SD=0.65) (P=0.015), and the (C), Outomce (O) (PICO), 2) searching directors. ATs included individuals in signs/symptoms of mental/emotional for evidence, 3) critical appraisal of the graduate assistant, high school, high disorders, or personal/social conflicts evidence, 4) use of clinical expertise, 5) school/clinic, junior college, and as more prepared (Mean= 1.64± implementing evidence into patient university/college NATA employment SD=0.86) than ATs (Mean= 1.30± care. Design: Within subjects design, categories. ATEP directors included SD=0.95) (P=0.016). The PS content pre-/post-test evaluations of students’ individuals listed on the Commission area was ranked below 50% of the EBP knowledge, attitudes and intended on Accreditation of Athletic Training other content areas for all variables. use through the Evidence-Based Education website at the time of the Top ranked content areas included Concept Knowledge, Attitude and Use study. Participants completed the web- acute care of injuries/illnesses, (EBKCAU) survey. Patients or Other ts: based Athletic Training Educational orthopedic clinical examination/ Participan Stratified purposeful Competency Questionnaire (ATECQ) diagnosis, and risk management/injury sample of 82 students enrolled in within 5-weeks. The ATECQ replicated prevention. Conclusions: ATEP therapeutic modalities or rehabilitation the Board of Certification’s Role directors and ATs do not consider the courses from 9 institutions sponsoring Delineation Study’s content evaluation psychosocial aspects in athletic CAATE-accredited programs. (5th Ed.). A pilot study was completed training as important or critical as other Seventy-eight students (95%) to determine content-related and face content areas, and are therefore less completed the knowledge portion of the

S-58 Volume 46 • Number 3 (Supplement) May 2011 evaluation; 68 students (83%) fully use of EBP concepts. To our the students focused on acquiring completed all sections of the survey. knowledge, this is the first study medical literature, with only slight Interventions: The EBCKAU survey addressing student knowledge, emphasis on appraising and applying it (multiple choice, Likert scale, and open- attitudes, and use of EBP relating to a to clinical practice. A portion of the ended questions) was developed to teaching model. SATS also expressed acquiring medical assess changes in student knowledge, literature on their own to address a familiarity, confidence, interest, 11165MOPE problem faced in their clinical practices, perceived importance, intended use, Senior Athletic Training Students’ but the SATS did not appraise the and perceived barriers of EBP. Perceptions And Self-Reported medical literature, rather they tended to Demographic characteristics of Behaviors Of Evidence-Based use self-derived criteria to evaluate the students included GPA, number of Practice quality of evidence. The SATS did semesters enrolled in the ATEP, and Schneider GP, Stemmans CL, express confidence in their ability to academic year. Pilot study of the Eberman LE, Brattain Rogers N, communicate to their patients and EBCKAU showed reliability of Pitney WA: Indiana State University, establish trust by educating their knowledge multiple choice questions Terre Haute, IN; Ohio State patients. Conclusions: The SATS through Pearson correlation (r >.40). University, Columbus, OH; Northern acquired scholastic knowledge of EBP, The knowledge fill-in question earned Illinois University, DeKalb, IL but minimally integrated the evidence 100% agreement as all students into practice. Moreover, deliberate answered incorrectly on both Context: Professional athletic appraisal of the quality of evidence was administrations. Cronbach’s alpha training education requires integration not common. Other medical determined the attitudes section of evidence-based practice (EBP) into professions curricula have begun to reliability of satisfactory (α=.669-.814). curricula to justify the clinical practice include instruction on EBP. The Main Outcome Measures: SPSS v.16.0.1 of athletic training. Objective: To changes in athletic training curricula (SPSS Inc. Chicago, IL). Normality was determine senior athletic training can allow students to incorporate EBP attained through descriptive statistics: student (SATS) perceptions of EBP and into clinical practice. We can continue means, standard deviations, and examine the self-reported behaviors of to provide justification to our clinical frequencies; paired t-test determined EBP to gain insight into the practices through integration of EBP differences in pre-/post-knowledge instructional methods currently used to education into all levels of athletic scores; Wilcoxon matched pairs signed educate athletic training students. training education. ranks assessed differences in Design: Grounded theory method. familiarity, confidence in use, interest, Setting: Individual telephone 11153DOHE and importance of EBP concepts; interviews of SATS at 13 CAATE- Athletic Training Clinicians Pearson product-moment correlations accredited athletic training programs. Knowledge And Confidence Of (r) determined relationships between Patients or Other Participants: Evidence-Based Concepts For knowledge change scores and student Thirteen SATS [11=female, 2=male, in Clinical Decision-Making demographic factors; Spearman’s rank their last semester/quarter of their Welch CE, Van Lunen BL: Old correlations (p) detected relationships athletic training education program Dominion University, Norfolk, VA for familiarity, confidence in use, (ATEP)] were interviewed to explore interest, and importance with student their perceptions and self-reported Context: In order to develop effective demographics. Barriers and future use behaviors of EBP. Data Collection and strategies for the use of evidence-based were analyzed qualitatively for themes. Analysis: Interviews were conducted practice (EBP) to enhance clinical Results: Students significantly using a semi-structured guide. The decision-making, current knowledge increased their knowledge (t(78)=- interviews were transcribed verbatim levels must be investigated. Objective: 6.39,p<.001,d=.72), confidence in and analyzed using open, axial, and To assess athletic trainers’ (AT) current knowledge (z=-7.04,p < .01), familiarity selective coding procedures. knowledge of the steps of EBP as well (z =-6.55,p<.01), and confidence in use Trustworthiness was established using as their confidence in answering each of EBP skills (z=-6.37,p<.01). Pre-EBTM multiple analyst triangulation and an question correctly. Design: Cross- student mean knowledge scores were expert peer debriefer. Results: The sectional survey design. Setting: Self- 50%, and post-EBTM mean scores analysis revealed that SATS have a reported online survey. Patients or increased to 66%. Students’ interest positive perception of utilizing research Other Participants: 716 clinicians and importance scores did not increase. to guide or supplement their clinical (18.42% response rate) from a Barriers to student use of EBP included practices. The emerging theory convenience sample of ATs not time, available resources, ACI open- demonstrated that the SATS have affiliated with professional or post- mindedness, and experience. knowledge of how to use EBP when professional athletic training education Conclusions: The EBTM was effective providing care to their patients. The programs (age=37.1±10.3, years of in improving student knowledge and instructional methods experienced by athletic training experience

Journal of Athletic Training S-59 =13.0±9.4). Interventions: Partici- higher knowledge scores. Overall having a master’s degree and 16 with a pants were solicited via email to confidence was 2.67/4.0, indicating doctoral degree. Interventions: A new complete the Evidence-Based participants were “minimally survey was developed after an Concepts Assessment (EBCA). The confident” to “moderately confident” extensive literature review of CDR to knowledge section of the EBCA asked in their MCQ answers. Characteristics capture ATs awareness and clinical use participants to answer six multiple- associated with higher confidence of CDR that were identified by the choice questions (MCQ) regarding the scores were type of degree literature and successfully applied to steps of EBP. Additionally, participants (H(2)=63.237, p<0.001), years of other healthcare professionals. The were asked six Likert scale (range 1- athletic training experience (rs=0.139, survey was administered by the online 4) questions assessing their p<0.001), and hours of clinical program SurveyMonkey. The validity confidence in answering each MCQ practice per week (rs=0.151, of the new survey was established by correctly. Independent variables p<0.001). Conclusions: Improve- content expert review and pilot testing included type of degree, year of most ments can be made on ATs’ knowledge for readability. Reliability for this type recent degree, patient care setting, of EBP. Although ATs reported they of survey was unwarranted. Main hours of patient care per week, and were “moderately confident” in their Outcome Measures: AT clinical use of years of athletic training experience. answer choices of the MCQs, overall CDR, awareness of the Ottawa Ankle Reliability for the knowledge section knowledge scores were low. Future Rules, Ottawa Knee, Pittsburgh Knee was previously determined to be development of workshops and Rules, Leiden Ankle Rules, Canadian C- moderate to excellent (percent teaching modules should focus on spine, Nexus, Canadian CT Head, and agreement: MCQ1=96.3%, MCQ2= improving ATs’ knowledge of EBP as the New Orleans Criteria were the

77.8%, MCQ3=70.4%, MCQ4= well as moderate the effect this primary dependent measures. In

74.1%, MCQ5=85.2%, MCQ6= knowledge will have on clinical addition to the awareness and clinical 63.0%). Main Outcome Measures: decision-making. use for AT who do not use CDR their The dependent variables were the willingness to learn about them and scores calculated from participant 11347FODI possibly implement was also captured. responses. Knowledge scores were One In Four Athletic Trainers Are Results: Overall 52/200 (26%) of AT tabulated by awarding 1 point for the Aware And Use Clinical Decision report using CDR in their practice and correct answer with a maximum Rules 146/200 (74%) responded that they do achievable composite score of 6. The Ragan BG, Bamer, M, Shinew K, not use CDR. Ottawa Ankle Rules was confidence Likert section scores were Starkey C: Ohio University, Athens, the most familiar with 60/200 (30%) ATs achieved by totaling all values and then OH reporting they are aware of it. ATs calculating the average value back to awareness of the Ottawa Knee Rules the Likert scale composite score (total Context: Clinical Decision Rules was 31/200 (16.5%), Pittsburgh Knee divided by four). A higher score (CDR) quantify the relative Rules was 14/200 (7%), Leiden Ankle indicated participants had a higher importance of particular clinical Rules = 7/200 (3.5%) , Canadian C-spine confidence level with answering the findings and are used to enhance =19/200 (9.5%), Nexus =7/200 (3.5%), MCQs correctly. Significant diagnostic and decision accuracy. Canadian CT Head = 11/200 (5.5%), and differences (p<.05) and correlations Many healthcare pro-fessionals have the New Orleans Criteria was 7/200 were calculated (SPSS 16.0) using adopted and implemented these rules, (3.5%). The most commonly use CDR one-way ANOVAs, Kruskal-Wallis H but little is known about the awareness was the Ottawa Ankle Rules with 31/52 tests, and Pearson/Spearman and use of CDRs by athletic trainers (60%). One interesting finding was 26/ correlations. Results: Overall EBP (AT). Objective: The purpose was to 119 AT that report that they do not use knowledge was 63.92% out of 100%. determine AT’s awareness and clinical CDR were unwilling to learn and Characteristics associated with higher use of common CDR. Design: An possibly implement in the future. knowledge scores were type of degree observational design was used. Setting: Conclusions: CDR are not commonly (F=14.137, p<0.001) and year in Data were collected via an online used by AT and a majority of AT are which the most recent degree was survey program. Patients or Other unaware of the existence of these Participants received (rs=0.11, p=0.003). : One thousand AT were clinical tools. More research and Individuals with a bachelor’s degree emailed and invited to participate in the publicity should be focused on had an average knowledge score of study. A total 200 (106 males and 94 increasing the awareness and use of 61.21%±0.205, while individuals with females) completed the survey with CDR by AT to help with improving the a master’s degree averaged usable data (20% response rate). The quality, consistency and efficiency of 63.72%±0.184, and individuals with a mean age of the sample was 36±10.2 care by AT to our patients. terminal degree averaged 75.83% years with 12.2±9.2 years of clinical ±0.175. Additionally, individuals with experience. Forty-eight reported having recently awarded degrees produced a undergraduate degree, 136 report

S-60 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Measurement of Concussion Wednesday, June 22, 2011, 1:00PM-2:00PM, Room 218; Moderator: Tracy Covassin, PhD, ATC 11051FOSP 11061MOSP Reliability Of A Computerized differences across time for ImPACT Self-Reporting Of Concussion Neuropsychological Test and Green’s WMT composite scores. Symptoms: Reliability Between Resch JE, Brown CN, Macciocchi Greenhouse-Geisser corrections were The SCAT2 And Impact Symptom SN, Baumgartner TA, Walpert KM, utilized to correct for violations of Scales In Adolescent Athletes. Ferrara MS: University of Georgia, sphericity. Paired t-tests were utilized Grenz A, Bay RC, Lam KC, Chhabra Athens, GA; University of Texas at for post-hoc analysis. Analyses were A, Valovich McLeod TC: A.T. Still Arlington, Arlington, TX; Shepherd performed with α = .05. Results: University, Mesa, AZ, and The Center, Atlanta, GA; Georgia Participants were tested approxi- Orthopedic Clinic Association, Neurological Surgery, Athens, GA mately 47.27+ 2.7 days after day 0 and Phoenix, AZ approximately 6.90 + 1.1 days after the Context: Computerized neuro- second time point. ICC values ranged Context: The Sport Concussion psychological (CNP) testing is one from .37 to .45 for composite verbal Assessment Tool-2 (SCAT2) and the component of the suggested battery of memory, .52 to .55, for composite ImPACT computerized neurocognitive tests for concussion management. An visual memory .66 to .76, for visual test both utilize self-report symptom increase in psychometric evidence and motor speed, .49 to .71, for composite scales to determine normal daily identification of sources of error may reaction time and .43 to .82 for symptoms during baseline concussion lead to increased test-retest reliability impulse control. Results of the assessments. However, there are and subsequent validity. This repeated measures ANOVA revealed concerns related to how truthfully psychometric evidence will assist significant improvements over time athletes self-report their symptoms clinicians to more effectively utilize for visual motor speed(F(2,88) = and whether they are can reliably report computerized neuropsychological 4.078, p = .02) with significant symptoms on differing platforms. testing for concussion management. differences between day 0 and day 50 Objective: To determine whether Objective: To provide reliability (t(44) = -2.122, p = .039) and day 45 adolescent athletes are able to reliably evidence of a CNP test to support its and day 50 (t(44) = -2.521, p .015). self-report concussion symptoms. use in the management of sport-related Interestingly, ImPACT classified 22.2 Design: Cross-sectional. Setting: concussion utilizing clinically relevant percent and 28.9 percent of the sample High school athletic facilities. time points, while controlling for as impaired when they were healthy Patients or Other Participants: effort. Design: Repeated Measures controls on one or more variables at 1733 high school athletes participating Setting: Athletic Training Laboratory day 45 and day 50, respectively. All in the fall contact sports of football Patients or Other Participants: Green’s WMT scores exceeded 85 and volleyball (male=1369, female Forty-five healthy participants (17 percent suggesting a good effort was =364, age=15.8±1.1 years, grade= males, 28 females) : mean age 20.94 provided at all time points. 10.2±2.6) Interventions: Participants + 1.6 years with no history of con- Conclusions: This study supports were administered the SCAT2 and cussion or psychiatric problems. previous findings that suggest the test- ImPACT in a single-session during the Interventions: Participants were retest reliability of ImPACT is poor to preseason as a baseline concussion administered ImPACT at three good in healthy participants. The assessment. Scales were completed clinically relevant time points, day 0, results of this study indicate caution approximately one-hour apart with half day 45, and day 50. Green’s Word is necessary when interpreting of the athletes completing the SCAT2 Memory Test (WMT) was also repeated CNP test scores over time scale first and the other half administered pre- and post ImPACT to and support the use of a multi-facet completing ImPACT first. Both tools assess effort for each test approach to sport-related concussion include a self-report symptom scale administration. Main Outcome management. scored using a 6-point Likert Scale, Measures: ImPACT has five main have seventeen symptoms in common outcome measures: composite and (headache, balance problems, verbal memory, visual memory, visual dizziness, trouble falling asleep, motor speed, reaction time and drowsiness, sensitivity to light, impulse control. Intraclass correla- sensitivity to noise, irritability, tions coefficients (ICCs) were sadness, more emotional, feeling calculated utilizing a one-way random slowed down, difficulty concentrating, model to assess reliability between difficulty remembering, visual each time point. Repeated measures problems or blurred vision, feeling analysis of variance (ANOVA) was mentally foggy, nervous or anxious, and utilized to determine significant fatigue or low energy), and produce a Journal of Athletic Training S-61 11167DOSP total symptom score (TSS) and a total Understanding Athletic Trainers’ control, and behavior intentions of ATs. number of symptoms endorsed score Beliefs Toward Implementing A Main Outcome Measure(s): The expert (TSE). Main Outcome Measures: Multifacted Approach After A Sport- panel performed an item-content Dependent variables included the Related Concussion: Validity And relevance analysis for each item. seventeen individual symptom scale Reliability Measurements Of An Means, SDs and validity coefficients item scores common to both the Application Of The Theory Of were calculated for each item to SCAT2 and ImPACT, the SCAT2 TSS Planned Behavior establish fit to the concussion and TSE (STSS, STSE), and the Rigby JH, Vela LI, Housman JM, guidelines and TPB constructs. Face ImPACT TSS and TSE (ITSS, ITSE). Gobert DV: Texas State University- validity was assessed by reading each Kappa coeffients and Pearson r were San Marcos, San Marcos, TX item to the focus group and discussing used to assess exact agreement and the item’s meaning and clarity. We reliability of scoring between Context: Practice guidelines calculated Cronbach alpha coefficients matched-symptom pairs. Intraclass recommend a multifaceted approach for for the data to assess reliability. We correlation coefficients (ICC 2,1) evaluating and managing concussions performed a confirmatory factor were used for the TSS and TSE. but only a small percentage of athletic analysis on the data to verify the Results: Individual item agreement trainers (ATs) follow these loadings of items on the correct ranged from Kappa=0.25 (fatigue) to recommendations. To understand component of each TPB construct. Kappa=0.41(irritability) and individual compliance, it is important to Results: All included questions in the item reliability ranged from r=0.32 understand ATs’ beliefs towards final instrument had a mean item- (feel in a fog) to r=0.69 (irritability). concussion practice guidelines. content relevance score above 3.00 The TSS reliability was 0.83 Objective: To develop and assess the indicating an “acceptable” match to the (STSS=7.2±9.4; ITSS=6.2±8.7) and psychometric properties of an TPB and concussion guidelines. 131 the TSE reliability was 0.77 instrument founded on the Theory of ATs completed (response rate=37.4%; (STSE=4.0±4.2; ITSE=3.3±3.6). Planned Behavior (TPB) to measure the experience=2.66±1.01 years; setting Conclusions: Healthy adolescent concussion management beliefs of ATs. =college[35.9%], high school[60.3%], athletes are reliable in endorsing a Design: Instrument development other[3.8%]) the instrument. The similar number of symptoms and Setting: A three part process was used Cronbach’s alpha score for the entire similar symptom severity regardless to assess the instrument: (1) content instrument was 0.880 and 0.744, 0.795, of the platform (SCAT2 vs. ImPACT). validity assessment with an expert 0.801, and 0.759 for each TPB construct: However, there is lower agreement panel, (2) face validity assessment with attitude, subjective norms, perceived among scoring individual items, which an AT focus group, and (3) factor behavior control, and behavior may indicate some discrepancy in structure and reliability analysis with a intention, respectively. The specific symptom reports. Athletic sample of practicing ATs. Patients or confirmatory factor analysis validated trainers should be aware of these Other Participants: Five experts the presence of the four TPB discrepancies and, if feasible, consider (experience =7.5±3.2 years) with constructs. The items that loaded using both platforms when providing research interests in the TPB (n=2) and incorrectly were either deleted from the concussion-related patient care. sport-related concussions (n=3) instrument or the wording was changed Future studies should assess participated in the content validity to better match the TPB resulting in a agreement and reliability post- process while a focus group of nine ATs final survey with 57 questions. concussion as that situation often (experience=9.00±8.76 years) Conclusion: Evidence for the presents with a unique set of working in either high school (n=3) or psychometric properties of the challenges with athletes wanting to college/university (n=6) settings developed survey instrument were return to play and potentially assessed face validity. Three hundred demonstrated. The instrument should downplaying their self-report and fifty practicing high school and be used to understand ATs’ beliefs symptoms. college/university ATs randomly toward implementing a multifaceted selected from the NATA database were concussion management approach in e-mailed the instrument after content patients. and face validation. Interventions: A 65-item survey was constructed to reflect the current recommended concussion guidelines of the NATA and International Conference on Concussion in Sport to measure the TPB constructs: behavior attitudes, subjective norms, perceived behavioral

S-62 Volume 46 • Number 3 (Supplement) May 2011 11022FOSP The Relationship Between Higher scores on the SCAT2 and the Traditional Concussion Measures VIS, VIM, and VIS composites and And Health-Related Quality Of Life lower scores on the RT and IC In Adolescent Athletes composites indicate better per- Valovich McLeod TC, Bay RC, Lam formance. Higher scores on the HIT-6 KC, Chhabra A, Parsons JT, Snyder and lower scores on the PedsQL and AR: A.T. Still University, Mesa, AZ, MFS indicate lower HRQOL. Data and The Orthopedic Clinic were analyzed using Pearson-Product Association, Phoenix, AZ Moment Correlations and multiple regression. Alpha was set at 0.05, two- Context: Current evidence and tailed. Results: Preliminary analysis guidelines advocate use of a multi- of the relationship between ImPACT dimensional approach to concussion composite and HRQOL scores management, including symptom indicated no association; Pearson reports, cognition and postural correlations ranged between r=0.01- stability. However, the sole use of these 0.15. However, all zero-order measures neglects obtaining correlations between the SCAT2 and information regarding social, emotional, HRQOL measures were significant and school issues, otherwise known as (p<0.001), ranging from r=0.31-0.54. health-related quality of life (HRQOL). Similarly, significant correlations The relationship between traditional (p<0.001) between the ITSS and HRQOL concussion assessments and HRQOL measures were found, ranging from measures has not been explicated. r=0.32-0.54. Multiple regression Objective: To determine the relationship analyses indicated that HRQOL between traditional concussion measures predicted 33% of the assessments and HRQOL measures. variability in the SCAT2 score and 42% Design: Cross-sectional. Setting: High of the variance in the ITSS scores. The school athletic facilities. Patients or EF, CF, PF, SCF and HIT-6 all Other Participants: Interscholastic significantly (p<0.02) predicted the athletes participating in contact sports SCAT2 score. The EF, CF, GF, SCF and (n=1176; males=929, females=247, HIT-6 scores were all significant age=15.7±1.3, grade=10.2±2.6). predictors (p<0.005) of the ITSS. Interventions: Participants were Conclusions: Baseline measures of administered the Sport-Concussion HRQOL appear to be primarily related Assessment Tool-2 (SCAT2), ImPACT to self-report symptoms rather than neurocognitive test, Pediatric Quality cognitive function, with higher PedsQL of Life Inventory (PedsQL), PedsQL and MFS scores and lower HIT-6 scores Multidimensional Fatigue Scale (MFS), related to higher scores on the SCAT2 and Headache Impact Test (HIT-6) and a lower ITSS. These data during a single-session preseason demonstrate the importance of self- baseline. All measures have established report symptoms in determining one’s reliability and validity. Main Outcome own health status. Future work Measures: Dependent variables assessing these relationships following included: the SCAT2 total score, 5 concussion may be important, as composite scores from ImPACT [verbal impaired cognitive function could memory (VEM), visual memory (VIM), impact the athlete’s academic visual motor (VIS), reaction time (RT) performance. and impulse control (IC)], ImPACT total symptom score (ITSS), 4 subscale scores of the PedsQL [physical (PF), emotional (EF), social (SOF), and school (SCF) functioning], 3 subscale scores of the MFS [general (GF), sleep (SLF), and cognitive (CF) fatigue], and the HIT-6 total score.

Journal of Athletic Training S-63 Free Communications, Oral Presentations: Unique Conditions in Adolescent Athletes Wednesday, June 22, 2011, 2:00PM-3:00PM, Room 218; Moderator: Mary Barron, PhD, ATC 11108SC 11166OC Cubonavicular Coalition In A High indicated an abnormal articulation Late Detection Of Capitellar School Football Player: A Case between the cuboid and navicular with Osteochondritis Dissecans In Report associated irregularity and arthrosis, High School Football Player Sulewski AL: Myrtle Beach High suggesting a cubonavicular coalition. Benson SB: The Steadman Clinic, School, Myrtle Beach, SC The orthopedic surgeon recommended Vail, CO the continuation of a conservative Background: A 16 year old male treatment plan and prescribed custom Background: A 17 YO, football player football player reported to the athletic orthotics fabricated by a podiatrist and at a rural high school with no athletic trainer complaining of left mid-foot pain NSAIDs. Pain management and trainer complaining of right elbow pain during the first week of fall football therapeutic exercise continued with the with catching and locking for four years. practice. Patient described pain as athletic trainer (as noted above) and The patient did not recall a mechanism insidious with no specific mechanism of participation restrictions included of injury, but believed the pain began injury, noting an initial onset of pain conditioning activities limited by pain after an ATV accident four years prior during summer conditioning activities. (i.e., sprinting, jumping). Significant causing elbow hyperextension. During Pain occurred during his defensive symptom reduction occurred within 1 exam the patient reported 3/10 pain at stance and push off; points of maximal week of orthotic intervention and rest and 8/10 pain with elbow movement dorsiflexion with concentric plantar NSAIDs. Uniqueness: Tarsal coalition on a 0 to 10 Visual Analog Scale. Pain flexion loading (including sprinting and is a genetic malformation of the foot was characterized as progressively jumping). Patient described the pain as that is estimated to affect less than 1% worsening with locking, popping and an 8/10 at its worst, but reported of the population. The most common grinding. The treating orthopedic minimal to no pain while weight bearing tarsal coalitions occur between the surgeon was the patient’s third opinion (static stance and walking). He had no talocalcaneal and calcaneonavicular subsequent to seeing a general previous history of foot or ankle injury. junctions with cubonavicular coalitions practitioner and orthopedic surgeon. Mild pain noted during palpation over accounting for only 1% of coalitions Differential Diagnosis: Osteonecrosis, medial aspect of navicular and on the reported in the literature (or .01% of all osteochondral fracture, medial dorsum of his foot in the cubo-navicular tarsal coalitions). Typically, symptoms epicondylitis, osteochondritis disse- articulation. Foot posture presented with present during adolescence upon cans, hereditary epiphyseal dysplasia normal medial longitudinal arch and (-) osseous maturation. Although not and Panner’s Disease. Treatment: navicular drop test. Tarsal glides elicited present in this case, bilateral coalitions Active range of motion in the involved mild pain. Foot and ankle active and are estimated to be present in 40-68% elbow was 0/3/140 degrees, as resisted range of motion were pain free of patients diagnosed with a tarsal compared to the uninvolved elbow at and within normal limits bilaterally. coalition. Conclusion: The case of non- 0/0/145 degrees. Plain radiographic Patient and legal guardian provided traumatic medial foot pain presented in films were benign, revealing no acute consent for presentation of case. an adolescent athlete resulted in a or chronic pathology present. MRI Differential Diagnosis: Stress fracture, diagnosis of a cubonavicular tarsal revealed multiple loose bodies and a mid-foot sprain, Lisfranc injury, coalition determined by CT imaging. capitellar osteochondral defect accessory navicular, tarsal coalition. Conservative management, custom (OCD). The orthopedic surgeon Treatment: Initially, management by the orthotics and NSAIDs significantly diagnosed the patient with capitellar athletic trainer included palliative care reduced symptoms, resulting in minimal osteochondritis dissecans and with therapeutic modalities (e.g., moist activity modifications. Tarsal coalitions recommended surgical treatment due heat packs, ice), prophylactic taping to are genetic deformities that, although to the severity of the lesion and support his medial longitudinal arch for rare, should be considered part of the presence of multiple loose bodies. The participation, and daily therapeutic differential diagnosis by certified patient consented, and a procedure exercises to strengthen ankle stabilizers athletic trainers working with the including a synovectomy with removal and intrinsic foot muscles. After non- adolescent population. Proper of two large loose bodies from the resolution of symptoms after 4 weeks, recognition, initial management and anterior compartment, chondroplasty athlete was referred to an orthopedic timely referral for imaging allow for of the capitellum, removal of extensive surgeon for further evaluation; who appropriate diagnosis and long term hypertrophic tissue from the posterior subsequently ordered a Computerized management for safe participation in compartment and removal of two small Tomography (CT) scan to rule out a sport. loose bodies from the posteriomedial stress fracture. Diagnostic imaging was performed. The patient was

S-64 Volume 46 • Number 3 (Supplement) May 2011 instructed to begin physical therapy refer the athlete for appropriate compliant. Therefore, the AT examined immediately after surgery to gain full treatment in order to have a positive modifications to the weight lifting active range of motion for the initial prognosis and high quality of life long equipment to address the athlete’s three weeks and then progress to term. limited elbow and wrist extension, strengthening as tolerated once full limited supination, and the dislocating range of motion was achieved. The 11301FC radius. The AT evaluated the athlete’s patient reported back nine days status/ Range Of Motion Limitations For An lifting technique for the bicep curl and post right elbow surgery with no pain Athlete With Nail-Patella Syndrome bench press lifts. The athlete or swelling. He reported performing Polubinsky RL, Plos JM, Leiting performed the bicep curl using the no physical therapy due to vacation, so KA: Western Illinois University, straight bar, the easy curl bar, and he presented with 0/30/110 right Macomb, IL dumbbells. Due to the athlete’s limited elbow range of motion. The patient supination, he could not comfortably wished to return to activity, but was Background: This case report grip the straight bar for the bicep curl instructed to begin physical therapy and involves a unique condition known as technique. This was also true using the return in six weeks. He did not return Nail-Patella Syndrome (NPS) in an easy curl bar, however; the athlete was for a follow up appointment to 18-year-old male wrestler. Nail- able to maintain a comfortable grip measure range of motion, but is Patella Syndrome is a genetic disorder using the dumbbells for the bicep curl currently ten weeks status/post surgery that causes individuals to be born with thus relieving the elbow pain. The with no reported symptoms. several skeletal deformities and athlete performed the bench press Uniqueness: Osteochondral defects abnormalities within the body. Due to using the straight bar and dumbbells. of the capitellum can be treated non- his condition, the athlete is aware of No elbow pain was reported with the operatively when stable and detected the risk involved with participation in straight bar, however, due to the limited early. However, lesions with frag- the various activities but is determined elbow extension and dislocating mentation and formation of loose to compete in the same manner as the radius; the athlete was in an unsafe bodies have limited capacity to heal other athletes on the team. The athlete position with weights overhead. The AT due to growth plate factors and poor reported to the athletic trainer (AT) recommended the use of dumbbell blood supply of the distal humerus. after he experienced elbow pain while weights for the bench press lifts in Furthermore, degenerative joint performing weight lifting techniques. order to eliminate the risk of injury. disease (DJD) has been reported in up Due to the NPS, the athlete had a Uniqueness: It is estimated that 1 in to 50% of those affected long term. dislocating radius and restricted ranges 50,000 persons worldwide have In fact, capitellar OCD is one of the of motion at the elbows, forearms, and characteristics of the NPS condition. leading causes of permanent elbow wrists. In comparison to normative It is rare that a child would go disability. Most physicians are hesitant values, the athlete’s elbow extension undiagnosed with NPS but the to operate on adolescent patients due lacked 20-26° (L:R), pronation lacked possibility exists that ATs may have an to the ability to heal non-operatively 2-6° (R:L), supination lacked 64-70° athlete with the condition under their and possibility of interfering with an (L:R), and wrist extension lacked 47- immediate care. Conclusions: open physis. However, this case 53° (R:L). Due to the insufficient Athletes with NPS demonstrate demonstrates the consequences of range of motion in the upper extremity, changes in their structural and physical leaving an OCD lesion untreated and the athlete sustained bilateral elbow function. However, these athletes still the importance of early recognition strains from attempting to lift weights posses a competitive desire, normal and treatment. Conclusion: Capitel- during practice. Differential Diag- cognitive and emotional functions, and lar OCD is an increasing cause of nosis: Elbow sprains, con-tusions, and a commitment to participate in elbow pain and dysfunction in elbow dislocation. Treatment: After athletics. Treatments of the musculo- adolescent athletes who endure the injury evaluation, the athlete was skeletal injuries follow similar repetitive stress. This football lineman initially treated with ice and rest for 3 guidelines for athletes who do not have fits the profile of an athlete days. The next step in the treatment the NPS condition. However, special susceptible to such an injury; however, protocol was to determine if consideration must be given to the he endured this disorder for four years modification in the lifting techniques physical restrictions in his range of due to misdiagnosis and inability to could be made to alleviate the athlete’s motion and the AT must be prepared to detect the disorder by rural medical discomfort and strain on the elbow make modifications to ensure safe care. Once appropriately diagnosed joints. The AT suggested the use of a sport participation. and treated, the patient was pain free protective brace with padding to keep and able to resume a normal lifestyle. the athlete within his normal limits (- Therefore, athletic trainers working with 26° of extension, -70° of supination). a high school population must correctly However, the athlete felt too restricted identify Capitellar OCD and properly in this brace and refused to be

Journal of Athletic Training S-65 11169FC Heterotopic Ossification In A Male Differential Diagnosis: Based on the Volleyball Player mechanism of injury a contusion to the Yoder A, Kahanov L, Kreiswirth E, soft tissue and or ilium was diagnosed. Myer G, Martin M: Indiana State SI Joint pathology was ruled out University, Terre Haute, IN, and through clinical tests. The chiropractor Rocky Mountain University, Provo, diagnosed the patient with a left up- UT slipped ilium and hip contusion. A plain film radiograph revealed a large Background: A 17-year-old male high ossification at the left ilium and a healed school volleyball player reported he fracture at the ASIS. Treatment The repetitively “dove for balls” during athlete was initially treated for a practices landing on his left hip. The contusion/hip pointer by the ATC, athlete’s complaint, at initial injury, was including core stability and stretching. persistent left hip and back pain. The The chiropractor treated the patient for assessment by a certified athletic an up-slipped ilium on the left and hip trainer, (ATC) revealed pain at the left contusion. The PCP recommended rest ilium and the anterior sacroiliac joint from all aggravating activity and (SI). Signs and symptoms included mild suggested elective surgery to remove swelling over the ilium with no the ossification. The athlete declined superficial discoloration or deformities. surgery and rested for two-months Range of motion and strength were based on personal comfort. At two within normal limits. Joint compression months, the athlete had no compliant and distraction for SI joint pathology, of pain and returned to volleyball pelvic fracture and radiculopathy were wearing a protective pad over the negative. The mechanism of injury ossification. The athlete continued a indicated trauma to the ASIS consistent home program of core stability with a hip pointer. The athlete ceased exercises. Eight-months, after the initial volleyball practice for two weeks due evaluation, the athlete was able to to pain. He received treatment which participate in volleyball with no included passive hip and low back restrictions, however the mass remained stretching and ice application for 15 visible over the left ilium. Uniqueness: minutes. The ATC diagnosed the injury Due to the rarity of HO in athletes, and as a left hip contusion (“hip pointer”) the prolonged evaluative process to with concomitant low back pain. After identify HO, this case presents unique two weeks, no physical abnormalities circumstances that should be to the area were documented and the considered in the evaluation of diagnosis remained, yet the athlete was repetitive hip injuries. Conclusions: The still in discomfort. At that point, the initial evaluation of this athlete athlete sought care through his presented as a standard “hip pointer” chiropractor and continued to be seen or ASIS contusion. This case daily by the athletic trainer from 2 to 6 highlights the continued need for weeks post initial injury. The athlete monitoring of repetitive traumas progressed through sport-specific particularly in athletes who may have exercises, including core stability open epiphysis. Additionally, bone exercises. Six weeks post initial remodeling can become extreme in some evaluation, the athlete returned to cases leading to excess growth unrestricted in-season practice and accentuating the need for continued competition with a pain scale of 3/10. monitoring. Appropriate and timely Six months post-injury, the athlete diagnostic testing is key to conclusive reported to the athletic trainer with a diagnosis; however, prevention may large mass on his left hip. The patient ameliorate the opportunity for like was referred to his primary care injuries. Preventative hip padding of physician for further evaluation. An x- athletes who incur repetitive trauma ray was ordered, which depicted a large may be appropriate. ossification over the patients left ASIS.

S-66 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Management of Unique Orthopaedic Injuries Wednesday, June 22, 2011, 3:30PM-4:30PM, Room 218; Moderator: Kelly Pugh, MS, ATC 11158MC Popliteus Tendinitis In A Division I impaction fracture of the anterolateral thorough physical examination is Collegiate Female Tennis Player: A tibial plateau and a partial tear of the paramount to a successful diagnosis Case Study distal posterior IT band, elucidating a and subsequent management protocol. Gardner IK, Silvestri PG, Petron DJ, diagnosis. After approximately 1 month Effective treatment appears to consist Hicks-Little CA: University of Utah, of conservative management, the lateral of activity modification, massage Salt Lake City, UT knee pain resolved. Approximately 2 techniques, taping, and ice. weeks later, however, the lateral knee Rehabilitation should address the Background: A 20 year old NCAA pain returned with similar clinical biomechanical function of the popliteus Division 1 female tennis player findings. A follow-up orthopedic muscle in both non-weight bearing and presented with lateral knee pain. There referral ascertained a recurrence of weight bearing conditions. was no specific mechanism of injury, ITBS. A regimen of conservative but previous history included a therapy was implemented over the 11286MC Posterior Knee Dislocation In A hyperextension injury, approximately 7 following 8 weeks which yielded Male Rugby Player weeks prior, and contralateral iliotibial improvement in symptoms but not Gour-Provencal G, Dover GC, band syndrome (ITBS). Her chief resolution. At this time, the athlete’s DeMont RG: Concordia University, complaint was weakness, especially chief complaint was a feeling of Montreal, QC with lateral movements. She was unable instability and a vague sensation of to play tennis and had discomfort with “something there.” The athlete visited activities of daily living (ADLs), a knee specialist, who injected her Background: We present a case of a including walking up and down hills/ lateral knee with a partial dose of unique posterior knee dislocation that stairs. She reported sleeping on her cortisone to investigate iliotibial band resulted in the rupture of the four unaffected side increased discomfort. involvement. With no resolution of ligaments, medial hamstrings, popliteal The athlete presented with an antalgic symptoms, another MRI was taken artery and a torn capsule without any gait, no swelling or mechanical which revealed an accumulation of fluid menisci damage or fracture. A healthy symptoms, and no reported usage of related to the popliteus muscle-tendon 25 years old male rugby player kicked oral medications. Clinical examination complex. A final diagnosis was made of the ball with his right leg while being revealed non-specific lateral joint line popliteus tendinitis. During this time, tackled. The patient complained of tenderness, and tenderness over the the athlete’s activity was severely excruciating pain at the right knee, lateral femoral condyle and distal limited due to discomfort. The athlete reported a snapping sound, and felt like hamstring tendon. The patient had full presented to physical therapy for everything was “gone” in his knee. knee flexion and extension, however, further conservative management, Extensive swelling and posterior discomfort and difficulty was elicited consisting of ultrasound, massage, and deformity was present. Within two at 20-45 degrees of active knee flexion. a taping technique, which facilitated a minutes, the athlete complained of Manual muscle strength was within functional return to activity decreased sensation on the dorsal normal limits. A varus stress test approximately 4 weeks after the final aspect of his right foot. A distal pulse revealed discomfort but no laxity. All diagnosis. Uniqueness: To our was present. The AT in charge decided other ligamentous testing yielded knowledge, this case is the first to call the ambulance, splinted the limb negative findings. McMurray’s test did reported of its kind in a NCAA Division with the use of an air cast and monitored not reproduce any mechanical 1 tennis player. Popliteus tendinitis is the vitals that were normal (HR: 70bpm, symptoms or discomfort. No uncommon and often misdiagnosed, BP: 121/70, BF: 16 breaths/min, T: 36.6C, neurovascular compromise was noted. typically emerging after some form of O2 saturation: 99%). The patient Differential Diagnosis: Fibular knee ligament trauma. A clinical retained a positive attitude and was collateral ligament sprain, ITBS, lateral diagnosis is difficult due to the cooperative immediately post trauma, hamstring pathology, lateral meniscus complexity of posterolateral knee pain. during hospital care, and through tear, and fibular head stress fracture. Conclusions: A young, healthy female rehabilitation. Differential Diagnosis: Treatment: An orthopedic referral was tennis player presented with lateral Possible injuries included inert tissue made to determine the cause of lateral knee pain. Clinical diagnosis is difficult (tibiofemoral dislocation, rupture to knee pain. Magnetic resonance imaging for this condition. Although popliteus ACL, PCL, LCL, MCL, torn capsule, (MRI) revealed no damage to the muscle-tendon pathology is relatively meniscus tear), contractile tissues ligaments, meniscus, or cartilage at the infrequent, it occurs more commonly crossing the tibiofemoral joint, knee joint. The MRI showed an in the athletic population. Thus a primary vascular tissue (popliteal

Journal of Athletic Training S-67 artery and vein), and fracture. Results rupture of the ACL, PCL, LCL, MCL, positive log roll test. Two of the three of the X-rays and MRI showed right medial hamstrings and popliteal artery of the athletes had full strength and knee dislocation, rupture of the ACL, (postero-lateral aspect) as well as a only had pain with maximal hip flexion PCL, LCL, MCL, medial hamstrings, torn capsule. No fracture was noted and or knee flexion at the end ranges of popliteal artery (postero-lateral the menisci were normal. Successful motion. One distance runner had 4/5 aspect), and a torn capsule. No fracture surgery was performed 2 days post- strength for all hip range of motion or meniscus damaged was noted. trauma. We believe that a positive secondary to pain. There was an Treatment: A right knee dislocation outlook can greatly improve the average time of 4 weeks of conservative was confirmed and reduced by a prognosis for the patient and result in treatment that was administered before Physician. Following imaging quicker rehabilitation. We learned that a lack of progress caused them to be diagnostics, the patient was transferred it is possible to retain vascularity in referred to the team physician. to a trauma care hospital for repair such traumatic injury, but attention to Treatment: All X-rays taken came back surgery. The surgery was conducted 2 these structures remains crucial in our negative for any stress injury. MRIs days post-trauma, and consisted of evaluations to prevent additional were ordered for all three athletes and ACL, PCL, MCL, LCL repair using complications. all came back positive for a femoral neck Ligament Augmentation and stress injury. All stress injuries were Reconstruction System (LARS) 11078MC classified as compression-side stress artificial ligaments, repair of the Anterior Hip Pain In Three Female injuries to the femoral neck. Athletes popliteal artery, repair of the medial Collegiate Track Athletes: A Case spent an average of two weeks on hamstrings and the joint capsule. The Series crutches and were restricted from all patient was then put in a hip-knee- Sanchez Z, Uhl T, Butterfield TA: weight-bearing activities during that ankle-foot orthosis. The orthopedist University of Kentucky, Lexington, time. Results: Water activities were provided a standard rehabilitation KY prescribed for training for the first 4 protocol that stipulates that full weight weeks. Following week 4, 2/3 of the bearing is contraindicated for the first Background: Three 18 year old female athletes began a rehabilitation program 3 months post-surgery and range is freshman (Height: 1.63m +/- .07; Weight: focused on hip and core strengthening limited to 120° of flexion to protect 57.75kg +/- 6.8) on the track team came and lower-extremity flexibility. The last the surgical grafts. One week post- into the training room in the spring of athlete left for summer and didn’t surgery, the patient had 90° of knee 2010 with complaints of right anterior participate. After an average of 6 weeks flexion and -15° of knee extension. hip pain. Two of the athletes were all athletes had progressed to weight- Had 3-/5 in knee flexion, 2+/5 in knee distance runners and one was a pole- bearing cross-training activities extension. A lot of muscle atrophy was vaulter. The two distance runners had including biking, elliptical, and the present especially at the VMO. At 3 been averaging forty miles a week in Alter-G treadmill. After an average of 9 weeks post-surgery, the patient had 97° the fall cross-country season. The pole weeks all athletes had returned to full of knee flexion and -5° of knee vaulter had been participating in activity with no complaints of hip pain. extension. He had 3+/5 in knee flexion weight-lifting and conditioning Both distance runners followed a and 4+/5 in knee extension. The VMO activities of moderate intensity in the specific running progression to safely was still atrophied but showed some fall track off-season. After returning increase their training intensity. contraction. The hip-knee-ankle-foot from winter break, the pole vaulter Uniqueness: Femoral neck stress orthosis was replaced by a greatly increased her training intensity fractures have a low incidence rate prophylactic knee brace 6 weeks post- in an attempt to quickly “get in shape”. compared to other stress injuries to the surgery, allowing the patient to weight The two distance runners increased lower extremity. All three athletes had bear and walk 6 weeks ahead of their mileage to an average of 65 miles a greatly increased their training intensity schedule. Uniqueness: Tibiofemoral week in preparation for the outdoor in anticipation of the spring outdoor dislocations with significant damage track season. Two of the three athletes track and field season and could be are exceptionally rare in sports were oligomenorrhic and had a previous described as hard-headed who settings. Acute knee dislocations history of stress fractures. All three frequently tried to train through pain. usually present following high velocity athletes described an insidious onset They admitted to training despite trauma, and are accompanied with of pain over their anterior hip, which having pain for at least 1 month before neurological deficiencies. In this case, increased with activity. Upon seeking medical help. Conclusions: the dislocation was without any evaluation, 100% of the athletes had Training errors, menstrual irregularities fractures, menisci damage, and more pain with passive hip internal rotation and a previous history of stress injury importantly any tibial or common especially at the end range of motion. may predispose young female athletes peroneal nerve damage. Conclusions: Two of the three of the athletes had a to developing another overuse stress A male rugby player suffered from a positive FADDIR test and one athlete injury. Stress fractures can be present knee dislocation that resulted in the had a positive straight leg-raise test and without plain radiographic evidence.

S-68 Volume 46 • Number 3 (Supplement) May 2011 Additional imaging techniques such as operative imaging of each patient; the interventions. The presence of MRI should be performed when a stress fresh graft was secured in place using posterior glenoid deterioration limits fracture of the femoral neck is 3 parallel screws. The placement and treatment options. These two cases suspected. Communication with the position was arranged for the best have had reportedly no complications athletic training staff about painful congruent joint mechanics. Under since surgery. ATs dealing with symptoms during training is crucial to anesthesia after the meticulous persisting posterior shoulder instability early recognition of a possible stress placement of the allograft, both should recognize when traditional and/ injury and proper treatment and early patients presented with perfect joint or conservative treatments are diagnostic testing. congruency and stable PROM. Post- unsuccessful. If the athletes presents operative rehabilitation included with full strength and full ROM, AT’s 11109OC immobilization for an average of 21 need to consider the mechanical Anatomic Reconstruction Of days. At this time, PROM(internal components of the shoulder and seek Posterior Glenoid Deficiency rotation to body, full external rotation, imaging for further investigation and Using Distal Tibial full forward flexion and full diagnosis. In almost all cases, early Osteoarticular Allograft In abduction)was permitted, as well as recognition can improve the prognosis The Treatment Of Recurrent pendulum type exercises to facilitate and longevity of the joint. This case Posterior Shoulder Instability: cartilage health and homeostasis. At 6 series has provided evidence that there A Case Series weeks, active assisted motion was is an excellent chance of success with Leake M, West AE, Gaskill TR, Millett permitted. Return to full activity was distal tibial osteoarticular allografts PJ: The Steadman Clinic, Vail, CO allowed at approximately 6-7 months, when dealing with posterior shoulder dependent on how the patient was instability due to bone loss of the Background: Patient population progressing. Results: Post-operatively, posterior glenoid. includes two adolescent male athletes both patients report an improvement of (15.5y/o±0.5) who suffered significant symptoms, have no recurrent instability bone loss of the posterior glenoid due and stable shoulder function. Post- to a traumatic posterior shoulder operative CT scans demonstrated dislocation and recurrent posterior complete healing of the tibial bone glenohumeral instability. Each young graft. The first patient(12 months s/ athlete had an initial traumatic p)returned to recreational sporting dislocation playing football and activities with minimal to no limitations. experienced persistent symptoms of The second patient(5 months s/p) is instability. The patients had similar starting to progress to light upper body clinical presentations: instability, activity. Uniqueness: Posterior recurrent posterior subluxation, full dislocations represent less than five PROM, no muscle atrophy, 5/5 rotator percent of all shoulder dislocations cuff strength, positive apprehension/ (Bahk et. al, 2007). When symptoms of relocation test, negative poster load/ instability persist after failed treatments shift test, and pain with posterior load and surrounding soft tissue is intact, to the glenoid. Radiographs for both further mechanical dysfunction, patients showed no remarkable possibly of bony structures should be findings. CT scans depicted the taken into consideration. Posterior deficiency of the posterior glenoid glenoid deficiency can result from cavity(40%±8%). Treatment: recurrent posterior instability. Due to Ultimately, both patients underwent the rarity of the condition, the options surgical treatment of glenoid of treatment are not congruent with reconstruction using a distal tibial anterior instability(Burkhart et. al, 2002, osteoarticular allograft. The first patient Lo, 2004). In previous literature opted for this procedure after an (Provencher et. al, 2009), distal tibial autogenous iliac crest allograft osteoarticular allografts proved to be reconstruction failed. The second excellent sources of bone restoration patient decided to undergo the and joint cartilage. These cases are procedure after a diagnostic unique due to the nature of the arthroscopy. The surgical procedure pathology, the type and location of the was fundamentally the same for both allograft. Conclusions: Both patients patients: a pre-operatively prepared presented with symptoms of posterior graft was designed based on pre- instability that had previously failed

Journal of Athletic Training S-69 Free Communications, Oral Presentations: Youth & Adolescent Injury Monday, June 20, 2011, 9:00AM-10:15AM, Room 219; Moderator: Tamara McLeod, PhD, ATC 11182MOBI 11318FOBI Maturation Does Not Influence flexion (KF), hip flexion (HF) and hip Lower Extremity Biomechanics Mechanics In Adolescent Male abduction (HAB) at initial contact (IC) During Anticipated And Lacrosse Athletes During An and peak knee flexion (PKF). Separate Unanticipated Cutting Tasks In Male Unanticipated Sidestep Cutting Task ANOVA’s were performed for each And Female Preadolescent Athletes Sullivan C, Greska E, Cortes N, dependent variable to assess statistical DiStefano LJ, Blackburn JT, Garrett Ringleb S, Van Lunen B: Old differences between groups. Alpha WE, Guskiewicz KM, Marshall SW, Dominion University, Norfolk VA, and level was set a priori at 0.05 Results: Stephenson LJ, Padua DA: University George Mason University, Fairfax, VA At IC there was no statistically of North Carolina, Chapel Hill, NC; significant difference found between University of Connecticut, Storrs, CT; Context: The incidence of noncontact any levels of puberty for KAB (PRE= Duke University, Durham, NC; Ohio knee injuries has been studied -3.58±6.60°, MID=-4.22±3.48°, University, Athens, OH extensively amongst high school and POST= -4.25±4.00°, p=0.942), KF collegiate athletes. Little research has (PRE=-21.30±8.50°,MID= Context: Anterior cruciate ligament been focused on the adolescent -27.6 ± 7.52°, POST =-23.30 ±9.39°, (ACL) injuries frequently occur during population and maturational changes p= 0.243), HF (PRE= 53.61±20.59°, sidestep cutting tasks. Unanticipated in relation to the risk factors of such an MID=62.64±15.13°, POST= 50.03± cutting tasks elicit more knee valgus and injury. Objective: The purpose of this 19.65°, p=0.253) or HAB (PRE= rotation compared to anticipated tasks study is to determine if there is a -10.61±10.46°, MID=-13.86±5.66°, in adults. Sex differences in cutting difference between Pre-pubescent POST=-15.04±4.51°, p=0.381). At biomechanics have been shown in adult (PRE), pubescent (MID) and Post- PKF there was also no statistically and youth populations. However, it is pubescent (POST) male lacrosse significant difference found between unknown if preadolescent males and athletes as indicated by knee and hip any level of puberty at KAB (PRE= females respond differently to kinetics and kinematics during an -4.84±8.33°, MID=-5.08±5.54°, anticipated and unanticipated cutting unanticipated sidestep cutting task POST=-8.91±6.54°, p=0.307), KF tasks. Objective: To compare the effects (SS). Design: Cross-sectional study. (PRE=-46.96±7.86°,MID= of anticipation between sexes during Setting: Controlled laboratory. Patients -51.27± 5.39°, POST=-54.42± sidestep cutting tasks in preadolescent or Other Participants: Thirty-one male 10.11°, p=0.150), HF (PRE= 45.83± soccer athletes. We hypothesized participants between the ages of nine 17.89°, MID=54.81±15.16°, POST= females during the unanticipated task and fourteen were recruited and 44.97±19.88°, p=0.358) or HAB would possess the greatest amount of categorized into 3 groups; PRE (n=8, (PRE=-14.83±10.19°, MID=- hip and knee rotation and knee valgus. 9.88±1.13years, 137.25±8.76cm, 17.45± 6.74°, POST=-18.12± 5.33°, Design: Cross-sectional. Setting: 32.74±7.12kg), MID (n=12, 11.42± p=0.613). Conclusions: In agree- Research laboratory. Patients or Other 0.90years, 153.58±10.73cm, 44.47± ment with previous studies viewing Participants: Sixty-three healthy youth 10.91kg), and POST (n=11, 12.91± adolescent athletes, this study soccer athletes (Males: n=35, 0.70years, 165.55±5.93cm, 53.44± demonstrated that pubertal maturation mass=34.2±5.4 kg, height=143.1±6.3 cm, 8.71kg). All participants were free of in males does not demonstrate an age=10±1 years; Females: n=28, lower extremity injury during the time effect on lower extremity mass=33.8±5.4 kg, height=141.0±6.6 cm, of the study. Intervention: The pubertal biomechanics. This shows that there age=10±1 years) volunteered to maturation observation scale (PMOS), is not a shift toward perilous lower participate. Interventions: Participants which corresponds to Tanner’s stages, extremity mechanics, which may lead completed three trials of an anticipated was used to allot the subjects into their to noncontact knee injuries in males (ANT) and an unanticipated (UNANT) corresponding maturation levels. Three- throughout their adolescent sidestep cutting task in a random order dimensional motion analysis, coupled maturation phases. Future studies during a single test session. A live with two force plates, was used to should focus on the differences model acted as a defensive opponent capture five successful SS trials. Main between genders at different pubertal to delineate direction during the Outcome Measures: The independent stages to better understand and unanticipated task. Participants jumped variable of this study was maturation quantify the mechanical changes forward from a 30-cm high box a stage with 3 levels; PRE, MID and brought about by maturation. distance of half their body height, POST. The dependent variables were landed with their dominant foot on a knee abduction moment (KAM), knee force plate and performed a 60 degree flexion moment (KFM), hip flexion cut towards their non-dominant limb. moment (HFM), hip abduction moment An optical motion analysis system was (HAM), knee abduction (KAB), knee synchronized with the force plate to S-70 Volume 46 • Number 3 (Supplement) May 2011 11319DOBI measure three-dimensional joint The Effects Of Instruction And Sex calculated (post-pre). Separate two- kinematics, kinetics, and ground On Landing Biomechanics Of Youth way analyses of covariance (group x reaction forces. Separate mixed model Soccer Athletes sex) were performed on the change analyses of variance were performed for Stephenson LJ, DiStefano LJ, scores for all dependent variables after each dependent variable to evaluate Blackburn JT, Bell DR, Padua DA: controlling for the baseline value differences between cutting tasks and University of North Carolina, Chapel (α≤.05). A Bonferroni correction was sex (α≤.05). A Bonferroni correction Hill, NC; Ohio University, Athens, used to evaluate significant findings. was used to evaluate significant OH; University of Connecticut, Main Outcome Measures: Sagittal and findings. Main Outcome Measures: Storrs, CT; University of Wisconsin, frontal plane knee angles at initial Three-dimensional knee and hip Madison, WI contact and peak values over the kinematics at initial ground contact, stance phase, as well as peak vertical peak angles and moments (normalized Context: Postpubertal females (VGRF) and posterior ground reaction to bodyweight and height) during the demonstrate different landing forces (PGRF), anterior tibial shear stance phase, and peak vertical ground biomechanics than males, which may force, internal knee extension reaction force (VGRF) normalized to put them at increased risk for ACL moment, and external knee valgus bodyweight were calculated using the injury. Limited knowledge is available moment were measured over the average of the three trials in each regarding sex differences in landing stance phase. Forces were normalized condition. Results: Significant task by biomechanics in younger populations to body weight and moments were sex interactions were observed for or if males and females respond normalized to body weight and height. knee valgus at initial contact differently to instructions regarding Results: A significant sex by group (F(1,61)=7.98, P=0.006) and knee landing technique. Objective: To interaction was observed for PGRF rotation at initial contact (F =6.28, (1,61) determine the effects of sex and (F(1.55)=4.56, P<0.05). Post hoc testing P=0.01). Females demonstrated more instruction on landing biomechanics in revealed that males in the FB group knee valgus at initial contact during youth soccer athletes. We hy- significantly reduced their PGRF UNANT (1.67±2.65°) than ANT pothesized females would respond more than males in the CON group (-0.69±2.69°). Females (-10.82± more favorably to instructions than (Change scores: FB=0.42±0.52%BW, 8.70°) landed with more knee external males. Design: Randomized controlled CON=-0.02± 0.31% BW). Significant rotation than males (-6.59±8.69°) trial. Setting: Research laboratory. differences were found between during ANT. UNANT resulted in more Participants: Sixty healthy soccer groups for VGRF (F(1,55)=39.301, peak knee flexion (F(1,62)=11.30, athletes (females: n=25, age=10±1 years, P<0.001, Change scores: CON=- P=0.001), knee valgus (F(1,62)=4.70, height=140.34±6.48cm, 0.17±0.63%BW, FB=-1.38± 0.97% P=0.03), hip flexion (F(1,60)=18.47, mass=33.06±5.03kg; males: n=35, BW) and knee valgus moment P=0.001), hip internal rotation age=10±1 years, height= 143.03± (F(1,55)=9.219, P=0.01, Change scores: (F(1,62)=5.11, P=0.03), and external 6.23cm, mass=34.42±5.34kg) vol- CON=-0.0001 ±0.06% BW*BH, knee valgus moment (F(1,62)=12.59, unteered to participate and were FB=-0.04±0.08%BW*BH). No other P=0.001). No other significant randomly assigned to either a feedback significant differences were observed differences were observed (P>0.05). (FB)(n=19 males, 13 females) or control (P>0.05). Conclusion: Males are Conclusions: Unantici-pated sidestep (CON) group (n=16 males, 12 females). more effective than females with cutting tasks resulted in more Interventions: Two sets of three trials reducing PGRF after receiving movements associated with ACL injury of a jump-landing task were performed instruction. Both sexes are able to risk than anticipated cutting tasks in during a single testing session. The FB reduce VGRF and knee valgus moment preadolescent athletes. Males and group was provided with instructions after instruction but these young females had similar responses to regarding proper landing technique athletes do not appear to be able to changes in the anticipatory condition prior to each trial of the second set of modify knee kinematics. Future except for knee valgus at initial landings. The task required participants research should evaluate if contact. Injury prevention programs to jump forward from a 30cm high box instructions can be modified to affect need to modify lower extremity placed a distance of half their height knee kinematics in young athletes. movements during both unanticipated away from a force plate, land with their and anticipated cutting tasks. dominant foot on the force plate, and immediately jump for maximal vertical height. An optical three-dimensional motion analysis system and a force plate measured lower extremity kinematics and kinetics. Change scores for each dependent variable were

Journal of Athletic Training S-71 11126MONE The Effects Of Fatigue And Gender analysis of variance (ANOVA) was changes associated with growth and On Reach Scores In High School used to determine if differences maturation may provide insight into Athletes existed between group (male vs. lower extremity injury risk and O’Neill M, Needle AR, Swanik CB, female) and time (pre vs. post-fatigue). prevention. Objective: To compare Jaric S, Glutting JJ, Kaminski TW: An alpha level of p <.05 was used to the postural control of adults, University of Delaware, Newark, DE determine significance. Results: adolescents, and pre-adolescents There was a significant group by time using Time-To-Boundary (TTB).

Context: More than 7 million interaction (Pillai’s trace F1,30 = 4.339; Design: Cross-sectional study. students are involved in high school P = .047) for the left composite reach Setting: Musculoskeletal laboratory. sports annually in the United States. score. Females demonstrated a Patients or Other Participants: A Disturbances in posture as result of significant decline in composite reach group of adults (n=35, 14 males, 21 fatigue have been postulated to effect scores (88.9 ± 2.0 cm to 86.7 ± 2.0 females, age:26.2±6.4 years, range:20- male and female interscholastic athletes cm) compared to males (91.4 ± 2.0 cm 45), a group of adolescents (n=36, 17 differently. It is important that this to 92.5 ± 2.0 cm). The right composite males, 19 females, age:15.6±1.0 years, population be studied and the reach score also demonstrated a range:14-17), and a group of pre- mechanism by which injuries are similar trend (Pillai’s trace F1,30 = 3.7; adolescents (n=36 , 17 males, 19 produced be determined. Objective: P = .065) between males/females females, age:11.9±0.9 years, range:10- The purpose of this study was to post-fatigue. Females demonstrated a 13) were studied. Inclusion criteria for determine the effect of gender and decline in composite reach scores all subjects were no history of lower fatigue on reach scores in a group of (87.4± 2.3 cm to 84.8± 2.3 cm) extremity injury in the past six weeks healthy high school athletes as compared to males (90.0± 2.3 cm to or history of balance disorders. measured by a modified version of the 91.0± 2.3 cm). Conclusions: These Intervention(s): All subjects per- Star Excursion Balance Test (SEBT). findings suggest that female and male formed three, ten-second trials of Design: Pre-test/post-test group interscholastic athletes respond to the barefoot single-limb stance on a comparison. Setting: A climate- SEBT task post-fatigue in different forceplate with eyes open on their left controlled, sports-center. Patients or ways. While reach scores decline in leg. The mean of the three trials for Other Participants: A total of 30 females post-fatigue, intriguingly the each measure was used for analysis. healthy varsity high school athletes; 15 male athletes responded with greater Main Outcome Measure(s): The male (age= 17.1±1.0yr; height= reach scores. Sufficient performance mean of TTB minima(s) (MeanTTB) 175.8±9.2cm; mass=70.1±8.5kg) and on the SEBT requires strength, and the standard deviation of TTB 15 female (age= 16.4±1.0yr; height flexibility, and proprioception, any of minima(s) (SDTTB) in the medial- =166.0±8.2cm; mass=60.6±7kg) which can be affected by fatigue lateral (ML) and anterior-posterior participated in this study. Inter- making athletes prone to injury. The (AP) directions were the dependent ventions: Dynamic postural control implications of this research on the variables. The independent variable was (reach distance) was tested using the female athlete and proneness to lower group (pre-adolescents, adolescents, modified SEBT before and after extremity injury need to be further adults). Separate one-way ANOVAs completing a functional fatigue investigated. were used to compare each TTB protocol (FFP) involving running, variable. Post hoc Fisher’s LSD pair- 11070MONE cutting, and jumping tasks. The Y- wise comparisons were calculated to Age-Related Postural Control Balance Test Kit (Perform Better, explain any significant group effects. Alterations Among Cranston, RI) was used to quantify Hedge’s g effect sizes (ES) were PreAdolescents, Adolescents, reach distances (cm) in the anterior calculated for all pairwise And Adults (ANT), posteromedial (PM), and comparisons. Alpha level was set a Lounsberry NL, Hoch MC, posterolateral (PL) directions. Three priori at p≤0.05. Results: For the McKeon PO: University of trials in each direction were performed. TTBML measures, there were no Kentucky, Lexington, KY The FFP circuit was completed until significant group effects for the fatigue was reached using a set of MeanTTBML (p=0.09) and the published criteria. Post-fatigue SEBT Context: Postural control deficits SDTTBML Minima (p=0.45). For the testing commenced immediately upon have been linked to increased lower TTBAP measures, there were completion. Main Outcome Measures: extremity injury risk. Postural control significant group effects for the Height-normalized ANT, PM, PL has been studied extensively in adults MeanTTBAP (p<0.001) and SDTTBAP reaches along with the composite and young children, but little research (p>0.02). The adults (MeanTTBAP reach scores for both the right and left has examined the adolescent and pre- =5.43±1.18s, SDTTBAP =3.26± side were used as dependent variables. adolescent populations. Developing an 0.84s) had significantly higher values A univariate, repeated-measures understanding of postural control than the adolescent (MeanTTBAP

S-72 Volume 46 • Number 3 (Supplement) May 2011 =4.09±1.25s, p=0.006, ES=0.68; SDTTBAP=2.44±0.74s, p=0.05, ES=0.55) and pre-adolescent groups (MeanTTBAP=3.87±1.27s, p<0.001, ES=1.26; SDTTBAP=2.67±1.13s, p=0.008, ES=0.58) The adolescent group had significantly higher values for the MeanTTBAP (p=0.008, ES=0.63), but not the SDTTBAP (p=0.49, ES=0.16). Conclusion: Age-related postural control alterations are present among pre- adolescents, adolescents, and adults. In the ML direction, there were no differences between groups. However, the AP direction revealed that adults had significantly higher TTB than both adolescents and preadolescents. The adolescents had higher MeanTTBAP compared to pre-adolescents. These findings indicate that TTB in the AP direction may detect age-related postural control alterations and may be an important factor in understanding how the sensorimotor system matures through adolescents. Future research should examine the relationship between age, skeletal growth, and the onset of puberty as potential mediating factors associated with postural control alterations and their relationship to lower extremity injury risk in adolescents and pre- adolescents.

Journal of Athletic Training S-73 Free Communications, Thematic Poster: Core Temperature & Heat Illness Monday, June 20, 2011, 10:30AM-12:00PM, Room 219; Moderator: Sandra Fowkes-Godek, PhD, ATC 11207OOEX 11254MOEX Ice Slushie Ingestion Decreases every minute for a 30min time period. The Effects Of Caffeine Core Body Temperature In Male The players ingested the sensors 12±3 Consumption On Core Body Football Players Prior To A hr prior to data collection to ensure that Temperature In The Physically Standard Pre-Season Practice they were in the intestinal tract and Active During Exercise: A Bartolozzi AR, Morrison KE, therefore would not be directly affected Systematic Review Burkholder R, McCann J, Fowkes by fluid temperature. The data was Martinez A, Menzies A, Vela LI: Godek S: Pennsylvania Hospital, collapsed into 4 time periods: 0 to Texas State University, San Philadelphia, PA; West Chester 7.5min (7.5min), 7.5 to 15 min (15min), Marcos, TX University, West Chester, PA; 15min to 22.5min (22.5min) and 22.5 min Philadelphia Eagles, Philadelphia, PA to 30 min (30min) for ease of Context: Caffeine has been shown to interpretation. Two-way group (Slushie have a variety of physiological effects Context: An elevated core body versus Tea) by time (7.5min, 15min, including acting as a diuretic, being a temperature (39.5-40pC) associated 22.5min and 30min) ANOVA was used. stimulant of sympathetic nervous with exercise in hot environments Separate one-way ANOVA with system, and increasing metabolic rate. hinders exercise performance. Tukey’s post-hoc analysis were used These effects could lead to increased Therefore, researchers have studied when group differences occurred (α heat storage and core body external methods (cold water immersion = 0.05). Main Outcomes Measures: temperature. Objective: To answer the ∆ or cooling vests) of lowering core % Tc. Results: Ambient temperature following clinical question: Does and humidity were not different temperature (Tc) prior to exercise. caffeine have an effect on core body Recently, ingesting of ice slurry between trials (22.1±.43pC and temperature in the physically activity solutions (internal method of 27±3.7%). Two-way ANOVA revealed during exercise? Data Sources: We ∆ decreasing T ) reduced T and improved group differences for % Tc, P=.013. searched Medline, Sports Discus, c c ∆ endurance performance in runners and In Slushie, % Tc was significant over CINAHL, and Cochrane between 1967 cyclists. This has never been studied time (P<.001) and was different from to November 2010 using the terms ∆ in large subjects such as American 0min at 22.5min (% Tc = -.366± caffeine, core temperature, body ∆ football players. Objective: First, to .34pC) and 30min ((% Tc = -.425± temperature, athlete, athlete*, investigate the effect of tea slushie .37pC), both P=.01. Additionally, the physically active, exercise, and ∆ (Slushie) versus cold tea (Tea) % Tc at 15min (-.116 ±.17pC) was exercise* resulting in a total of 167 ingestion on the percent change in different from 30min (-.425± articles. Study Selection: Studies that .37pC),P=.05. No differences in %”T resting Tc (%”Tc ) in euthermic football c met six criteria were included: 1) used players prior to practice; and second, over time occurred in Tea and there an experimental design, 2) investigated to determine if physical characteristics were no correlations between %”Tc and physically active/athletic population, ∆ (mass or BSA/mass) were associated mass or % Tc and BSA/mass. 3) defined exercise/activity level, 4) Conclusions: We could not measure with %”Tc after slushie ingestion. defined type and amount of caffeine Design: Cross-over study. Setting: performance (energy output) during consumed, 5) measured core body Controlled laboratory. Patients or practice but clearly consuming slushie temperature and 6) reported results for Other Participants: Nine collegiate solutions (-1°C) successfully calculation of effect sizes. Data football players representing many decreased Tc compared to identical Extraction: Two authors inde- positions (height=181.5±3.4 cm, refrigerated fluids. This may be pendently assessed the articles using mass=100.3±21kg, BSA=2.19± .21m2 clinically important prior to the the PEDro scale. We reached a 2 -1 and BSA/mass=223±24cm · kg ) vol- afternoon practice when resting Tc are consensus score when disputes arose. unteered. Interventions: On two usually higher than in the morning. Effect size (ES) were calculated with occasions in a counterbalanced order Ingesting slushies prior to pre-season the Cohens d and associated 95% the subjects ingested 7.5g·kg-1 body football practice may enhance confidence intervals (CI) for the mass of an identical nutritional formula performance by decreasing pre- comparisons of caffeine on core body but in the form of either Slushie (-1°C) exercise Tc. temperature. A positive ES indicated or refrigerated Tea (7°C) before an an increase of core body temperature afternoon pre-season practice. Every 5 when caffeine was consumed. Data minutes subjects were given 1.25g·kg-1 Synthesis: Six articles provided of either drink to ensure a standardized means and dispersions to calculate ES ingestion rate during which we and 95% CI. The average PEDro score measured Tc using ingestible sensors was a 5 ± 1.41 (range: 3-7). One article

S-74 Volume 46 • Number 3 (Supplement) May 2011 demonstrated a moderate negative ES conditions during the same pre- comparison of the practice schedules (d= 1.50 95% CI=1.17 to 1.70) season. Objective: To determine if for T1 vs. T2 during the days of indicating that consuming caffeine Tcmax or %”mass was different between collection does suggest probable decreased core body temperature. All players from different teams under practice intensity differences. other studies (n=5) showed positive, different environmental conditions. T1conducted twice as many practices weak to strong effects, indicating that We hypothesized that the team (T1) in full pads with tackling to the ground caffeine actually increased core body with higher intensity practices (i.e. than T2. Specifically, T1 practiced in temperature during exercise. Of these more tackle to the ground periods) full pads consecutively over the 4 days, studies, none of the CIs crossed zero. would sustain higher Tcmax values when while T2 practiced in full pads only The most notable findings were in Ping compared to a second team (T2) with twice, with two days in between 2009 (1.50 95% CI =1.17 to 1.70) and limited tackle to the ground periods, consisting of practice in shells with no Alves, 1995 (2.07 95% CI=2.07 to regardless of environmental condi- live periods. Therefore, the results 2.27) showing a strong clinical effect. tions. Design: Observational cohort of this study support the notion that Conclusions: There were several study. Setting: Identical data was exercise intensity is the most studies demonstrating that caffeine collected during practices on days 2 – modifiable and influential factor on does have an effect on core body 5 of two NFL pre-season training Tcmax. temperature. We noted that the camps in different geographical areas. protocols and the amounts of caffeine Patients or Other Participants: 11304MOEX consumed were inconsistent in each Thirteen players from each team Examining How Hydration And study. In studies where strong to volunteered and were matched by Intensity Influence Core Body moderate effects were found, the raw playing position and physical Temperature In NCAA Division I data showed that group core body characteristics [T1 (age: 26±2.6y, Elite Football Players During Pre- temperature differences were only mass: 115±21kg, height: 188±6.4cm, season Practices In The Heat tenths of a degree different. In BSA: 2.4±0.22 m2, BSA/mass: Martschinske JL, DeMartini JK, addition, all but two articles scored 211±19cm2/kg) vs. T2 (age: 26±3y, Casa DJ, Ganio MS, Walz S, Jay O, low (5 or below) on the PEDro scale. mass: 112±20kg, height: 187±8.7cm, Stearns RL, Lopez RM, McDermott There is a need for meticulous, well BSA: 2.4±0.28m2, BSA/mass: BP, Pagnotta KD, Minton DM, Coris designed studies investigating the 219±17.5 cm2/kg). Interventions: E: Department of Kinesiology, effects of caffeine on core body Subjects ingested a temperature sensor University of Connecticut, Storrs, temperature in the physically active. the night before or early morning prior CT; University of Texas to data collection. Core temperature Southwestern, Dallas, TX; 11198FOEX was recorded before and then every 10 University of South Florida, Tampa, Core Temperature Responses In minutes during practices. Pre and post FL; University of Ottawa, Ottawa, NFL Players On Two Different practice body weight was used to ON; Department of Health and Teams Practicing In Different determine %∆mass. Wet bulb globe Human Performance, University Environmental Conditions During temperature (WGBT) was recorded at of Tennessee at Chattanooga, Pre-Season the beginning, middle and end of all Chattanooga, TN; University of Morrison KE, Fowkes-Godek S, practices using the same device. South Carolina, Columbia, SC Sugarman ES, Sikka R, Roche R, Independent t-tests and Pearson’s Scullin G, Baer D, Burkholder R: HEAT correlations were performed ( = 0.05). Context: Laboratory literature Institute at West Chester University, Main Outcome Measures: Tcmax and supports the notion that hydration West Chester, PA; Minnesota Vikings, %”mass. Results: Physical charac- status coupled with high intensity Minneapolis, MN; Philadelphia teristics were not different between exercise influence core body Eagles, Philadelphia, PA teams. Average WBGT was higher in temperature. There are limited field T2 (83±4.8pF) vs. T1 (75.4±6pF), studies showing the influence of

Context: There are previous reports however, Tcmax was higher in T1 hydration status on core body on maximal core temperature (Tcmax) (102±.7pF) compared to T2 (101.3 temperature and virtually no field differences and percent body mass loss ±.8pF), P < .001. There were no studies reflecting how intensity (%”mass) between selected positions differences in %”mass between teams influences core body temperature in of professional football players (NFL) and with data combined (n=125 pairs), American football. Objective: on one team. There are also reports of %”mass was not related to Tcmax (P =.83, Observe elite football athletes’

Tcmax differences between days 2, 3 and r = -.21). Conclusions: The results of gastrointestinal temperature (TGI) as it 4 versus day 10 on the same team. this study suggest that hotter changes due to distance covered (DC), Previous research has not examined environmental conditions did not heart rate (HR), velocity (V), and

Tcmax and %”mass in two separate teams produce higher Tcmax values in NFL hydration status. Design: practicing in different environmental players during pre-season training. A Observational field study. Setting:

Journal of Athletic Training S-75 First eight consecutive days (total of with recent literature, our results show (Control) or cooling vest (Cooling) nine practice sessions) of preseason a rise in core body temperature during 5-min rest breaks provided Division I football practice in the heat resulting from a high level intensity of every 20 min during 60 min of intense, (WBGT: 85.19 ± 2.97 °F). Patients exercise (high metabolic heat exercise in the heat. Participants were or Other Participants: Twenty-nine production). All the subjects for this monitored every 5 min during 30 min male DI football players (age = 21±1 study had ad libitum access to fluids, of recovery in the shade. Exercise years, height = 74±3 in, and mass = high background knowledge of sessions consisted of typical American 242±52 lbs) voluntarily participated. hydration, and therefore did not have football training and conditioning Interventions: An ingestible significant level of dehydration. Future exercises at an average heart rate of thermistor was given at least three research should utilize more of a 85-95% of heart rate maximum. hours prior to each practice, allowing heterogeneous population. Participants consumed water ad

TGI measures approximately every 5 libitum during rest breaks after data minutes during practice with a 11276MOEX were collected. Meals, snacks, and handheld recording device. Subjects Perceptual Responses To hydration status were controlled. were fitted with the Catapult™ unit Intermittent, Superficial Cooling Main Outcome Measure(s): We under their equipment prior to During Exercise In The Heat assessed perceptual responses: practice. The system consisted of a Toy MG, Cleary MA, Lopez RM: thermal sensations on a 9-point scale, compression vest with a slot in the Department of Kinesiology and thirst sensations on a 9-point scale, upper back for a GPS unit, which Rehabilitation Science, Human and RPE on a 15-point Borg scale. provided a continuous measurement of Performance Research Laboratory, Thermoregulation/cardiovascular DC, HR, and V. Prior to and after University of Hawaii at Manoa, responses: gastrointestinal temperature Honolulu, HI, and Department of practice sessions, hydration indices of (Tgi), skin temperature (Tsk), and heart body mass loss (BML) and urine Orthopedics & Sports Medicine, rate (HR) were measured for descriptive University of South Florida, Tampa, specific gravity (USG) were taken. and safety purposes. We used a 2-way Main Outcome Measures: Measures FL repeated-measures (condition x time) of intensity including average HR, V, analysis of variance (ANOVA) and and total practice DC. V is presented Context: Prevention of heat-related reported data as mean ± SD. Results: as percent of total practice spent at 2- illness using superficial cooling We found significant (p=0.026) garments during exercise in hot 4 m/s. Maximum TGI and hydration decreases in thermal sensations for environments has yielded conflicting indices including BML and USG. A Cooling (4.4±0.2) compared to Control multivariate regression analysis was results relating to attenuation of (5.0±0.2). Thirst responses approached utilized to determine predictor cardiovascular strain/fatigue. Fatigue, significance (p=0.051, partial eta a physical process, may instead be an variables for maximum TGI. squared=0.359, power=0.517) with less Collinearity was accounted for and emotional construct described by thirst in Cooling (4.5±0.3) compared to sufficient independence between perceptual responses. Objective: Control (5.3±0.4). The RPE responses predictive variables. Statistical Evaluate the effect of intermittent, were not significantly (p=0.164, partial significance was set at P < 0.05. superficial cooling on perceptual eta squared =0.203, power=0.273) Results: Intensity as measured by (HR responses during exercise in a hot- different between Cooling (10.4±0.5) humid environment. Design: A (138 ± 9 bpm), V (0.04 ± 0.01%), and and Control (11.4±0.8). Tgi for Cooling DC (3185 ± 856 m·s-1)) significantly randomized, counterbalanced, repeated (38.2±0.2°C) decreased significantly accounted for 32% of the variability measures investigation with two (p=0.046) compared to Control conditions (Cooling, Control) during observed in maximal TGI (101.89 ± (38.5±0.1°C). Tsk for Cooling 0.76°F, r=0.56 P=0.026). However, exercise and recovery. Setting: (31.8±0.4°C) decreased significantly hydration status as measured by Outdoors on artificial turf in a hot, humid (p<0.001) compared to Control (34.4±0.5 tropical climate in the sun (percent BML (1.56 ± 0.80%) and USG °C). HR responses were not change (0.004 ± 0.004)) was not a (WBGTo=27.0±0.8°C, range=25.8- significantly different (p=0.307, partial 28.1°C) and in the shade (WBGT significant predictor of maximal TGI o eta squared=0.115, power=0.163) in (P=0.45). Therefore, when combining =25.4±0.9°C, range=24.3-26.8°C). Cooling (147.6±2.6bpm) compared to measures of intensity and hydration Participants: Purposeful sample of Control (150.1±3.5bpm). Conclusions: 16 participants from a pool meeting status, the prediction of maximal TGI, In an athletic setting, intermittent, was no longer statistical significance inclusionary criteria and 10 were superficial cooling was effective in included in data analysis (age= (P=0.06). Conclusions: These reducing thermal sensations and Tsk but findings suggest that measures of 22.6±1.6y; height=176.0±6.9cm; was not effective in substantially mass=76.5±7.8kg; body fat=15.6±5.4%). intensity influenced increases in TGI, reducing Tgi. No effect was observed while hydration indices did not Interventions: Participants wore one for RPE or HR indicating that wearing a of the following: shorts and t-shirt substantially influence TGI. Consistent cooling vest did not attenuate the

S-76 Volume 46 • Number 3 (Supplement) May 2011 11F08DOIN increased cardiovascular strain Data Collection and Analysis: Data Exertional Heat Illness During A observed during intense exercise. analysis included open coding Single Interscholastic Football Coaches, athletic trainers, and strength procedures by a 3-member research Season In Georgia and conditioning specialists should team. Credibility was established by Miles, JD, Cooper E, Resch J, Ferrara, understand that cooling vests are not member checks and multiple analyst MS: The University of Georgia, effective in reducing cardiovascular triangulation. Results: Two main Athens, GA, and University of Texas strain but may be used to reduce themes emerged to explain the at Arlington, Dallas, TX thermal sensations. viewpoint of the physician on best practices: 1) Supervisory role of the Context: Exertional Heat Illness 11337MOHE physician and 2) Core body (EHI) is a common occurrence in Recognition And Treatment Of temperature. Participants strongly football, particularly in the southern Exertional Heat Stroke: A agreed that T was critical for portion of the United States. There Perspective From The Team re diagnosis, however the role of the have been very few studies that have Physician physician does not include educating been conducted at the interscholastic McDowell LM, Mazerolle SM, Casa the AT on proper T implementation, level to determine EHI injury rates DJ, Pagnotta KD, Armstrong LE: re but rather enforcing a protocol that (IR). Objective: To determine the EHI University of Connecticut, Storrs, CT includes evidence-based medicine. IR at the interscholastic level in Two major themes materialized to Georgia by practice type and week of Context: Rectal temperature explain how ATs could be encouraged season. Design: Prospective design. assessment (T ) and cold-water re to use Tre assessment and CWI in Setting: Interscholastic institutions immersion (CWI) are the gold standards clinical practice: 1) Pre-certification (n=22) from 5 geographic regions in for the recognition and treatment of and 2) Post-Certification. Pre- the state of Georgia (North, Metro exertional heat stroke (EHS), but athletic certification was supported by two Atlanta, Central, Southeast, Southwest) trainers (ATs) are reluctant to implement lower level themes a) Real-time Participants: Interscholastic football them regularly into clinical practice. ATs experience, and b) Skill set mandate, athletes from 22 schools across the work under the guidance of a physician, while the Post-certification theme was state of Georgia for one competition but little information is available illustrated by one lower theme: season. Data collection was for August regarding the perceptions of the Professional development. Con- and September, 2009. Interventions: aforementioned methods from the team clusions: The sports medicine An ATC was identified at each school physician’s perspective. Objective: To physician supports Tre and CWI and and recorded all exposure and EHI data. investigate team physicians’ practice believes it should be performed by the Data included the total number of beliefs regarding the recognition and AT. Physicians, in recognition of the participants (athlete-exposures, AE), immediate treatment of EHS and the dichotomy between best and actual and practice type. EHI types were ways to increase the use of best practice, believe that to increase the identified as heat cramps, heat practices. Design: Exploratory study use of best practices the AT must exhaustion, heat syncope, and heat using semi-structured focus groups and receive formal training with those stroke as defined by the National follow-up phone interviews. Setting: skills in a structured learning Athletic Trainers Association Position College, university, and secondary environment as well as gain real life Statement. Main Outcome Measures: school clinical setting. Patients or exposure to the implementation of Dependent variables included EHI Other Participants: 12 team those methods. Physicians also occurrences and exposure physicians using criterion, recognize the dynamic nature of information. IR was calculated using convenience, and snowball sampling medicine and development of best the following equation: number of technique were included in the study. practices, therefore they injuries/number of athlete exposures The criteria included the title “team recommended for the AT to maintain (AE) x 1000 with 95% confidence physician” for a college/university or current through professional intervals (CI). Results: The total secondary school, at least 3 years of development. Future studies should number of EHI’s was 213 and total full-time work experience beyond investigate the practice beliefs of number of AE’s was 76673 for one their residency and possession of a emergency room physicians as well as season. The overall IR was 2.78/ family medicine or internal medicine those physicians employed within the 1000AE (95%CI=2.40,3.15). For EHI specialization. Seven were involved secondary school setting without a type, the IR was 2.15/1000AE with the focus groups and 5 completed sports medicine specialization. (95%CI=1.82, 2.48) for exertional phone interviews. The mean age was cramps, 2.15/1000AE (95%CI=1.82, 44.2 ± 3.8 with 10.2 ± 7.1 years of 2.48) for heat syncope, 0.39/1000AE sports medicine specific experience. (95%CI=0.25, 0.53) for heat Participants represented 11 states. exhaustion. There were no reported

Journal of Athletic Training S-77 incidences of heat stroke. EHI’s IR per EMS and Athletic Trainers (ATs). among medical professionals; a failure practice session type were as follows: Design: A basic qualitative design to utilize best practices. Unlike the walk-through was 1.38/1000AE using in-person focus groups. Setting: AT, cool first transport second is not (95%CI=0.60, 2.21), regular prac- Regionally biased EMS companies. considered standard practice for EMS, tices was 1.86/1000AE (95%CI Participants: A total of 17 (3 females due to protocol procedures, therefore =1.47, 2.26), split practice was 2.66/ and 14 males) EMS professionals alternative, but effective methods must 1000AE (95%CI=1.57, 3.74), including Emergency Medical be investigated. Proper education scrimmages was 1.37/1000AE (95% Technicians (EMTs) (n=11) and consistent with the most current CI=0.03, 2.72), and games was 8.55/ Paramedics (n=6), age 28+8 years literature regarding EHS must be 1000AE (95%CI=6.77, 10.34). For participated in the study. EMS taught within EMS certification each week, the highest IR occurred in professionals averaged 6.3+5.3years of preparation to ensure the most the fourth official week of practice, experience. Data Collection and efficient recognition and treatment of 6.72/1000AE (95%CI=4.84, 8.60), Analysis: Interviews were transcribed EHS. A relationship among EMS followed by the second official week verbatim and data was analyzed using professionals and ATs should be of practice, 4.33/1000AE (95%CI open coding procedures. Peer review formed to create familiarity among the =2.89, 5.76) and then the first official and multiple analyst data triangulation professions and establish emergency week of practice, 3.83/1000AE were conducted to establish treatment protocols ensuring (95%CI=2.79, 4.87). Conclusion: trustworthiness. Results: Educational consistent EBP and optimal care. The greatest number of EHIs occurred preparation emerged as the during regular practice sessions and predominate explanation for the lack games. The highest IR occurred in the of EBP regarding EHS. Three sub- fourth official week of practice which themes help illustrate educational generally coincided with the first week preparation including temperature of games. Approximately 75% of the assessment (educational training and total EHI cases occurred during the knowledge), rapid cooling month of August. Athletic Trainers and (educational training, knowledge, and coaches should utilize all prevention logistics), and the role of the AT/ measures especially during the month Healthcare professional. Educational of August to minimize the IR for EHI’s training and knowledge provided for and potential catastrophic events. the EMS professional, regarding temperature assessment was limited, 11011MOEM in some cases inaccurate as compared Utilization Of Evidence-Based to the most current EBP, and Practice By Emergency Medical highlighted a disparity in the EMS Service Professionals Regarding professional’s ability to accurately The Recognition And Treatment Of diagnosis EHS. Because the education Exertional Heat Stroke EMS professionals receive is limited Applegate KA, Mazerolle SM, Casa partly due to scope of practice, the DJ, Pagnotta KD, Maresh CM: knowledge they bring to clinical practice University of Connecticut, Storrs, CT reflects this disconnect. Rapid cooling educational training and knowledge Context: Current Evidence Based illustrates the use of and belief in Practice (EBP) supports the use of alternative methods other than CWI such rectal thermometry (Tre) for an accurate as ice bags, air conditioning, and shaded diagnosis and cold water-immersion areas. Logistics played a limiting role (CWI) for the treatment of Exertional for the use of CWI as immediate Heat Stroke (EHS) for an optimal transport is considered more important outcome. Emergency Medical Services than immediate rapid cooling as well as (EMS) play a critical role for the impossible in an ambulance. The true diagnosis and treatment of EHS as they role of the AT/Health care professional may be the first to arrive on scene, was unknown to many EMS however there is limited data regarding professionals, which created confusion their implementation of EBP. Objective: between two separate medical Investigate current practice regarding professionals. Conclusion: Findings EHS by EMS professionals and explore from this research are consistent with the relationship that exists between previous literature regarding EBP

S-78 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Influencing Factors on the Athletic Shoulder Monday, June 20, 2011, 12:15PM-1:15PM, Room 219; Moderator: TBD 11193DOBI 11218MOTE Scapular Kinematic And Postural on the horizontal plane) were digitized Acute Effects Of Dynamic And Static Changes In Collegiate Swimmers to calculate the forward shoulder angle Stretch On The Peak Torque And Due To Swim Training (inclination of the line extending from ROM Of Shoulder Internal And Hibberd EE, Oyama S, Prentice WE, C7 to shoulder) and forward head angle External Rotation Spang JT, Myers JB: Department of (inclination of the line extending from Smart MM, Greenwood LD, Boucher Exercise and Sport Science, C7 to tragus). Mixed-model analysis of AM, Barnard-Brak L, La Bounty P, University of North Carolina at variance and dependent t-tests were Greenwood M: Baylor University, Chapel Hill, Chapel Hill, NC used to assess changes in scapular Waco, TX kinematic variables and posture Context: Shoulder pain and injuries are variables (forward head angle and Context: Previous research suggests common in swimmers due to the forward shoulder angle) between the that static stretching acutely impairs demands of the sport. Altered scapular testing sessions. Results: A significant muscular performance by reducing kinematics and posture have been session main effect was present for successive strength and power found in swimmers and these alterations internal/external rotation (F(1,27)=25.085, production in the lower extremity and have been linked to shoulder injuries. p<0.0005), protraction/retraction that it should be replaced with dynamic

Normal training regimens may be (F(1,25)=10.88, p=0.003), and elevation/ stretching. However, the complexity of contributing to altered patterns of depression (F(1,25)=4.279, p=0.049) when the glenohumeral joint and the scapular kinematics and posture that collapsed across angle. On average, the difference in biomechanical demands predispose them to injury. To date, how swimmers’ scapulae were 11.1°±2.21° between the upper and lower extremity scapular kinematics and posture more internally rotated, 8.83°±2.67° make it difficult to generalize the results change with pre-season training is more protracted and 2.85°±1.38° more to overhead movements. Objective: The unknown. Objective: To assess the elevated at the post-test compared to primary purpose was to determine if alterations in scapular kinematic and the pre-test. Additionally, the swimmers static and/or dynamic stretch postural patterns that occur over 6 had 4.83°±0.74° greater forward head techniques affect the peak torque and weeks of pre-season swimming practice. posture at the post-test than pre-test average power of the shoulder rotators.

Design: Pre-test/post-test design. (t(39)=6.313, p<0.005). Conclusions: A secondary purpose was to assess Setting: University natatorium and Subjects moved into a position of and compare range of motion (ROM) research laboratory. Participants: significantly greater scapular internal after the two stretching techniques. Forty division one collegiate swimmers rotation, scapular protraction, scapular Design: A cross-over design. Setting: (age=19.0±1.0 years, mass=74.4±11.0 elevation, and forward head posture. All subjects were tested in a controlled kg, height=179.1±3.39 cm) with no These alterations in scapular kinematics research laboratory using the same current shoulder injury. Interventions: and posture place the shoulder in a equipment and settings for each Scapular kinematics on the dominant position that may promote impingement session. Participants: A volunteer limb (internal/external rotation, anterior/ and may predispose the swimmers to sample of sixteen physically active posterior tilting, upward/downward shoulder pain and injury. Muscle females (age=20.38 ±1.93years, rotation, protraction/retraction, imbalances and tightness that develop height=161.9±5.8cm, mass =61.23±6.43) elevation/depression) were assessed due to the swim training may be were recruited for participation. using an electromagnetic tracking responsible for these alterations that Subjects must have had glenohumeral device, while the subjects performed 15 occur after only 6-weeks of pre-season range of motion within normal limits, humeral elevations in the scapular training. Developing a stretching and been involved in upper-extremity plane. Forward head and forward strengthening program to counteract activity within the last year, and had no shoulder posture were calculated by these adaptations to swim training is injury to the upper extremity. photographing the subjects’ upper imperative to counteract these negative Interventions: Each subject underwent torso/head in the frontal plane. Main changes and thus prevent shoulder a baseline (no-stretch) session first and Outcome Measures: Means of the injuries in competitive swimmers. then performed the static and dynamic scapular kinematic variables at 0, 30, 60, stretch sessions in a randomized order 90, and 120 degrees of humeral with 48-72 hours between sessions. elevation were calculated from the Main Outcome Measures: Baseline middle five repetitions for each trial. measurements were taken to compare The landmarks in the photographs (C7, to the post-stretch outcomes of the tragus, shoulder joint, and two points static and dynamic sessions. These

Journal of Athletic Training S-79 11079MOIN measurements included internal and Descriptive Analysis Of Pitch subject. Average cumulative pitch total external ROM with a universal Volume In Four Division I Collegiate for the season was 13,385 pitches goniometer and isokinetic measures of Softball Pitches (range=8,690-19,019). Forty-five peak torque and average power at 60°/ Reichard RL, Uhl TL, Bush HM: percent of the total pitch volume was second and 180°/second using a Biodex Division of Athletic Training, thrown in games (range of game System 3 Isokinetic dynamometer. University of Kentucky, Lexington, volume=1,444-11,616). On game days, Statistical analysis was performed KY subjects threw an average of 22±6.2 utilizing a 2(static, dynamic group) x catch throws, 188±8.9 game-day bullpen 2(pre-test, post-test) mixed ANOVA with Context: There is a lack of information pitches and 108±27 game pitches. baseline as the covariate. A probability describing typical pitch volumes for Subjects pitched an average of 5±2.3 level of p<0.05 was set a priori. collegiate softball pitchers. Objective: innings and 26±26 pitches per inning. Results: There were no significant To describe pitch volumes and levels Fifty-five percent of total pitch volume differences in internal (p=0.748) or of soreness for four Division I was thrown in practice (range of external rotation (p=0.590) or ROM collegiate softball pitchers for one practice volume=4,460-5,244). On between baseline (IR=59.12±5.88, season. Design: Prospective and practice days, subjects threw an ER=82.89±5.18), static (IR=57.91±5.53, descriptive. Setting: Athletic training average of 23±6.6 catch throws and ER=86.88±3.44), and dynamic room. Participants: Sample was based 114±10.9 bullpen pitches. Subjects’ (IR=57.54±5.66, ER=86.59±3.78) on convenience and consisted of four highest average daily soreness was conditions. Measurements of isokinetic female collegiate softball pitchers (age= 0.8±1.0 during softball activity. average power showed no significant 20±1 years, weight=67±6 kilograms, Conclusions: These data are limited difference in mean power output in height=168±54 centimeters). The due to small number of subjects, watts at 60° (p=0.356) or 180°/second subjects averaged 12 years of softball however are useful in developing (p=0.797) between baseline (IR60°/ experience. All subjects were healthy rehabilitation and training programs sec=13.93±4.67, IR180°/sec=20.78±7.13, at the beginning of the season. specific to the demands of these ER60°/sec= 16.39±3.76, ER180°/ Interventions: Pitch volume data was athletes. This is one of few sec=28.16±7.46), static (IR60°/ collected during practice by catchers investigations to quantify pitch volume sec=14.45±4.00, IR180°/sec= 23.53 recording each pitch with a hand-held and first to include practice throws, ±9.47, ER60°/sec=16.11±3.47, counter. Game pitches were collected which adds substantially to the total ER180°/sec=28.71±7.89), or dynamic by the coaching staff; game-day warm- pitch volume. The high volume of (IR60°/sec=14.56±3.96, IR180°/ ups were counted by investigators. A throwing does not appear to create an sec= 24.61±9.03, ER60°/sec= 16.09 pitch was defined as one full revolution increase in soreness over the season. ±3.68, ER180°/sec= 29.17± 7.91) of the arm, regardless of the distance These data seem to support the concept conditions. No significant differences from the catcher. Game pitches were that the more natural mechanics of were found between groups in classified as: catch throws; game-day underhand softball pitching is less isokinetic peak torque at 60°/second bullpen; and game. Practice pitches stressful to the upper extremity. Direct (p=0.646) or 180°/second (p= 0.909) with were classified as: catch throws and comparison to overhead baseball baseline (IR60°/sec=16.67±4.28, IR180°/ bullpen. Subjects filled out a daily pitchers is needed in the future to sec= 15.01±3.98, ER60°/sec16.86±3.38, exposure sheet to record pitch volumes confirm this. ER180°/sec=17.7±2.64), static (IR60°/ and shoulder soreness. A numeric sec=17.43±4.55, IR180°/sec=14.90±4.53, rating scale of 0-10 (0=no soreness, 11210MOBI Comparison Of Trunk Rotation ER60°/sec= 16.49±2.82, ER180°/sec= 10=pain affecting sleep) was used to Flexibility Between Collegiate 17.35±3.08), or dynamic (IR60°/ measure soreness during softball Softball Players With And Without A sec=17.14 ±3.8, IR180°/sec=15.00±4.38, activity. Softball exposures were History Of Upper Extremity Injuries ER60°/sec=16.67±3.20, ER180°/ categorized as participation in games, Aragon VJ, Oyama S, Oliaro SM, sec=17.41±2.83) conditions. Con- practices or injured. Main Outcome Padua DA, Myers JB: University of clusions: No significant differences Measures: Descriptive analyses of North Carolina at Chapel Hill, Chapel were found in ROM peak torque or softball exposures, cumulative and Hill, NC, and Duke University, power output after static or dynamic average pitch totals, percentage of Durham, NC stretching. Therefore, neither static game and practice pitches, average nor dynamic stretching appear to be innings pitched, pitches per inning, and detrimental or beneficial to the soreness levels in each category were Context: Limited trunk rotation measured performance variables. calculated. Results: The four subjects flexibility may restrict trunk rotation had an average of 70±16.11 practice motion during throwing, and thus exposures, 26±14.75 game exposures interfere with energy transfer from the and 2±1.64 injured exposures per lower extremity to the upper extremity

S-80 Volume 46 • Number 3 (Supplement) May 2011 via the trunk. Ineffective transfer of with limited trunk rotation when energy is thought to cause increased measured with the HKRT-B when stresses on upper extremity joints that rotating forward were 3.98 times (CI: 1.2- lead to injury. No research to date 13.0) more likely to have an injury compares trunk rotation flexibility in history compared to those without softball players with and without a (X2=5.64, p=.018). Conclusion: The history of upper extremity injury. Trunk results suggest an association between rotation flexibility is traditionally limited trunk forward rotation flexibility assessed in a seated position, yet and throwing-related upper extremity assessment in a half-kneeling position injury. Limited trunk flexibility in the may better replicate a functional forward direction may inhibit the body’s movement (throwing) and thus provide ability to use trunk movement to absorb a better way to measure trunk rotation energy during the deceleration phase flexibility in softball players. Objective: of throwing, which could result in To compare trunk rotation flexibility greater stress placed on the upper between softball position players with extremity joints, and thus increased risk and without a history of upper extremity of injury. HKRT-B was able to throwing related injury using three demonstrate the difference in trunk clinical tests. Design: Cross-sectional rotation flexibility between participants design. Setting: University softball with and without injury history. facilities. Participants: Sixty-five female Clinicians may use HKRT-B to screen collegiate softball position players for trunk rotation flexibility to identify (age=19.5±1.2years, height =165.4± softball players who may be at 7.0cm, mass=69.1kg). Interventions: increased risk for developing upper Trunk rotation flexibility was extremity injury. measured with three clinical tests: half kneeling rotation test with bar in back (HKRT-B), half kneeling rotation test with bar in front (HKRT-F), and seated rotation test (SRT). Trunk rotation flexibility was assessed in both forward (throwing shoulder moving forward) and backward (throwing shoulder moving backward) directions. Additionally, participants completed an injury history questionnaire. Outcome measure: Participants were placed into groups with and without an injury history based on the questionnaire response. For each clinical test, trunk rotation flexibility were compared between participants with and without an injury history using independent samples t-tests. Additionally, chi- square analysis was used to determine an association between limited trunk rotation flexibility and an injury history when significant group difference was found. Results: Softball players with an injury history had significantly limited trunk forward rotation flexibility when measured using the HKRT-B

(mean difference =3.1°± 4.7°, t63=-2.24, p=.029). No other rotation tests demonstrated differences between groups. Furthermore, softball players

Journal of Athletic Training S-81 Free Communications, Oral Presentations: Exercise Fatigue & Lower Extremity Biomechanics Tuesday, June 21, 2011, 8:00AM-9:00AM, Room 219; Moderator: Abbey Thomas, PhD, ATC 11098MONE 11039DONE Gender Comparison Of Central subject height (ms/cm) were elicited A Comparison Of Lower And Peripheral Neuromuscular via transcrianial magnetic stimulation Extremity Neuromuscular Function Following A Sub- and measured via surface Function In Healthy Individuals Maximal Exercise Protocol electromyography (EMG). Quadri- Following A Sub-Maximal Stern AS, Kuenze C, Cross K, Sauer L, ceps and hamstring peak EMG Exercise Protocol Herman D, Hart JM: University of activation(% MVIC) and peak Kuenze C, Hart JM: University of Virginia, Charlottesville, VA torque(Nm/kg) were measured during Virginia, Charlottesville, VA respective MVICs. Independent Context: Noncontact anterior samples t-tests were used to compare Context: A clear understanding of cruciate ligament (ACL) injuries are groups at baseline for all dependent lower extremity neuromuscular common in sports that involve rapid variables while ANCOVA was utilized function is essential to injury changes of directions, including to compare groups following exercise prevention and structuring of decelerating, pivoting, and landing while controlling for baseline rehabilitation protocols following from a jump. Females are 2 to 8 times measurement. Results At baseline, injury. Non-contact lower extremity more likely to sustain a noncontact males exhibited significantly higher injuries commonly occur when ACL injury than males. Both central quadriceps torque (males=2.50 ± athletes become fatigued. While there and peripheral muscle fatigue during 0.71Nm/kg, females=1.88 ± 0.40Nm/ is growing base of knowledge about exercise may exacerbate neuro- kg, P=0.01), quadriceps activation neuromuscular function in healthy and muscular factors that increase risk for (males=236.9 ± 126.1 mV, females injured populations at rest, the effects noncontact anterior cruciate ligament =114.2 ± 84.2%, P=0.01), quadriceps of sub-maximal exercise on both (ACL) injury. Objective: To compare MEP amplitude (males=193.3 ± 192.6 quadriceps and soleus function are lower extremity motor evoked mV, females=88.7 ± 102.9 mV, unclear. Objective: To determine the potentials (MEPs), muscle strength, P=0.02) and hamstring MEP amplitude effects of sub-maximal lower and EMG activation after a (males=186.7 ± 135.5 mV, females= extremity exercise on quadriceps and standardized exercise protocol in 83.8 ± 72.0 mV, P=0.02). After soleus neuromuscular function in males and females. Design: Pre-test, exercise, males exhibited a healthy individuals. Design: Post-test group comparison. Setting: significantly greater decrease in Descriptive laboratory study. Laboratory. Patients or Other quadriceps torque (males= -8.62%, Setting: Laboratory. Patients or Participants: Thirty-four healthy and females= 2.69%, P=0.03) and Other Participants: Twenty healthy recreationally active volunteers with hamstring MEP amplitude (males= participants (11 Females, 9 Males; no history of lower extremity -25.80%, females= -5.72%, P<0.001) age=25.0±4.6yrs, height=170.2±10.6cm, injury(17 females, age = 21.9 ± 2.3 when compared to males. Conversely, weight=68.7±12.8kg) with no history of years, weight = 77.8 ± 3.0 kg, height = females exhibited a significantly significant lower extremity injury were 171.1 ± 6.6 cm and 17 males, age = greater decrease in quadriceps MEP recruited from the university 23.4 ± 6.5 years, weight = 81.6 ± 3.3 amplitude (males= -2.10%, females= community. Interventions: Subjects kg, height = 179.6 ± 7.3 cm). -33.0%, P=0.01) when compared to performed a standardized 30-minute Interventions: Subjects performed a males. Conclusions: Males ex- exercise protocol that involved 5 standardized 30 minute exercise perienced greater peripheral repeated cycles of aerobic and protocol that involved 5 repeated neuromuscular changes manifested as anaerobic exercises. Each cycle cycles of aerobic and anaerobic more pronounced reductions in consisted of 5 minutes of uphill walking exercises. Cycles consisted of 5 quadriceps torque following exercise. (aerobic) and 1 minute of body weight minutes of uphill walking (aerobic) Females experienced greater central squatting and step-ups (anaerobic). and 1 minute of body weight squatting neuromuscular changes manifested as Main Outcome Measures: Patients and step-ups (anaerobic). Subjects more pronounced reduction in performed a seated maximal voluntary reported ratings of perceived exertion quadriceps MEP amplitude. Reduced isometric contraction with the knee bent throughout the protocol to ensure the central neural drive of the quadriceps to 60-degrees bilaterally. An electrical exercise intensity remained at a coupled with knee extension torque stimulus was triggered when a force moderate level. Main Outcome preservation following exercise may plateau was present resulting in a Measures: Quadriceps and hamstring create an environment of increased transient increase in knee extension MEP peak-peak amplitude(V) and risk for knee injury in females. (SIB torque). Quadriceps central transmission velocity normalized to activation ratio (CAR) was calculated

S-82 Volume 46 • Number 3 (Supplement) May 2011 11262FOBI by dividing MVIC torque and SIB Changes In Lower Extremity makes. Higher LESS scores are torque as an estimate of the proportion Movement Patterns During indicative of poorer landings. In order of the quadriceps motor neuron pool Fatiguing Exercise to assess changes during the FFP, the that can be activated during an McGrath ML, Padua DA, Stergiou N, SBJs from the first FFP represented isometric MVIC. Soleus Hoffmann Blackburn JT, Lewek MD, Giuliani C: ‘pre-fatigue’ landing (PRE), SBJs during reflex (V), M-wave (V) and H:M ratio University of North Carolina, Chapel the final FFP represented ‘post-fatigue’ (%) were measured in the prone Hill, NC, and University of Nebraska landing (POST), and SBJs completed position. Progressive electrical at Omaha, Omaha, NE during the middle FFP represented ‘50% stimulation (0-200V) of the tibial nerve fatigue’ (50%). Each item score and the was delivered and soleus reflex Context: Neuromuscular fatigue is a total LESS score were averaged for the potentials were recorded via surface possible risk factor for many first 3 SBJs completed in each selected electromyography. Individual t-tests musculoskeletal injuries, including the FFP, then analyzed using repeated- were used to analyze differences in the Anterior Cruciate Ligament (ACL). measures ANOVAs with Bonferroni dependent variables from baseline to However, the effects of fatigue on lower post-hoc tests (≤0.05). Results: post-exercise. Pearson’s (r) correla- extremity movement patterns have not Fatigue resulted in a significant tions were used to determine the been fully explored, particularly how increase in total LESS score relationship between measures at fatigue progressively impacts (PRE=6.07±1.26, 50%=6.64±1.95, baseline and for changes from baseline movement. Objective: To determine POST=7.07±1.68; F2,44= 6.130, p=0.004). to post-exercise. Results: Quadriceps how increasing amounts of neuro- Post-hoc tests revealed significant MVIC torque (baseline= 3.32±0.73 Nm/ muscular fatigue affects lower increase between PRE and POST (t22= kg, post=2.83±0.74 Nm/kg, P<0.001), extremity movement patterns during a -3.430, p=0.002). Item-specific quadriceps CAR (baseline=88.8±5.7%, functional fatigue protocol (FFP). analysis indicated fatigue increased post=79.1±11.6%, P<0.001), soleus Design: Single-group repeated- lateral trunk flexion at IC Hoffman reflex (baseline=6.89±3.47 V, measures design. Setting: Gymnasium (PRE=0.02±0.10, 50%=0.14±0.24, post=5.48±3.42 V, P<0.001), soleus H:M basketball court. Patients of Other POST=0.16±0.23; F2,44=3.778, p= ratio (baseline= 63.7±19.9%, post= Participants: Twenty-three healthy, 0.031), and increased overall joint 50.7±26.8%, P=0.001) significantly club-level volleyball, soccer, or displacement stiffness (PRE= decreased from baseline to post- basketball athletes (14 F, 9 M; 1.01±0.34, 50%=1.13±0.42, POST= exercise. There were no significant age=19.74±2.09 years, height= 1.30±0.50; F2,44=5.966, p=0.005). correlations between measures at 1.77±0.10m, mass= 72.05±11.47kg) Post-hoc tests revealed significant baseline while the change in volunteered for the study. Inter- increases between PRE and POST for quadriceps CAR and soleus H:M ventions: Participants performed the both lateral trunk flexion at IC (t22=- ratio were positively correlated FFP, which consisted of multi- 2.761, p=0.011) and overall joint (“CAR=-11.1±10.0%, “H:M ratio directional sprints, side-shuffles, and displacement stiffness (t22=-2.989, =-23.7±23.9%, r=0.53, P=0.02). back-peddling, followed by five p=0.007). Conclusions: Neuro- Conclusions: Thirty minutes of sub- standing broad jumps (SBJs) to at least muscular fatigue increased the overall maximal lower extremity exercise 75% of their pre-fatigue maximum SBJ LESS score by a full point between resulted in significant decrease in distance. During the 5 SJBs, handheld PRE and POST, indicating increased neuromuscular function of the camcorders recorded front and side landing errors that may predispose an quadriceps and soleus muscles. The views as each participant landed. Each athlete for lower extremity injury. lack of significant correlation between participant repeated the above Lateral trunk flexion during landing, measures at baseline implicates unique sequence until their time to completion and overall joint displacement aspects of neuromuscular function are was >150% of their initial time on 3 stiffness, were the two items most being explained by each measure. consecutive trials. Main Outcome affected by fatigue. These results However, the percent change in Measures: The Landing Error Scoring indicate that fatigue may significantly quadriceps CAR and soleus H:M ratio System (LESS) was used to quantify the impair landing postures, and further were moderately correlated which movements of the lower extremity support the hypothesis that fatigue indicates that 30 minutes of general during the SBJs, using video recordings may increase potential injury risk. sub-maximal exercise is sufficient to taken during the FFP. The LESS is a cause measurable decrements in lower validated and reliable 17-item checklist extremity neuromuscular function in that examines foot, knee, hip, and trunk health individuals. postures at two points during landing: initial contact (IC) and peak knee flexion. The participant receives a ‘point’ for every landing ‘error’ he/she

Journal of Athletic Training S-83 11033DOGA Changes To Frontal And was combined for analysis. 1x5 Transverse Plane Lumbo-Pelvic- ANOVA’s with follow up pair-wise Hip Running Biomechanics comparisons were performed to Following Cycling In Triathletes examine the differences between pre- Harrison BC, Rendos N, Dicharry J, and post-cycling running bio- Weltman A, Hertel J, Hart J: mechanics. Statistical significance University of Virginia, was set a priori at p=.05. Results: We Charlottesville, VA observed the following main effects for time: Peak Hip Internal Rotation Context: Epidemiological evidence significantly increased from baseline suggests that lower-extremity overuse (21.8° ± 7.2) at each post-cycling injuries are common in triathlon. It is time-point (2min=24.8° ± 9.2, possible that adaptations at the trunk 6min=25.2° ± 9.0, 10min=25.6° ± 9.4, and hip due to prolonged cycling effect 14min=25.3° ± 8.9 p<.001); as did trunk and hip biomechanics during Peak Pelvis Obliquity (baseline=1.1° running. Aberrant hip biomechanics ± 0.8) (2min=1.5° ± 0.8, 6min=1.4° ± have recently been implicated in the 0.9, 10min=1.6° ± 0.95, 14min=1.5° etiology of chronic knee pathologies. ± 0.8 p<.001), and Peak Spine Lateral Excessive frontal plane trunk Bend (baseline=3.7° ± 1.3) (2min biomechanics may also play a role in =4.1° ± 1.4, 6min=4.0° ± 1.2, 10min overuse running injuries. Identifying =4.2° ± 1.4, 14min=4.3° ± 1.4 p< changes to kinematic and kinetic .001); while Peak Hip Abduction parameters at the trunk and hip may Moment (baseline=0.8Nm ± 0.2) provide insight into the development significantly decreased (2min=0.7Nm of lower-extremity in triathlon. ± 0.2, 6min=0.76Nm ± 0.2, 10min Objective: To determine the frontal and =0.77Nm ± 0.2, 14min=0.73Nm ± 0.2 transverse plane running biomechanic p<.001) Conclusions: Frontal and adaptations at the trunk and hip transverse plane running kinematics of following a cycling intervention. the trunk and hips are altered by 30min Design: Descriptive laboratory study. of non-fatiguing stationary cycling in Setting: Motion analysis laboratory. an aerodynamic position. The changes Patients or Other Participants: A to frontal plane spine and pelvis sample of 28 healthy subjects with prior motion may provide a mechanism to triathlon experience (height= 1.73 ± minimize external frontal plane 0.09 m, mass= 63.0 ± 7.7kg, age= 24.6 moments at the hips as these were ± 5.8 years) was used. Interventions: significantly lower following cycling. 3D running kinematics and kinetics were obtained before and at 4 time points (2min, 6min, 10min, 14min) following a 30-min stationary cycling protocol performed in an aerodynamic riding position at a self-selected cadence and power output. Ratings of Perceived Exertion were maintained between 12-14 (out of 20) throughout the cycling intervention to minimize the effects of fatigue. A self-selected running velocity was chosen and held constant between baseline and post- cycling run sessions. Main Outcome Measures: Peak Spine, Pelvis, and Hip Frontal and Transverse Plane Angles and Moments from a sample of 10 gait cycles at each time point were averaged. Data from both limbs

S-84 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Injury Epidemiology Tuesday, June 21, 2011, 9:15AM-10:00AM, Room 219; Moderator: Steve Zinder, PhD, ATC 11058DOIN Injury Incidence In Submission recorded. Data which met the causes of this difference are unknown. Wresting Fighters During The 2009 inclusionary criteria were categorized Objective: To compare differences in Worlds No-Gi Championships by joint (elbow, shoulder, knee, and the distribution of hamstring strain Kreiswirth, EM, Myer GD, Rauh, MJ: ankle). Incidence rates (IR) per 1000 injuries in male and female college Rocky Mountain University of Health athletic exposures (AEs) were soccer players across the time of Professions, Provo, UT, and calculated for overall injury incidence, season, practice or game participation, Cincinnati Children’s Hospital belt rank, and body region. Results: and specific practice activities. Design: Medical Center, Cincinnati, OH During the tournament there were 58 Descriptive epidemiology study. total reported injuries and 1606 Setting: Colleges and universities that Context: Submission wrestling (SW) is recorded AEs. Percentage and rate of voluntarily participated in the NCAA a modern combat martial art that injuries per location were ankle (13.8%, Injury Surveillance System (ISS) for employs joint locks during competition 5.0/1,000 AEs), knee (20.7%, 7.5/1,000 men’s and women’s soccer during fall to submit an opponent and achieve AEs), elbow (20.7%, 7.5/1,000 AEs), seasons from 2004-2007. Patients or match victory. This martial art is a shoulder (13.8%, 5.0/1,000 AEs), and Other Participants: A total of 226 gateway sport for Mixed Martial Arts other (laceration, head, neck, rib) hamstring strains (males=131, (MMA), which is a relatively young, (31.0%, 11.2/1,000 AEs). Blue/black belt females =95) were reported to the ISS but rapidly growing participant combat (least/most experienced) competitors during the data capture period. sport worldwide. Due to their relatively had a significantly higher rate of upper Interventions: At each participating new infrastructures, there are limited extremity (combined shoulder & elbow institution, athletic trainers reported injury incidence reports available for injuries) than purple/brown belt athlete-exposures and injury event data SW or MMA. However, SW may competitors (RR=3.5, 95% CI: 1.0, 18.7; via the online ISS. For this analysis, provide a preview of joint injury p=.03). Although nonsignificant, we only examined hamstring strain patterns expected in MMA purple/brown belt competitors were injuries. Main Outcome Measures: competitions. Objectives: The purpose twice as likely (RR=1.97, 95%CI: 0.7, 5.4; To examine differences in injury of this investigation was to determine p=0.14) to incur a lower extremity injury characteristics between male and incidence rates for injury types at SW (combined knee/ankle) than blue/black female soccer players who incurred belt rank levels sustained at an belt competitors. Conclusions: The data hamstring strains, Chi-Square or international level SW tournament, and from this SW tournament indicate that Fisher Exact tests, as appropriate, to evaluate the risk of injury by belt rank the risk of injury is highest at knee and were used to compare the frequencies and body region. Design: Prospective elbow joints. However, higher belt rank/ of hamstring strains that occurred cohort Setting: 2009 Worlds No-Gi experience may be associated with within levels of the following Championship. Patients or Other increased upper extremity injury variables: time of season (pre-season, Participants: We studied 951 athletes, incidence during SW competition. in-season), activity (game, practice), aged 18 to 50 years, who competed in Further research in warranted to and practice activity (warm-up, drills, the 2009 No-Gi Championships. examine underlying mechanism of conditioning). Exact proportions Participants were categorized into belt injuries to these high risk joints to (percentages) for each level of graduation levels for group optimize techniques to reduce their independent variable are reported comparisons (belt rank progression occurrence in SW competition. without confidence intervals or other level: blue [least experienced], purple, variability estimates because these brown, and black [most experienced]). 11029DOIN results represent exact count data of A Comparison Of Hamstring Interventions: No intervention – the reported injuries. Results: Males Strain Event Data Between Sexes observational. Rate ratios (RR) and 95% had a higher frequency of hamstring During Practices And Games In confidence intervals (CI) were used to strains in-season (males=59%, NCAA Soccer compare belt rank injury rates. Main females=45%), while females had a Cross KM, Conaway M, Gurka KK, Outcome Measure: A reportable injury higher frequency during pre-season Saliba S, Hertel J: University of was defined as any joint injury that (males=41%, females=55%, p=0.04). Virginia, Charlottesville, VA occurred during competition for which Males had a higher frequency of an athlete received any level of care hamstring strains during games from the on-site medical staff Context: Among National Collegiate (males=46%, females=36%), while (physician, athletic trainer). Other Athletic Association (NCAA) soccer females had a higher frequency during injuries reported such as back, rib, head, players, males have a higher incidence practice (males=51%, females=62%, fingers, and skin injuries, were also of hamstring strains than females. The p=0.01). Among males, there were no

Journal of Athletic Training S-85 differences in the frequency of age from 2004 to 2008. demonstrated that patients may hamstring strains among practice Interventions: The E codes 884.9, experience multiple injuries (34 activities during pre-season compared 885.9, 886.0, and 917.0 were searched. patients) and orthopedic and medical to in-season (warm-up: pre- All diagnosises were included. No injury simultaneously (25). This study season=2%, in-season=4%; drills: person was excluded based on age, may lead to further understanding of pre-season=69%, in-season=74%; gender, or race. Main Outcome the prevalence of traumatic athletic conditioning: pre-season=29%, in- Measures: The outcome measures injury in this population with season=22%, p=0.70) Among were the trauma E codes, sex, age, subsequent prevention strategies. females, however, a significantly larger location of injury, prior history, proportion of hamstring strains during mechanism of injury, trauma practice occurred while conditioning classification, sport, orthopedic injury in preseason (pre-season=43%, in- and joint, medical injury and area, season=7%) but during drills in-season diagnosis number, and surgery. (pre-season=52%, in-season=86%, Frequency and descriptive statistics p=0.05). Conclusions: Differences were calculated using SPSS 17 (SPSS in the timing of hamstring strains Inc., Chicago, IL). Results: Three related to time of season, games hundred and eighteen patients were versus practice participation, and identified as having an injury related specific practice activities exist to sports; 258 were male, and 60 were between male and female collegiate female and average age was 14.2 years. soccer players. Compared to males, Intake status was: (1) admitted (152); females had a higher proportion of (2) transferred and admitted (133); (3) hamstrings strains that occurred during transferred (33); and (4) death (0). pre-season when the majority of The most common mechanism of athlete-exposures were during injury (MOI) was player to player practice. Additionally, hamstring contact (166). The balance of MOIs strains in females were more frequent were contact with playing surface (97), during conditioning activities during contact with playing apparatus (41), pre-season practices compared to in- and no contact (14). Sport level or season practices. These findings may locations were: high school / youth assist clinicians and researchers in the league competition (205); recreation development of sex-specific injury (83), school (24), home (5), or camp prevention initiatives for collegiate (1). Twenty-one people had a prior soccer athletes. history of the same injury. Twenty different sports were implicated in 11270SOEM injuries seen in the ED - the most Athletic Injuries Classified As common were: football (110), soccer Trauma At A Pediatric Hospital (41), and basketball (41). The From 2004 To 2008 occurrences of orthopedic and non- Rogers KJ, Hochstuhl D, Murphy S, orthopedic injuries were 259 and 84 O’Brien K, Shah SA: Alfred I duPont respectively. Twenty-five patients had Hospital for Children, Wilmington, both an orthopedic and medical injury. DE Elbow (52) and forearm (38) fractures were the most frequent orthopedic Context: The rationale for the study injuries. The most common non- was to document trauma related orthopedic injuries were concussions athletic injuries that occurred through (37) and spleen (11). Thirty-six a pediatric emergency department patients had multiple injuries: 2 (34), (ED) over a five year period. 3 (1), and 4 (1). Surgical intervention Objective: To review distribution of occurred in 58% of the cases. Five of sports and type of trauma with the 184 surgical cases were medical subsequent care. Design: Retro- related. Conclusions: No study to our spective review of medical charts. knowledge has classified the pediatric Setting: Pediatric hospital. Patients athletic injury trauma frequency and or Other Participants: Patients related treatment for both orthopedic between the ages of 1 – 19 years of and medical injuries. This study

S-86 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Professional Issues Tuesday, June 21, 2011, 10:15AM-11:30AM, Room 219; Moderator: Jim Mensch, PhD, ATC 11200DOHE A Systematic Review of Case Law: of care, and 3. public policy, or their a grounded theory followed by a The Legal Foundation for a Standard lack of conclusive legal reasoning. quantitative assessment of descriptors of Care in the Practice of Athletic Data Synthesis: Two hundred and using a semantic differential and Training eighteen total and 188 unique cases vignettes. Setting: Certified Athletic Musler J: Northeastern University, involving athletic trainers were Trainers. Patients or Other Boston, MA identified. Seventy nine of the 188 Participants: The Delphi panel cases were determined to be relevant consisted of ATs with 5 years minimal Context: The only true check and to the practice of athletic training. experience (N=13) stratified across the balance to professional practice is by Eleven cases addressed duty to care, three largest employment settings and way of judicial review (litigation). 34 cases addressed standard of care, 3 the four largest NATA districts. A Judicial review is a reactionary process cases addressed public policy, and 31 stratified random sample of 5% across occurring only after the legal wrong has cases had no conclusive legal the 10 NATA districts produced been committed. Case law serves as reasoning. Conclusion: The case participants (N=301) completing the society’s record of judicial reasoning; analysis established a clear legal duty quantitative survey. Interventions: The however there is no easily accessible for a secondary school, college or Delphi panel completed individual open resource to present the opinion of the university to provide health care to ended audio recorded interviews with court (case law). This study involved a those who are injured during sponsored the researcher. Questions revolved systematic review of recorded case law athletic activities. Case analysis also around descriptions of the best, most at the state and federal level involving establishes a minimum standard of care successful, and ATs you would or an athletic trainer employed by a clinic, that should be offered by an institution wouldn’t hire or let treat people you secondary school, college or university. and by the athletic trainer. The analysis care about. Transcribed interviews were Objective: Conduct a systematic review produced limited results for the reviewed for clarity with each panelist, of case law to: 1. define the legal duty establishment of legal boundaries to condensed, and reviewed for to provide care to individuals the practice of athletic training. The discussion three times by all members participating in athletic activities; 2. case synthesis resulted in the until consensus on the topics was define the minimum standard of care that development of 15 recommendations reached. Open coding of transcribed should be offered to individuals in the form of standards that should interview text produced descriptive participating in athletic activities; and reduce an unfavorable outcome as a adjectives used in the semantic 3. define the legal boundaries in the result of judicial review. Six standards differential for quantitative assessment practice of athletic training. Data were developed identifying and interview concepts were assessed Sources: LexisNexis and WestLaw institutional responsibility, and nine using vignettes covering responses to databases were searched for the standards were developed identifying typical day AT scenarios. The descriptive phrase “athletic trainer”, minimal clinical practice in athletic quantitative survey was completed as “athletic training” and “trainer” to training. a web-based application. Main identify recorded decisions in the state Outcome Measures: The Delphi study and federal courts. Data Selection: A 11317FOHE resulted in the development of the three phase process was used to Exploring The Constructs Of A Quality Affirmation Theory (QAT). It identify cases. First, cases were Quality Athletic Trainer depicts care, communication, identified with a descriptive word Raab SA: Valdosta State University, commitment, and integrity as sub- search and entered into a spreadsheet. Valdosta, GA constructs of affective traits and Second, a review of the case summary knowledge as a sub-construct of was performed to determine the context Context: There is a lack of consensus effective traits in quality ATs. The QAT of the descriptive phrase. Finally, a in the athletic training (AT) literature descriptors were quantitative assessed complete review of the court record was pertaining to the exact characterization using the Quality Athletic Trainer performed to determine the relevance of a quality AT. Objective: To conduct Questionnaire (QATQ). The QATQ is of the athletic trainer or the practice of a grounded theory qualitative study to comprised of a semantic differential athletic training. Data Extraction: All conceptualize the latent constructs of contrasting adjectives called the cases were coded based on their a quality AT. To sequentially assess Quality Athletic Trainer Scale (QATS) relevance to athletic training. All cases these latent constructs quantitatively. and typical day scenario vignettes coded as “relevant” were categorized Design: A sequential exploratory called the Quality Athletic Trainer based on their potential influence in design starting with a qualitative study Dilemmas (QATD). Results: QATQ three areas: 1. duty to care, 2. standard utilizing a Delphi technique to establish summative scores were (M=

Journal of Athletic Training S-87 101.08±21.24). The QATS (p=.949) individuals participated in follow-up their full skill set. Athletic trainers in and the QATD (p=.764) indicate phone interviews. Textual data was this setting may experience some homogeneity of the instrument analyzed using inductive content level of conflict borne from turf wars, providing measures of validity. Sub- analysis. Trustworthiness was lack of other’s understanding of the AT construct factor analysis and internal established with member checks during profession, or lack of respect. consistency demonstrated a cohesive the phone interviews and peer Because the socialization experiences measure of the construct quality. The debriefing. Results: Four themes are largely informal in nature, ATs may independent variables did not predict emerged from this study: 1) AT role in have an opportunity to educate others summative scores of the QATQ multidisciplinary relationships, 2) wide and negotiate the utilization of his/her indicating that participants expressed ranging socialization experiences, 3) full level of expertise. attitudes favoring the positive perceived improvement of patient adjective descriptors of quality outcomes, and 4) factors associated regardless of age, sex, years of with interpersonal conflict. The first experience, or educational level. theme, AT role in multidisciplinary Conclusion: This study is a starting relationships, consisted of two lower point on development of a global order themes: a) ATs as integral team understanding of a quality ATC. The member, and b) ATs with a relegated study identified important aspects of role. The majority of participants quality. Further assessment of how articulated a team approach with the AT these constructs will impact an athletic playing a key role in patient care. A trainers ability to balance their smaller portion of the participants had professional lives with personal lives roles whereby they were consigned to while providing quality care to patients assist, support, or aide the roles of other is warranted. health care providers. The second theme, wide ranging socialization 11017FOHE experiences, relates to how ATs were The Professional Socialization oriented to their role in the clinical Experiences Of Athletic Trainers In setting during their induction period. The Clinical Context The majority experienced very informal Pitney WA, Mazerolle SM: Northern induction processes. Others Illinois University, DeKalb, IL, and experienced either a formal or semi- University of Connecticut, Storres, formal induction process. The theme CT improved patient outcomes resulted from participants articulating that Context: Compared to other sports working in a multidisciplinary medicine contexts like the secondary environment expanded their knowledge, school, athletic trainers (ATs) in a skill, and treatment options, and clinical setting find themselves subsequently improved patient care interacting with many other health outcomes. Although many positive professionals (e.g. physical therapists) interactions between ATs and other on multidisciplinary teams to provide professionals were noted, the last patient services. Objective: To gain theme, factors associated with insight and understanding about the interpersonal conflict, identified lack organizational socialization of ATs of respect from others, different working in multidisciplinary, clinical treatment philosophies, and turf wars settings. Design: Qualitative study as reasons that caused conflict within using iterative, asynchronous the clinical setting. Conclusions: ATs electronic interview questions and entering a multidisciplinary clinical follow-up, oral interviews. Setting: context can expect to expand their Clinical environment. Patients or Other knowledge, skills, and treatment Participants: 52 (27 female; 24 male; 1 approaches toward improving patient undisclosed) ATs aged 36.6±9.8 with care outcomes. Although many ATs 6.9±7.7 years of experience in their will work as an integral team member, current role. Data Collection and some may be relegated to assist or Analysis: In-depth interviews were support other health care providers and conducted with all participants and 10 thus, the ATs may not fully employ

S-88 Volume 46 • Number 3 (Supplement) May 2011 11265FOHE 11321MOHE Employment Characteristics 1001-3000 students, ≥3001 students), Personal And School Predict Presence Of Team presence of football (yes, no). Main Characteristics Predict The Physician In Secondary School Outcome Measures: The dependent Employment Model Of Secondary Athletic Training Practice Setting variable was SSAT compliance with the School Athletic Trainers Huxel Bliven K, Parsons JT, Bay RC, team physician supervision/direction Nicollelo T, Parsons JT, Huxel Bliven Snyder AR, Lam KC, Valovich requirement (yes or no). A frequency K, Bay RC, Snyder AR, Lam KC, McLeod TC: A.T. Still University, analysis was used to determine Valovich McLeod TC: A.T. Still Mesa, AZ compliance and a simultaneous logistic University, Mesa, AZ regression was used to identify Context: Emphasis on the practice of variables associated with compliance. Context: Interest in the practice of secondary school athletic trainers Alpha was set at ≤0.05, two-tailed. secondary school athletic trainers (SSATs) has increased due to Results: 88.9% (2975/3347) of SSATs (SSATs) has increased because of intensified scrutiny of injury in high reported practicing with team physician public attention regarding high school school athletes. Characteristics of the supervision/direction, while 11.1% sports injuries, but the characteristics secondary school (SS) practice setting (372/3347) practiced without team of this practice setting have rarely been remain unknown, including compliance physician supervision/direction. studied. For example, the two most with practice standards. For example, SSATs who were more likely to practice common employment models for SSATs supervision/direction from a team with the supervision/direction of a team are direct employment by a school/ physician is a common legal physician are those: with BOC school district or outreach services requirement and BOC standard of certification ≥6 years [6-11 yrs: p=0.002, provides by a third party. However, little practice. However, the level of SSAT OR=1.51, 95% C.I. (1.16 to 1.95); ≥16 yrs: is known about the frequency of these compliance with the team physician p<0.001, OR=1.68, 95% C.I. (1.26 to employment arrangments models, or the supervision/direction requirement is 2.32)]; with state-regulated practices factors that might predict them. unknown. Objective: 1) To determine [p<0.001, OR=3.05, 95% C.I. (2.23 to Objective: To identify the frequency of SSAT compliance levels with the team 4.12)]; who work in a private SS the direct and outreach SSAT physician supervision/direction (independent or parochial) [private- employment models and the predictors requirement, 2) to identify employment- independent: p=0.006, OR=2.61, 95% of those models. Design: Cross- setting variables that predict C.I. (1.31 to 5.18); private-parochial: sectional survey. Setting: Web-based compliance. Design: Cross-sectional, p<0.001, OR=2.16, 95% C.I. (1.49 to survey of U.S. secondary schools with survey. Setting: Web-based survey of 3.13)]; in a SS with ≥1001 students [1001- an athletic trainer. Patients or Other U.S. SSs with an athletic trainer. 3000 students: p<.001, OR=2.36, 95% Participants: Of the 6,875 NATA Patients or Other Participants: Of the C.I. (1.85 to 3.00); ≥3001 students: members working in the secondary 6875 NATA members working in the SS p<0.001, OR=3.79, 95% C.I. (1.94 to school (SS) setting, a voluntary sample setting, a voluntary sample of 4024 7.39)]; and whose SS sponsors football of 4,024 (58.5%) responded to the (58.5%) responded to the survey. 3381 [p<0.001, OR=3.36, 95% C.I. (2.05 to survey. 3,356(83.4%) of those of those respondents (84.0%) answered 5.50)]. Conclusions: Most SSATs respondents completed the survey the survey questions necessary to comply with the team physician questions necessary to complete this complete this analysis (Male=1749; supervision/direction requirement, analysis [Male=1,728(51.5%); Female Female=1632, Age=35.7 ±9.9yrs). although a large percentage does not. =1,628(48.5%) Age=35.8±9.9 years]. Interventions: The National Sports The identified employment-setting Interventions: The National Sports Safety in Secondary Schools characteristics that uniquely predict a Safety in Secondary Schools Bench- Benchmark Study (N4SB) survey was SSAT’s compliance may be used to mark Study (N4SB) survey was developed by an expert panel and identify and support those at increased developed by an expert panel and includes demographic, practice, and risk for violating laws and practice includes personal demographic, school school-related questions relevant to the standards. demographic, and practice character- SS setting. A mixed sampling strategy istics questions. A mixed sampling targeted 17000+ NATA members to strategy targeted 17,000+ NATA ensure reaching ATs who might work members to ensure reaching those ATs in a SS setting. The independent who might work in a SS setting. The variables were: time certified (≤5 yrs, 6- independent variables were: highest 15 yrs, ≥16 yrs), practicing with state- level of education, length of time regulation (yes, no), type of SS (public, certified, state regulatory status, type public charter, private-independent, of school, school enrollment, and private-parochial, combination, other), football sponsored by SS. Main school enrollment (≤1000 students, Outcome Measures: The dependent

Journal of Athletic Training S-89 variable was employment model (dichotomous: direct employment vs. outreach). A frequency analysis was used to determine employment model frequency and simultaneous logistic regression was used to identify variables predictive of SSAT em- ployment models. Alpha was p=0.05, two-tailed. Results: 2,377 (72.5%) respondents reported direct employ- ment by a school or school district. The following variables significantly (p<.04 level) reduced the odds of outreach employment: level of education [doctoral degree: RO=0.211, 95% C.I. (.050 to .890)]; years certified [6-15 years: RO=.578, 95% CI (.480 to .694); 16+ years: RO=.339, 95% CI (.274 to .420)]; type of school [charter: RO=.427, 95% CI (.205 to .889); private-independent: RO=.235, 95% CI (.125 to .440); private-parochial: RO=.544, 95% CI (.417 to .710)]; school enrollment [1,000-3,000: RO=.589, 95% CI (.496 to .699); >3,000: RO=.540, 95% CI (.368 to .792)]. Having an additional professional degree (p=.024, RO=2.95, 95% CI (1.153 to 7.556) increased the odds of outreach employment. Conclusions: Most SSATs are directly employed by school/school districts. Doctorally degreed, experienced ATs working in charter or private schools with larger enrollments are less likely to be employed through an outreach model than lesser educated, novice ATs working in small, public schools. Strategic marketing efforts for AT employment in the SS setting may benefit from this information. Implications for job stability and salary / benefit compensation should be investigated.

S-90 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Thematic Poster: General Medical Conditions Tuesday, June 21, 2011, 4:30PM-6:15PM, Room 219; Moderator: Matt McQueen, MD 11023SC 11173FC Tachycardia And Dizziness In A resting HR of 102-137 was also Gluten Intolerance In A Female Collegiate Track Athlete With recorded and interpreted as sinus Triathlete: A Case Report Attention Deficit Disorder tachycardia. While discussing the Detwiler K: University of La Verne, La Hart CH, Bernhardt DT: University condition with the athlete’s father, it Verne, CA of Wisconsin, Madison, WI was revealed that the athlete had a brother with similar symptoms who Background: This case describes a Background: The athlete is a 19-year- was successfully treated with a beta- 23-year-old female triathlete and old sophomore male hurdler with the blocker. A few weeks later, the Adderall certified athletic trainer (AT) with a track team. During the summer between was withheld and the exercise stress history of scoliosis and a family his first and second years of college, test was repeated. At rest, he had a history of celiac disease (CD). The he sought evaluation at home for his pulse of 96 and BP of 122/70. During athlete’s chief complaint was achy lack of focus and difficulty the test he had appropriate BP and HR diffuse lower back pain (LBP) that concentrating. Testing revealed that he responses (200 bpm; 182/78) but did regularly woke her while sleeping. had Attention Deficit Disorder (ADD) experience symptoms prior to There was no mechanism of injury or and was treated with Adderall 20mg. stopping the test due to fatigue. His change in activity. Her triathlon When he was seen by a team physician symptoms continued over 2 minutes training did not affect her symptoms; to document his condition and the use after exercise cessation. Recovery HR however prolonged sitting and of stimulants, he also reported episodes was 102 bpm with BP of 122/80. The inactivity seemed to increase her pain. of dizziness and tunnel vision diagnosis was exercise-related The athlete had normal AROM and full associated with a series of 30-yd sprints inappropriate sinus tachycardia strength of the trunk and weakness of with 2 min rest. He denied chest pain syndrome. The Adderall was ruled out the right hip abductors and scapular and syncope. He had a history of trivial as a cause of the tachycardia. He was stabilizers. The athlete was tender to pulmonic stenosis which resolved as placed on propranolol 20 mg daily. He palpation over the thoracic and lumbar an infant. BP prior to the start of school had no further episodes of symptoms. musculature, but was not tender over was 127/82. An examination was not Within 2 months, he decided to the spine. The slump test was positive performed by the athletic trainer as the discontinue his participation in on the right leg. The straight leg raise athlete presented this to the team athletics partly because of the test, valsalva test, quadrant test, and physician when discussing ADD condition and the medication. stork standing test were all negative. medications. Differential Diagnosis: Uniqueness: This case is unique in that Her neurological exam was normal. The differential diagnosis included the presence of the stimulants clouded Several months after the athlete began abnormal response to Adderall, anxiety, the picture, as the initiation of experiencing LBP, she began noticing exercise-induced atypical migraine, and stimulant therapy coincided with the intermittent abdominal cramping, cardiac arrhythmia. Treatment: On initial presentation of these symptoms. occasional poor appetite, frequent gas, physician examination, his blood Another unique feature is that the and loosely formed bowel movements. pressure was 127/82 with an elevated athlete’s sibling had a similar The athlete did not experience any resting heart rate of 100 bpm. Resting condition. Conclusions: An otherwise nausea, fever, or sudden weight loss/ EKG and complete echocardiogram healthy 19 year old male presents with gain. The athlete denied camping, were unremarkable. Lab values for TSH, tachycardia, dizziness and tunnel traveling, or taking any new Free T4 and CBC were within normal vision during exercise after starting medication. Differential Diagnosis: limits. With an exercise stress test he stimulant therapy for ADD. The LBP: possible disk pathology or had normal HR (200 bpm) and BP (180/ stimulants and other serious cardiac worsening scoliosis. Digestive 60) elevation with no symptoms. The conditions were ruled out as the cause symptoms: irritable bowel syndrome test lasted 10:56 and was terminated due of the symptoms. He continued to use (IBS), rule out celiac disease. to fatigue. While wearing a 24 hr Holter stimulants and was placed on Treatment: The athlete, also a monitor, an episode of sinus propranolol. As the use of stimulants certified athletic trainer (AT), started tachycardia with HR of 200 bpm was for treatment of ADD becomes more self-treatment, but when symptoms recorded. He then received a 30-day prevalent, it is important for athletic continued to worsen, she saw her event recorder which recorded an event trainers to be aware of the possibility physician and was diagnosed with during practice associated with of adverse reactions these medications “lower back pain.” She was referred for dizziness and narrowed vision and a may cause in our athletes. It is also further rehabilitation. The athlete pulse 178-200 bpm. A second event important to be vigilant for serious demonstrated improvement of associated with palpitations and a cardiac conditions. symptoms, up to 75% at times, and

Journal of Athletic Training S-91 improved core strength and scapular significant dietary limitations, and a Treatment: The athlete was pre- stabilization. Rehabilitation was knowledgeable AT can assist the athlete scribed inhalers beginning in eighth discontinued and the patient continued in avoiding gluten in the diet, which grade. She used Advair, Singulair and self-treatment as needed. During this will improve the athlete’s quality of Albuterol with no effect. She has not time, the athlete also saw her physician life and athletic performance. been tested or treated for her seasonal for her digestive symptoms. The allergies. An EKG stress was normal physician ordered blood work to check 11342SC as were a lung function test and for celiac disease. The results were Breathing Difficulty In A High ultrasound. A nasal endoscopic normal other than a slightly elevated School Athlete examination was performed revealing IgG antibody level. Due to the Terhune W, Patel R, Danov Z, Bezold mild anterior adductor movement of grandmother’s history of celiac L: University of Kentucky, Lexington, the vocal folds during rest breathing. disease and the elevated IgG, the KY; Woodford County High School, When shortness of breath was athlete was referred to a Versailles, KY reproduced, complete closure of the gastroenterologist. An upper true and false vocal folds was observed. endoscopy, a duodenal biopsy, and Background: This case will be Exercises to relieve paradoxical vocal blood tests to check thyroid levels discussing recurrent breathing fold motion resulted in an open airway. were ordered. The results of these tests difficulty in a female high school athlete. The patient was given the Reflux were normal, and celiac disease was She is a 16 year old junior high school Severity Index and scored a 28. Using ruled out. The athlete was diagnosed athlete competing in track and the Reflux Symptom Index any score with IBS. After two years of continued volleyball. The athlete stated that she over 13 indicates a positive finding for and worsening LBP and insidious onset was experiencing problems while laryngopharyngeal reflux. Using of right hip pain, the athlete visited a running races during the spring track biofeedback of the open airway, the Doctor of Osteopathy (DO) who season. She says that while running a athlete was instructed to achieve an treated her with manual therapy for race she began to experience tightness open airway with open throat breathing. three weeks with no improvement. The in her chest, numbness and tingling in The athlete was also instructed in DO questioned the athlete about the arms and hands, and that her throat rescue breathing exercise and menstrual or digestive irregularities, closes up. The athlete states that by abdominal breathing excises. She was and her previous history was discussed. the end of the race she could not given a home exercise program to be A two-week trial of a gluten-free diet breathe and collapsed upon reaching performed daily and during times when (GFD) was recommended, and upon the finish line. The symptoms began she has an elevated heart rate. The return to the DO two weeks later, the around the 100 yard mark and athlete was referred back to her family athlete reported that her LBP and progressed through the finish line (400 doctor for allergy testing and digestive symptoms had completely yard mark). She reports that she would treatment. Uniqueness: Unfortunately resolved. After a follow-up visit one experience an occasional panic anxiety Paradoxical vocal fold motion is often month later, still symptom free, the caused by the difficulty breathing. The misdiagnosed as asthma or exercise athlete was diagnosed with gluten athlete was able to recover after a few induced asthma. One study showed sensitivity/intolerance (GS), was minutes of rest, but complained of body that 10% of the patients diagnosed with discharged, and was advised to ache, a headache and a lethargic asthma were actually found to have continue the GFD. Uniqueness: This feeling. The athlete stated that she PVFM and an additional 30% were athlete was experiencing significant experienced the same signs and found to have PVFM combined with LBP which completely resolved after symptoms during her 8th grade track asthma. Yet another study of 164 a modification of her diet. It is unusual season. She also states that during the patients undergoing rhino-laryn- that diet would be the primary cause recent volleyball season the symptoms goscopy for any reason found that 20% of LBP, and this should be of interest would return after doing seven to eight of the females had PVFM. to ATs who treat athletes with LBP that conditioning sprints or while sprinting Conclusion: Currently the athlete is does not respond to traditional up the bleachers. She said that when symptom free and continues to treatment. Conclusions: Should the the symptoms did occur during the perform her breathing exercises with AT have an athlete who is experiencing volleyball season, she was able to no complaints. PVFM is often chronic pain that does not resolve with recover much faster and without the misdiagnosed as asthma or exercise the traditional treatment methods, it body aches and lethargy. She does induced asthma resulting in may be important to ask the athlete suffer from numerous seasonal allergies inappropriate treatment with asthma about any digestive symptoms, or ask as well as animal allergies. Differential medication often for long periods of about a family history of CD or GS. If Diagnosis: Seasonal allergies, exercise time without symptom relief. PVFM present, GS or CD should be induced asthma, laryngopharyngeal has been shown to occur in a wide range considered. Individuals with GS have reflux, paradoxical vocal fold motion of athletes and is not sport specific.

S-92 Volume 46 • Number 3 (Supplement) May 2011 Certified athletic trainers must be clinically able to recreate the sweating. No radiating pain was noted, more cognizant of its signs and symptoms; therefore able to diagnose but anterior and lateral compression symptoms to help expedite the the athlete with vocal cord dysfunction tests of the ribs were positive for pain diagnosis and treatment. and laryngopharyngeal reflux. The and crepitus. An ice bag was athlete accepted a series of breathing administered to the right abdominal 11346SC exercises to do before and after region and she was transported to the Vocal Cord Dysfunction In A High practice and instructed on proper local emergency department. School Football Player breathing technique during labored Differential Diagnosis: Rib fracture, MacDonald A, Hosey R, Kanga J: breathing. Uniqueness: Vocal cord xiphoid process fracture, costochondral University of Kentucky Orthopaedic dysfunction, classified as a rare separation, splenic injury, and/or solar Surgery & Sports Medicine, disorder, affects one in two-thousand plexus injury. Treatment: Upon arrival Lexington, KY, and University of people. It estimated that some forty to the emergency department, an Kentucky Pediatric Pulmonology, percent of diagnosed athletes with abdominal/pelvic CT scan with IV Lexington, KY exercise-induced asthma might in fact contrast, complete blood count suffer from vocal cord dysfunction. including platelets, Basic Panel 8, and Background: A seventeen year-old The disorder in this case was very a prothrombin time/International Caucasian male twelfth grader was frustrating for the athlete and his Normalized Ratio (PTINR) tests were participating in summer football camp family. They had visited numerous ordered. The abdominal/pelvic CT scan two-a-day practices. During the early health professionals with no resolution showed a small amount of fluid along stages of each practice, the athlete of symptoms. Being able to pinpoint the posteromedial surface of the liver would report difficulty getting air into the issue was a huge relief to the indicating a subcapsular hematoma. A his lungs with associated complaints athlete and his family. ‘ Conclusion: trace amount of free fluid in the right of dizziness, blurred vision, and a The breathing exercises did help the paracolic gutter and pelvis was also general loss of energy. The athlete athlete return to more uninterrupted noted suggesting a hemoperitoneum. would spend time away from drills for play, they did not, however, stop the The athlete was diagnosed with a Grade unspecified amounts of time with each episodes in their entirety. The athlete 3 laceration (>3 cm parenchymal depth) episode, and then return to practice still suffered two to three episodes per on the right lobe of the liver. She was until breathing difficulties returned. The week and did have to miss practice hemodynamically stable although athlete tested for a variety of different time, although not as much as prior to potassium and bicarbonate were low allergies, which had all returned being diagnosed. The athlete is hopeful and glucose was high (potassium, 3.1 negative. A cardiology workup had also that by doing the exercises in the mmol/L [normal=3.5-5.3 mmol/L]; returned negative. The athlete had winter, he can have an unimpeded bicarbonate, 22 mmol/L [normal= 23-32 received an albuterol inhaler from his senior year of lacrosse in the spring. mmol/L]; glucose, 132 mg/dL family physician who was treating the [normal=70-100 mg/dl]). Her vitals were athlete for asthma, however the 11330MC stable approximately 2.5 hours post- albuterol had little to no effect. The Grade Three Liver Laceration In injury (BP, 118/76 mm Hg; HR, 68/min; athlete began receiving physical An Intercollegiate Volleyball RR, 16/min; tympanic temperature, therapy for spinal alignment, which also Player: A Case Report 36.3°C). The athlete was admitted into had little to no effect on the breathing Milton AE, Hansen PJ, Miller KC, the ICU for observation and the difficulty. The parents were finally able Rhee YS: North Dakota State attending physician decided on a to schedule an appointment with a University, Fargo, ND conservative, non-operative approach pulmonologist who specialized in to treatment. Forty-eight hours post- working with athletes. Differential Background: A 20 year old, female injury, a second abdominal/pelvic CT diagnosis: asthma, exercise induced collegiate volleyball athlete (body scan and blood work was performed and asthma, vocal cord dysfunction, mass=74.8 kg; height=177.8 cm), with showed that the athlete was stable. She anxiety, seasonal allergies, general no previous history of abdominal injury, was admitted for an additional 2 days allergies. Treatment: The athlete dove for a ball and was struck in the for observation. After being discharged received attention by the pulmonologist anterolateral abdominal region during from the hospital, she was prohibited who, after ruling out a pneumothorax a match by a teammate’s knee. She from practicing until a third abdominal/ or pleural effusion through x-ray, experienced a solar plexus spasm, pelvic CT scan was performed and referred the athlete to a sports medicine shortness of breath, and nausea. She showed no residual injury to the liver specialist to rule out musculo-skeletal was assisted off the court by the (5 weeks post-injury). The physician issues. After musculo-skeletal issues Athletic Trainer. On-site evaluation cleared the athlete to begin a were dismissed, the pulmonologist then revealed sharp pain in the right upper progressive rehabilitation protocol referred the athlete onto a speech quadrant and epigastric area, pallor, focusing on cardiorespiratory and low therapist. The speech therapist was continued nausea, and excessive intensity sport-specific exercise. The

Journal of Athletic Training S-93 athlete returned to play 6 weeks post- athlete was removed from activity for tachycardia, as well as possible injury without complications; however, a week with continued reports of one predisposing contributing factors. she continued performing rehabilitation to two spells with associated focusing on cardiorespiratory palpitations, dyspnea, and chest 11277FC endurance. Uniqueness: Blunt tightness. No episodes of syncope or Ewings’ Sarcoma In A Junior abdominal injuries are rare in non- near syncope were stated, and there High School Football Player contact sports such as volleyball. were no alleviating or provoking Bobo L, Tate A: Magnolia West High Abdominal injury rates in volleyball factors. Referral to a local cardiologist School, Magnolia, TX; Stephen F. competitions occur 0.04 per 1,000 was recommended for further cardiac Austin State University, athlete exposures and are usually evaluation. The cardiologist performed Nacogdoches, TX muscular strains. Contact and collision an echocardiogram, ultrasound, and sports have a higher risk of blunt placed the athlete on a Holter monitor Background: A 14 year old male abdominal trauma, which would include for 24 hours. Spells of tachycardia with sustained an injury to his right shoulder liver injuries. Conclusions: Blunt abrupt onset and termination with rates during a junior high school football abdominal injuries, such as liver in the 180s and 190s were recorded from game during the fall of 2008. Upon an lacerations, can occur to any athlete the Holter monitor. Differential initial side-line evaluation, the athlete regardless of sport. Athletic Trainers Diagnosis: Heart murmur, Paroxysmal reported with full ranges of motion, working with non-contact sports must atrial tachycardia (PAT), paroxysmal normal strength, and only reported of be cognizant that abdominal injuries supraventricular tachycardia (PSVT). tenderness around the point of impact can occur and can be life threatening. Treatment: Treatment options were on his upper humerus. An ice bag was Proper recognition of the signs and discussed in depth with the patient. provided to him post-competition. The symptoms of internal organ injuries, like Options included pharmacologic athlete was still complaining of arm pain liver lacerations, and the administration suppression or an electrophysiologic the next day that prompted his parents of proper emergency care are critical. If (EP) study with radiofrequency catheter to make an appointment with the family the athlete is hemodynamically stable, ablation. With the third referral, a physician who ordered x-ray images of a conservative non-operative approach cardiac electrophysiologist recom- his shoulder. It was then that a tumor following a liver laceration yields mended the EP study as a preferred was discovered on the upper right successful results. approach with pharmacological humerus. Differential Diagnosis: suppression as a second-line option. Pathologic fracture, fracture, tackler’s 11274MC The patient elected for the EP study; it exostosis, bone and/or soft tissue Supraventricular Tachycardia was performed within the week. contusion, periosteal contusion. (SVT) In A College Female Localization of arrhythmia was unable Treatment: With an immediate referral, Basketball Athlete to be found during the procedure, so the family traveled to MD Anderson’s St Julian C, Bobo L, McCary L: radiofrequency energy was not used. Children’s Cancer Hospital where he Stephen F. Austin State University, The pharmacologic suppression option was diagnosed with Ewings’ sarcoma, Nacogdoches, TX was then placed in effect. Hypertensive a type of bone cancer. The patient’s medication was changed to a beta- right humerus was removed and Background: A 22 year old female blocker as to not to interfere with the replaced with a cadaver bone. To NCAA Division 1 basketball player new medication. The patient was prevent movement, the patient was sustained a cranial concussion with released from the hospital on the same placed in a full-body cast with his seizure during a 2010 spring basketball day as the EP procedure. No activity shoulder immobilized at a right angle. game. A full return to activity was was permitted for two days. Throughout his convalescing, permitted weeks later after physician Progressive return to play was chemotherapy was being administered evaluation and absence of symptoms implemented with full return to play and he continued to attend school. with and without activity. Hypertension with no limitations a week later. Because Ewing’s sarcoma can spread was a secondary diagnosis from this Uniqueness: Supraventricular to the lungs, the patient has since had concussion. In the beginning of the tachycardia is rarely experienced in 15 small tumors removed from both following basketball season, the athlete young elite athletes. It is also lungs. Uniqueness: Ewing’s sarcoma reported to the athletic trainer of uncommon to be unable to localize an usually presents with few symptoms. pounding chest, difficulty breathing, arrhythmia spot. The cranial Pain and occasional swelling at the site and dizziness after running in a practice concussion experienced months before of the tumor are common, along with session. Complaints of short bouts of could have opened the door for such the patient being febrile. Sometimes a “heart racing” continued to the next day conditions to have occurred. “pathologic fracture,” or a break in the throughout daily activities. Referral to Conclusion: This case presents bone at the site of the tumor can lead to the team physician followed, where a symptoms, diagnostic testing, and its discovery. This type of bone cancer heart murmur was suspected. The treatment options for supraventricular usually develops during puberty and

S-94 Volume 46 • Number 3 (Supplement) May 2011 is 10 times as common in Caucasian months following the initial surgery, a successful outcomes. Furthermore, children as in African-American, second surgery was required. The continued radiology testing is African, and Asian children. The bone second surgical procedure revealed a necessary to monitor treatment tumors may arise anywhere, but tend mass 20% large than the mass removed success. In addition to treating the to be located in the long bones of the during the first surgery. This mass was disease pathology, it is important to arms and legs, the pelvis, or the chest. negative for residual sarcoma and four address any function deficits, such as Metastasis occurs to the lungs and more cycles of chemotherapy we weakness or loss of ROM, which may other bones occurring in approximately prescribed. Three months following the occur secondary to chemotherapy. one-third of diagnosed children. second surgery, the patient had full Conclusion: An early diagnosis of this ROM of his left shoulder with cancer can increase the possibility of discomfort and atrophy of his deltoid, a favorable outcome. pectoralis and trapezius muscles, and rotator cuff weakness. Diagnostic tests 11065SC were negative. Rehabilitation consisted Shoulder Pain In An Adolescent of total body conditioning emphasizing Male core strength, trapezius and rotator cuff Jacobs D, Ireland ML, Schwartz HS: strengthening while limiting aggressive University of Kentucky, Lexington, passive ROM. Four months after the KY, and Vanderbilt University, second surgery the patient returned to Nashville, TN full activity with no serious side effects from the chemotherapy. He remained Background: A twelve year old male under the care of the sports medicine soccer player was referred to the sports physician for 3 years with the chief medicine clinic with pain and numbness complaint being limited range of motion down his left arm after performing in his left shoulder. At this time a MRI soccer throw-ins. Upon initial revealed osteonecrosis of the humeral evaluation he had no pain with palpation head with no evidence of the return of over the left AC joint and upper the sarcoma. Six months later a post- humerus, however, there was fullness op series of MRIs revealed a growing noted in the left axilla, which was firm lesion located approximately 5 cm below and tender upon palpation. Further the tip of the acromion. X-rays of evaluation revealed full ROM, no pain shoulder and chest were normal. He with a positive apprehension test, and underwent another surgery to rule out all other special tests negative. bone metastases. A dime size Differential Diagnosis: Bursitis, cyst, osteotomy was performed on the neurofibroma, or synovial cell sarcoma. proximal humerus and sent to Treatment: X-rays revealed no boney pathology. The defect was filled with abnormalities, but radiolucency on the polymethy cement, irrigated and closed left shoulder compared to the right in layers. The excised tissue was shoulder was noted. An MRI revealed benign. Three months later he returned a soft tissue mass anterior that did not to the oncologist, where he was enter the glenoid humeral joint. The released for full activity with the implications of the mass were discussed recommendation to continue to do at length with the patient and his strengthening and stretching exercises. parents, and it was recommended an He was also recommended to follow- orthopaedic oncologist evaluate him. up yearly with the oncologist. The oncologist recommended excision Uniqueness: Synovial sarcoma is rare of the mass to rule out a sarcoma. A CT and has a poor prognosis. It occurs of his chest, abdomen, and pelvis were mostly in adolescent males and is often also performed to rule out other possible missed diagnosed as it mimics other masses. Following operative tumor common injuries and is slow in resection, the biopsy revealed synovial developing. Half of the patients cell sarcoma. The treatment for synovial diagnosed will metastasize within two cell sarcoma consisted of four cycles years following initial treatment. of chemotherapy and repeat x-rays, MRI Conclusion: Early detection of and CT scans every three months. Four synovial cell sarcoma is important for

Journal of Athletic Training S-95 Free Communications, Oral Presentations: Intervention for Chronic Ankle Instability Wednesday, June 22, 2011, 8:00AM-9:00AM, Room 219; Moderator: Patrick McKeon, PhD, ATC 11239FONE 11028DOTE Effects Of Ankle Bracing And P=0.289, SV: P=0.295), stability level Pain Reduction After A Single Stability On Linear And Non-Linear (SA: P=0.144, SP: P=0.784, SV: P=0.788), Bout Of Posterior Talocrural Measures Of Postural Control or in the brace by stability interaction Joint Mobilizations In Acute Zinder SM, Goerger BM, Burns M, (SA: P=0.668, SP: P=0.599, SV: P=0.592) Ankle Sprain Patients Padua DA: University of North on any of the linear measures of Cosby Nl, Grindstaff TL, Parente Carolina at Chapel Hill, Chapel Hill, postural sway. Significant differences W, Hertel J: University of Virginia, NC were found in ApEn in the AP direction Charlottesville, VA, and Creighton for brace (NB: 0.30±0.07, LU: 0.26±0.07, University, Omaha, NE Context: Postural sway is a very SR: 0.26±0.06; P=0.001), and in the common measure used to investigate brace by stability interaction (stable- Context: During the acute phase of an balance deficits following ankle injury. NB: 0.30±0.06, stable-LU: 0.25±0..06, ankle sprain, rest, ice, compression and Practitioners commonly utilize ankle stable-SR: 0.27±0.06; unstable-NB: elevation are advocated to reduce braces in an attempt to minimize the 0.30±0.09, unstable-LU: 0.27±0.07, swelling and pain. Additionally, effect of these balance deficits. unstable-SR: 0.25±0.06; P= 0.018). No clinicians commonly use passive joint Traditional linear measures of postural differences were found for brace mobilizations to reduce pain through sway have often failed to elucidate condition (P=0.648), stability level modulation of stimulating mechano- significant differences. Approximate (P=0.889) or in the brace by stability receptors and altering afferent input. entropy, a non-linear measure of signal interaction (P=0.163) for ApEn in the Passive joint mobilizations have been complexity, has shown promise as a ML direction. Conclusions: While reported to relieve pain and improve more sensitive measure of postural significant differences across brace function in patients with ankle sprain, control. Objective: To investigate the conditions did exist, specifically in the however little evidence exists on the effects of ankle bracing on postural AP direction, they were only evident immediate effects of a single control in subjects with stable ankles when examined via the non-linear application of joint mobilization and and subjects exhibiting chronic ankle measure of approximate entropy. This pain relief. Objective: To examine the instability with both linear and non- suggests that ApEn is a more sensitive effects of a single bout of AP joint linear measures. Design: A repeated measure of postural control than mobilization on pain perception in measures pre-post test design. Setting: traditional linear measures. The two individuals with an acute lateral ankle Controlled, laboratory setting. Patients braced conditions constrained the sprain. Design: Single-blinded, or Other Participants: Twenty-eight system (lower ApEn score) to a much randomized controlled clinical trial. subjects (14 stable, age = 26.19±6.46 yrs, greater extent than the no brace Setting: Laboratory. Subjects: height = 166.07±12.90 cm, mass = condition. Contrary to intuitive Seventeen physically active individuals 69.90±13.46 kg; and 14 chronically thought, an over constrained postural (8 control, 9 treatment, mean age unstable, age = 23.76±5.82 yrs, height control system may be less able to 19.76±1.35 years, mean height = 174.00±11.67 cm, mass = 68.61±13.12 adapt to a particular task or 69.10±4.31 cm, and mean mass kg) participated in this study. environmental change. In future 71.34±16.45 kg) with mild acute lateral Interventions: Subjects completed four studies, investigators should consider ankle sprains participated. Subjects 30-second trials of single leg static supplementing the standard measures were immobilized for a minimum of three, balance with eyes open in each of three of postural stability with measures of but a maximum of seven, days, and had ankle bracing conditions: no brace signal complexity, such as approximate an average of a 6.5°±1.33° dorsiflexion (NB), lace-up brace (LU), and semi-rigid entropy, to determine the state of the ROM deficit compared to the brace (SR). All testing was performed postural control system. contralateral limb. Intervention(s): The on a force platform. Main Outcome treatment group received a single 30- Measures: Linear measures of sway second bout of Grade III AP joint area (SA), sway path (SP), and sway mobilization on the day their velocity (SV) along with non-linear immobilization device was removed, measures of approximate entropy while the control group did not receive (ApEn) in the anterior/posterior (AP) joint mobilization or physical contact. and medial/lateral (ML) directions. Main Outcome Measures: Self-reported Results: No differences were found for pain as assessed with the pain subscale brace condition (SA: P=0.142, SP: embedded in the Foot and Ankle Disability Index Activities for Daily

S-96 Volume 46 • Number 3 (Supplement) May 2011 Living (FADI-ADL) scale was eyes to move in the opposite direction significantly improved from pretest to assessed at baseline and 24 hours after of the head so that the intended image posttest (p=0.001). Of particular the receipt of the treatment or control can be centered on the fovea of the eye. interest were the OSI and more interventions. The FADI pain scale Objectives: To compare the ability of challenging mOSI dynamic postural consists of 4 items related to the traditional and VOR-enhanced stability tests that improved for both subject’s perception of pain at rest and rehabilitation protocols to improve right and left limbs over the 4-week during ADLs. Each item is scored from postural stability, dynamic visual acuity intervention: OSI pretest (8.4+3.4) to 0 (none) to 4 (unbearable), with lower and gaze stabilization among chronic posttest (3.1+1.8), p=0.001; mOSI scores within this subscale indicating ankle instability (CAI) patients. pretest (11.7+2.4) to posttest (5.5+1.8), decreased pain perception. The total Design: Randomized controlled trial. p=0.001). Conclusions: As hypothe- scores on the 4 items are converted to Setting: Research laboratory setting. sized, subjects in the VOR group a percentage, with a 100% representing Participants: 16 physically-active demonstrated significantly better no pain. A 2x2 (group by time) repeated women and men (age, 22.2+1.5 yrs; hgt, scores on the horizontal DVA and measures ANOVA was run to determine 171.1+7.0 cm; mass, 73.9+18.3 kg) with vertical GST tests. Both the the immediate effects of grade III AP unilateral CAI, defined as a history of TRADITIONAL and VOR rehabilitative talocrural joint mobilizations on pain at least two ankle sprains on the same protocols produced significant changes perception, using the pain subscale ankle and self-reported feelings of from pretest to posttest, suggesting components of the FADI-ADL. Pairwise giving way. Participants were free of any that both are effective in improving comparisons were conducted as post neurological or vestibular impairments. postural stability, gaze stabilization and hoc analyses. Results: There was a Interventions: Subjects were randomly dynamic visual acuity in CAI patients. significant group by time interaction assigned to 1 of 2 treatments: (p=0.04). Pain values were significantly Traditional rehabilitation group 11014FOBI Noise-Enhanced Balance And reduced in the treatment group (TRADITIONAL) = utilization of a CAI Functional Performance In Subjects (pre=72.22±10.87%, 24 hours ankle rehabilitation protocol modified With Chronic Ankle Instability post=84.03±14.36%, p=0.01), while there from McKeon et al. (2009) (n=8), or VOR Ross SE, Arnold BL, Linens SW, was not a significant change in the rehabilitation group = the modified Wright CJ, Moody SA, Treadwell control group (pre=81.25±14.94%, 24 McKeon CAI protocol with the addition KM, Laverty WK: Virginia hours post=80.47±7.04%, p=0.87). of head movements incorporated into Commonwealth University, Conclusion: Our findings suggest that all exercises (n=8). Each patient Richmond, VA a single 30-second bout of grade III AP participated in 3 rehabilitation sessions/ talocrural joint mobilizations was week for 4 weeks. The 2 experimental effective at reducing pain over a 24 groups were tested on 2 occasions: a Context: Stochastic resonance hour period in patients with mild acute pretest (Week 0) and posttest (Week stimulation (SRS) administered on the ankle sprains. 4); we used a Group (2) x Time (2) mixed skin over ankle muscles at low factorial ANOVA (p=0.05). Main subsensory intensities has improved 11232MONE Outcome Measures: Motor control static balance in subjects with chronic The Influence Of Vestibular- tests (MCT) obtained with the ankle instability (CAI). In theory, Ocular Reflex Training On NeuroCom EquiTest™; overall stability balance improvements with SRS should Postural Stability, Dynamic indices obtained bilaterally from transfer to other functional activities, Visual Acuity And Gaze standard (OSI) and modified (mOSI) which may facilitate rehabilitation. Stabilization In Patients With Athlete Single Leg Stability Tests with Objective: Our objective was to Chronic Ankle Instability a Biodex BalanceMaster™; dynamic determine static balance and functional Hilgendorf J, Vela LI, Gobert DV, visual acuity (DVA) and gaze performance improvements associated Harter RA: Department of Health and stabilization (GST) tests using the with SRS administered at a customized Human Performance and Department NeuroCom inVision™. Results: Vertical optimal intensity. Design: A two- of Physical Therapy, Texas State GST scores in the VOR improved treatment (SRSon, SRSoff) cross-over University, San Marcos, TX significantly pretest to posttest, design. Setting: Research laboratory. 136.0+27.1 to 165.0+11.5 deg/sec Patients or Other Participants: Twelve Context: The vestibular-ocular reflex compared to TRADITIONAL, subjects with CAI (171.83±9.31 cm, (VOR) is a low latency, reflexive eye 122.2+27.3 to 123.3+16.0 deg/sec (F 82.31±23.27 kg, 27.00±6.37 yrs) who movement that allows the eyes to (1,14) = 11.02, p=0.005). Significant reported sensations of lateral ankle compensate for head rotation in order group differences were also observed instability and ankle sprains. Subjects to stabilize gaze during the movement. for the horizontal DVA test (p=0.038). had to score ≤27 on the Cumberland The VOR is important during physical Six of the 9 outcome measures Ankle Instability Tool (CAIT) to activity because it is initiated each time evaluating postural stability, gaze participate in this study (CAIT the head starts to move, and causes the stabilization and dynamic visual acuity =19.67±3.75). Interventions: Sub-

Journal of Athletic Training S-97 jects first performed a static balance figure-of-8 hop (SRSon=15.25±4.62 s, test and then performed 3 functional SRSoff= 16.19 ±5.36 s; t(11)=-1.90, tests (shuttle run, side hop, figure-of- P=0.04). Conclusions: The 8 hop) without shoes in a customized optimal intensity for SRS counterbalanced method. Vibrating that improved static balance also tactors were placed over peroneal, enhanced functional performance in anterior tibialis, gastrocnemius, and subjects with CAI. SRS had the greatest posterior tibialis muscles on the leg impact on the side hop test by with CAI. A random noise signal enhancing functional performance by generated in a stimulation unit caused 18%. these tactors to vibrate. Quiet double leg static balance tests without vision or shoes were performed for 20 seconds on a force plate under a control condition (SRSoff) and 4 SRS intensities administered at 25%, 50%, 75%, and 90% of each subject’s sensory threshold. Three trials were performed for each condition in a counterbalanced order. The SRS intensity that produced the greatest balance improvement (measured by resultant center-of-pressure velocity) was used as the customized optimal intensity (SRSon) and was compared to the SRSoff condition for data analysis. Then, 3 trials for each functional test were performed under each condition

(SRSon, SRSoff) in a counterbalanced method. The shuttle run required subjects to run quickly to complete a 20 m course. The side hop test required subjects to hop quickly side- to-side 0.3 m on the leg with CAI to complete 10 repetitions. The figure- of-8 hop test required subjects to hop quickly through a 10 m figure-of-8 course on the leg with CAI. A stopwatch measured the time to complete each functional test. One- way paired samples t-tests compared α SRSon and SRSoff conditions ( =.05). Main Outcome Measures: Re- sultant center-of-pressure velocity (cm/s) and time (s) were dependent measures. Slower velocity and less time were indicative of improved static balance and functional performance, respectively. Results: SRSon improved static balance (SRSon=0.99

±0.21 cm/s, SRSoff= 1.14±0.29 cm/s; t(11)=-4.03, P=0.001), shuttle run

(SRSon=8.59±1.45 s, SRSoff=9.01

±1.62 s; t(11)=-2.68, P=0.01), side hop

(SRSon=8.76±1.36 s, SRSoff=10.65

±3.82 s; t(11)=-1.89, P=0.04), and

S-98 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Oral Presentations: Ankle Injury and Postural Control Wednesday, June 22, 2011, 11:30AM-12:45PM, Room 219; Moderator: Alan Needle, MS, ATC 11229FOBI 11220DOMU Ankle Kinematic Variability Is camera Vicon system (240Hz), Relationship Of Ankle Mechanical Negatively Correlated With Postural synchronized with a forceplate Stability To Dynamic Stability Stability Indices (1200Hz), collected kinematics at the McLeod MM, Ko JP, Pietrosimone Brown CN, Bowser B: University of ankle in 3 planes and ground reaction BG, Schaffner L, Gribble PA: Georgia, Athens, GA, and University forces. Inverse dynamics were used to University of Toledo, Toledo, OH of Delaware, Newark, DE calculate kinematic data at the ankle. Pearson R correlations were Context: Joint instability is defined Context: Chronic ankle instability conducted with α=0.05. Main by mechanical (MI) and functional (CAI) is a common outcome following Outcome Measures: CV values for instability (FI) contributions. a lateral ankle sprain. Ability to ankle motion in 3 planes were Arthrometer measured laxity and stabilize quickly during landing is calculated during landing and averaged dynamic stability measured with Time compromised in those with CAI, and over 10 trials, as were stability indices to Stabilization (TTS) are used variability of joint motion may play a in the anterior-posterior (APSI), commonly to define deficits related to role in the ability to stabilize quickly medial-lateral (MLSI), vertical planes ankle instability. While used separately, during landing. Objective: To (VSI), along with a composite indices it is not known if these measures of MI determine if measures of coefficient (DPSI). The relationship between and FI correlate. Objective: Determine of variation (CV) at the ankle joint are mean CV values and stability indices the strength of the correlation between negatively correlated with dynamic in 3 planes and the composite were ankle laxity and TTS. Design: postural stability indices (DPSI) during assessed via bivariate Pearson Descriptive laboratory study. Setting: a single leg jump landing. Design: correlation coefficients. Results: Research laboratory. Patients or Other Correlational. Setting: Biomechanics Ankle sagittal plane CV was negatively Participants: Sixteen participants with Laboratory. Patients or Other correlated with APSI (r=-0.33, a range of history of ankle injury (n=16; Participants: Eighty-eight volunteer p=0.002) while ankle frontal plane CV 4M, 12F; 20.50±1.18years, 172.56 recreational athletes divided into 4 was negatively correlated with VSI and ±9.56cm, 69.00±11.98kg). Inter- groups. Mechanical ankle instability DPSI (r=-0.24, p=0.02 and r=-0.23, ventions: For dynamic stability, (MAI): 8 males, 13 females, age p=0.03, respectively). No other participants performed a single-limb 19.9±1.0 years, height 172.5±6.7cm, relationships were statistically jump-landing task, from a height of 50% mass 68.7±8.4 kg; Functional ankle significant. Conclusions: As ankle of their maximum jump height onto a instability (FAI): 11 males, 12 females, motion variability increased, force plate, and obtained and age 20.3±1.6 years, height 173.4±9.4 performance on stability indices maintained a stable position for 5 cm, mass 70.7±11.9 kg; Controls: 12 improved, as indicated by decreased seconds. Ground reaction forces were males, 12 females, age 20.0±1.2 years, values. It appears that sagittal plane used to calculate Time to Stabilization height 171.1±7.1 cm, mass 65.4±9.8 ankle variability is related to anterior- (TTS) values, with smaller values kg; Copers: 8 males, 12 females, age posterior stability, while frontal plane indicating better dynamic stability. 20.1±1.1 years, height 173.0±11.0 cm, variability is related to vertical and Laxity of the ankle was quantified with mass 68.9±10.5 kg. MAI, FAI, and composite stability. While the an ankle arthrometer, with larger values Coper groups reported history of correlations were weak, it appears that indicating more ankle laxity. Means and previous moderate-severe ankle sprain. increased variability is related to standard deviations of 3 trials of landing MAI and FAI groups reported ≥2 improved landing stability. Lack of and laxity assessment were used from episodes of ankle instability in the last flexible landing movement strategies each subject. Main Outcome 12 months. MAI participants had may be related to deficits in landing Measures: Pearson product moment clinically lax lateral ankle ligaments stability in CAI populations. correlations were performed to while FAI, Copers, and Control determine the relationship of TTS participants did not. Interventions: measures with sagittal and frontal plane Retroreflective markers were attached ankle laxity. TTS was calculated in the to the body using a modified Helen- anterior/posterior (APTTS) and medial/ Hayes marker set. Participants stood lateral (MLTTS) directions. 70cm from an in-ground force plate Additionally, anterior/posterior and and performed an anterior vertical medial/lateral TTS values were jump to 50% of their measured combined into a single measure, maximum. Participants landed on the resultant vector TTS (RVTTS; involved leg and balanced for 3s. A 7- seconds). Total laxity in anterior/

Journal of Athletic Training S-99 posterior (APTotal; mm) and administered to all subjects and disability, while dynamic stability inversion/eversion (IETotal; degrees) reported as a percentage, with lower using TTS does not. Clinicians should served as the other variables. Results: values indicating more perceived ankle consider ankle laxity, but perhaps other The correlations between APTotal and instability. For dynamic stability, functional outcomes besides TTS, when APTTS (r=-0.107, P=0.69), IETotal and participants performed a single-limb addressing patients’ ankle disability MLTTS (r=0.134, P=0.62), APTotal and jump-landing task from a height of 50% complaints. RVTTS (r=-0.068, P=0.84) and IETotal of their maximum jump height onto a and RVTTS (r=-0.148, P=0.58) were all force plate, and obtained and 11042ONE weak. Conclusion: Ankle laxity and maintained a stable position for 5 Spatial Postural Control dynamic stability measured with TTS seconds. Ground reaction forces were Alterations With Chronic had very weak correlations to each used to calculate Time to Stabilization Ankle Instability other. It is likely that both are (TTS) values, with smaller values Pope M, Chinn L, McKeon PO, quantifying different contributions to indicating better dynamic stability. Mullineaux D, Sauer L, Hertel J: ankle disability, and therefore clinicians Laxity of the ankle was quantified with University of Virginia, Charlottesville should assess both MI and FI rather an ankle arthrometer, with larger values VA, and University of Kentucky, than assuming that one or the other is indicating more ankle laxity. Means and Lexington, KY more defining of ankle dysfunction. standard deviations of 3 trials of landing Continued research is needed to and laxity assessment were used from Context: Postural control deficits determine the most appropriate each subject. Main Outcome have been identified in chronic ankle combination of outcome measures for Measures: Two stepwise regression instability (CAI) individuals as assessing MI and FI contributions to analyses were performed to determine compared to healthy subjects. ankle instability. the amount of variance in self-reported Although deficits in static balance have ankle disability explained by dynamic previously been reported using center 11222FOMU stability and ankle laxity. The of pressure measures (COP) and, more Relationship Of Mechanical questionnaire scores served as recently, time to boundary measures Laxity And Dynamic Stability To dependant variables, with the FADI (TTB), the underlying mechanism Self-Reported Ankle Disability representing indices of disability behind these deficits warrants further Gribble PA, McLeod M, Ko JP, during activities of daily living (ADL), investigation. It is unclear if there are Pietrosimone BG, Schaffner L: and the FADISport representing indices differences in the spatial distribution of University of Toledo, Toledo, OH of disability during physical activity/ COP data points and TTB minima data exercise. Anterior/posterior and medial/ points on the planar surface of the foot Context: Disability related to chronic lateral TTS values were combined into during quiet single limb balance among ankle instability (CAI) is contributed to a single measure, resultant vector TTS individuals with and without CAI. by both mechanical and functional (RVTTS; seconds), that served as one Objective: To determine differences in impairments. Ligamentous laxity is a independent variable. Total laxity in the plantar location of the distribution measure of mechanical dysfunction, and anterior/posterior (APTotal; mm) and of the COP data points and the TTB measures of dynamic stability can be inversion/eversion (IETotal; degrees) minima data points between subjects considered functional stability. It is served as the other independent with and without CAI. Design: Case- unknown how measures of functional variables. Results: For FADI scores, control. Setting: Laboratory. Patients and mechanical ankle stability may the combination of RVTTS, APTotal or Other Participants: 50 healthy explain self-reported ankle disability. and IETotal explained 49.6% of the subjects (22 males, 28 females; Objective: Determine the amount of self- variance (r2=0.496, P=0.036), while age=23.0±4.6 yrs; height=168.3±10.0 reported disability that can be explained the combination of APTotal and IETotal cm; mass=69.8±12.7 kg), and 61 with measures of dynamic stability explained 49.5% of the variance subjects with self-reported CAI (31 during a jump-landing task and (r2=0.496, P=0.036). For FADISport males, 30 females; age=21.5±3.9 yrs; mechanical laxity measured with an scores, the combination of RVTTS, height=171.8±9.7 cm; mass=69.1±13.4 arthrometer. Design: Descriptive APTotal and IETotal explained 50.7% kg) participated. Interventions: All laboratory. Setting: Research of the variance (r2=0.507, P=0.032), while subjects performed three successful 10- laboratory. Patients or Other the combination of only APTotal and second trials of single leg quiet Participants: Sixteen participants with IETotal explained the same amount of standing on a force plate in eyes- a range of self-reported ankle injury variance (r2=0.507, P=0.010). opened and eyes-closed conditions. history (n=16; 4M, 12F; 20.50± Additionally, APTotal by itself Main Outcome Measures: COP and 1.18years, 172.56±9.56cm, 69.00± explained 47.1% of the variance in TTB minima were recorded for each 11.98kg). Interventions: The Foot FADISport (r2=0.471, P=0.003). trial. The plantar surface of each and Ankle Disability Index (FADI) and Conclusion: Ankle laxity appears to be subject’s foot was then divided into FADISport questionnaires were a good indicator of self-reported ankle four regions (anterolateral, antero-

S-100 Volume 46 • Number 3 (Supplement) May 2011 11021FONE medial, posterolateral, postero- Plantar Pressures In Those and 6) medial forefoot. A Group by medial). The number of COP data With And Without Chronic Area, mixed model, repeated measures points and the number of TTB minima Ankle Instability While ANOVA was performed with an alpha data points were recorded in each Landing A Lateral Hop level set a priori (p<0.05). Results: region. For each region, the mean Webster KA, Pietrosimone BG, There was no significant Group by Area number of data points of the three trials Armstrong CW, Gribble PA: interaction (F1,30=0.62, p=0.71) or in each condition was used for University of Toledo, Toledo, Group main effect (F1,30=1.24, statistical analysis. For each dependent OH, and Boston University, p=0.27). Within the main effect for variable an independent samples t-test ≤ Boston, MA Area (F5,26=38.68, p 0.00), the medial was used to compare differences in (47.20±15.17 PSI) and lateral each region between the two groups. Context: Previous studies of foot (36.03±12.60 PSI) forefoot displayed Results: During the eyes-opened plantar pressure measures in those with the highest areas of pressure across the trials, the CAI group had more COP chronic ankle instability (CAI) have two groups. Conclusions: Previous data points (CAI=178.91±149.93; found alterations in how pressure is studies have demonstrated higher healthy=100.34±108.92, p=0.003) and distributed during running gait. midfoot and lateral forefoot forces in TTB minima data points (CAI= However, limited exploration exists of CAI subjects during running gait, 16.01±13.66; healthy=8.24±8.74; in-shoe plantar pressures in CAI suggesting a more inverted foot p=0.001) in the anterolateral region of patients while performing other position which may predispose them the foot compared to healthy subjects. individual functional tasks, such as to lateral ankle sprains. The lack of When constraining the task to eye- landing from a lateral hop. Alterations statistically significant group closed, the CAI group showed greater in plantar pressure may reflect foot- differences in our study compared to anterior displacement (total number of positioning differences, predisposing previous work may be attributed to the anterolateral and anteromedial data CAI subjects to repeated injury. selected task. CAI subjects may be able points) of the COP and TTB minima Objective: To examine plantar pressure to correct patterns during one specific compared to the healthy group (COP: measures during landing of a lateral task in a controlled setting to prevent CAI=329.14 ±134.54; healthy= hop in those with and without CAI. lateral ankle sprain but may 250.23±119.60; p=0.002; TTB: Design: Case-Control study. Setting: demonstrate more lateral pressure CAI=30.02±12.67, healthy=21.69±10.44; Controlled research laboratory. during a repetitive type motion such p<0.001). Conclusions: The CAI group Participants: Thirty-two physically as running gait which would account exhibited a more anterolateral active subjects volunteered for the for the differences in outcomes of this positioning of the COP and TTB minima study. Sixteen CAI subjects (8M, 8F, study compared to previous data. in eyes-opened trials and a more 172.25 ±10.87cm, 69.13±13.31kg, More research evaluating in-shoe anterior position during eyes-closed 20.50±2.00yrs) were matched to 16 plantar pressures during various tasks trials. The differences in COP and TTB healthy subjects (8M, 8F 170.50 in those with CAI is necessary to minima distribution may demonstrate ±9.94cm, 69.63±14.82kg, 22.00 determine if consistent patterns exist possible neuromechanical compen- ±3.30yrs). Interventions: Subjects in this population. satory mechanisms being developed to were individually fit for in-shoe help those with CAI maintain postural pressure inserts, which were control during single limb stance. The positioned between the foot and the more anterior positioning of the CAI inside of the shoe. Subjects were asked group may be advantageous because to perform 5 lateral hops on each foot, they may be adopting a more the distance of which was normalized dorsiflexed stance in an effort to be in to the length of their lower leg and the a more stable, closed-packed and rigid height standardized to 5cm. An F- position of the foot and ankle. Scan® plantar pressure system However, further research assessing collected peak average foot pressures kinematic differences are needed to for 6 separately defined areas on the evaluate this hypothesis. plantar surface of the foot. Main Outcome Measures: Peak average pressures in pounds per square inch (PSI) for each area were collected at landing of the lateral hop and averaged across the 5 trials: 1) lateral rearfoot, 2) lateral midfoot, 3) lateral forefoot, 4) medial rearfoot, 5) medial midfoot,

Journal of Athletic Training S-101 Free Communications, Thematic Poster: Lower Extremity Function & Physiology Following Knee Injury Wednesday, June 22, 2011, 1:00PM-2:30PM, Room 219; Moderator: Melanie McGrath, PhD, ATC 11F17DONE 11041MONE Contributions Of Central Measures: Hierarchical linear Hip And Knee Muscle Function Activation Failure And Atrophy regression analysis was performed to Following Aerobic Exercise In To Quadriceps Weakness determine the association between Individuals With Patellofemoral Pain Associated With ACL quadriceps CAR and CSA and knee Syndrome Reconstruction extension MVIC in the ACLr limb. One- Ott BN, Cosby NL, Grindstaff TL, Thomas AC, Wojtys EW, Palmieri- way ANOVAs were performed to Hart JM: University of Virginia, Smith RM: University of Michigan, determine if quadriceps CAR, CSA, and Charlottesville, VA, and Creighton Ann Arbor, MI, and University of MVIC differed between limbs. Results: University, Omaha, NE Colorado Denver, Aurora, CO Regression analysis failed to demonstrate a significant relation Context: Patellofemoral pain Context: Quadriceps weakness between quadriceps CAR and CSA and syndrome (PFPS) is a common knee presents and persists after anterior the peak MVIC following ACLr (R2= disorder associated with altered lower cruciate ligament reconstruction (ACLr) 0.164, P=0.448). The CAR accounted for extremity muscle activation. There is in spite of otherwise successful 15.7% (P=0.20) of the variance in little evidence regarding the effects rehabilitation. The precise contributors quadriceps MVIC; subsequent aerobic exercise on quadriceps to lingering quadriceps weakness are inclusion of quadriceps CSA accounted strength and muscle activation during unknown, though muscle atrophy and for the remaining 0.7% (P=0.79). Peak dynamic tasks in individuals with PFPS. activation failure have been implicated. CSA (ACLr=68.21 ± 18.35cm2; unin- Objective: To compare knee Objective: This study sought to jured=81.19±20.08cm2; P< 0.001) extension torque and activation of the elucidate the roles of activation failure and the quadriceps MVIC (ACLr= gluteus medius (GM), vastus medialis and muscle atrophy in persistent 1.96±0.54Nm/kg; uninjured =2.81 oblique (VMO), vastus lateralis (VL) quadriceps weakness after ACLr. ±0.96Nm/kg; P=0.001) but not the during an anterior reaching task Design: Cohort study. Setting: This CAR (ACLr=0.83±0.13; uninjured following an aerobic exercise study was performed in a controlled =0.79±0.14; P=0.30) differed protocol between individuals with laboratory setting. Patients or Other between limbs. Conclusions: Though PFPS and healthy controls. Design: Participants: Twelve individuals both quadriceps atrophy and activation Descriptive laboratory study. Setting: (21.08±6.21 years; 1.73±0.09 m; failure were present in our subjects, Laboratory. Participants: Twenty 74.38±14.62 kg) undergoing ACLr six neither quadriceps CSA nor CAR was PFPS participants (age=20.90 months previously participated. related to knee extension strength. ±1.77years, height =170.69±6.72cm, Interventions: Quadriceps activation Future studies seem necessary to mass= 70.34± 7.88kg) were divided was assessed using the burst determine what additional factors may into two groups: patients reporting a superimposition technique and be associated with quadriceps MVIC clinically important increase (greater quantified via the central activation ratio so necessary modifications to current than a 1.4cm on a visual analog scale) (CAR). Muscle atrophy was determined rehabilitation strategies can be made. in perceived pain (high PFPS=11) and as the peak quadriceps cross sectional Until quadriceps weakness is patients who did not report increased area (CSA) from magnetic resonance sufficiently countered during pain (less than a 1.4cm),(low PFPS=9) images. Specifically, the borders of each rehabilitation, individuals may be at risk after exercise. Twenty healthy controls quadriceps muscle were traced in each for re-injury and/or joint degeneration. (age=22.60±3.62years, height= image in which they appeared using Funded by the Doctoral Research 168.21±6.63cm, mass= 65.50± ImageJ software (version 1.43u, NIH, Grant Program of the NATA Research 7.23kg) were also included in this Bethesda, MD). The image yielding the & Education Foundation. study. Intervention(s): Participants largest CSA was utilized to quantify walked at a self-selected speed on a peak quadriceps CSA. Quadriceps treadmill at 3.0mph for 20-minutes. strength assessment was performed on The treadmill incline was raised 1% an isokinetic dynamometer. The peak grade per minute for the first 15- value over three knee extension maximal minutes. Participants rated perceived voluntary isometric contraction (MVIC) exertion (RPE) at the start of each trials was normalized to subject body minute. During the last 5-minutes, mass (Nm/kg) and served to quantify participants adjusted the incline of the quadriceps strength. All testing was treadmill so they would maintained an performed bilaterally. Main Outcome RPE level of 15-17 through the end

S-102 Volume 46 • Number 3 (Supplement) May 2011 of the exercise protocol. Outcome rehabilitation protocol for patients duration of each daily session (TENS), measures were recorded before and with PFPS. or 20-minutes of knee joint immediately after exercise. Main cryotherapy immediately prior to each Outcome Measures: Normalized knee 11034FOTE daily exercise session (CRYO). extension torque and average root Quadriceps Function In ACL Main Outcome Measures: Nor- mean square electromyography (EMG) Deficient Knees After Rehabilitation malized knee extension force (Nm/kg muscle activation of the VMO, VL, and Exercises Augmented By TENS And of body weight) and quadriceps central GM during a single leg anterior Cryotherapy activation ratio were measured reaching task was taken pre and post Hart JM, Kuenze CM, Pietrosimone bilaterally before and after the first aerobic exercise. A 2x2 repeated BG, Diduch DR, Miller MD, Carson supervised treatment session and measures ANOVA was used to compare EW, Hart JA, Ingersoll CD: University within 24 hours of the last session. An knee extension torque between groups of Virginia, Charlottesville, VA; electrical stimulus (10, 0.6ms after exercise. EMG data violated University of Toledo, Toledo, OH; duration, 125V pulses at 100Hz) was parametric assumptions, therefore, Central Michigan University, Mt. manually triggered during a maximal Mann-Whitney U tests were used to Pleasant, MI volitional isometric contraction compare groups at baseline and after (MVIC) and delivered through 2 exercise; Wilcoxon test was used to Context: Quadriceps muscle carbon-impregnated rubber electrodes compare pre-post test within each activation failure contributed to by secured to the anterior thigh group. Results: Significantly de- reflex muscle inhibition is an (proximal-lateral and distal medial) creased knee extension torque was underlying factor to rehab-resistant, causing a transiently increased observed after exercise in PFPS patients persistent muscle weakness that superimposed burst force (SIB). % experiencing pain (control: pre=1.96± threatens long term joint health Central activation ratio (CAR) was 0.47Nm/kg, post=2.25±0.49Nm/kg; High following injury. Trans-cutaneous calculated as (MVIC/[MVIC+SIB]) PFPS: pre=1.63±0.62Nm/kg, post= electrical nerve stimulation(TENS) *100. ANCOVAs were used to assess 1.73±0.64Nm/kg, Low PFPS: and knee joint cryotherapy have each changes in outcome measures between pre=1.90±0.37Nm/kg, post= 1.95± been shown to reverse reflex muscle groups over a 2-week period using 0.38Nm/kg, P=0.03). Significant inhibition thereby providing an optimal baseline values as the covariate. decreases in GM activation during the environment for rehabilitation Cohen’s d effect size ([post-pre]/ anterior reaching task were observed exercises. Treatments that restore pooled standard deviation) was used to in PFPS patients who reported no pain normal neuromuscular function may evaluate the magnitude of within-group after exercise (control: pre=0.01±0.04, be an important prerequisite for changes over time. Results: The post=0.10±0.04; High PFPS: optimizing strength gains and following presents the P-value for pre=1.24±1.33, post=1.27±1.26, Low maintenance. Objective: To compare each ANCOVA followed by within- PFPS: pre=1.90±1.33, post=1.62±1.30, strength and quadriceps muscle group effect sizes. There were no P=0.021). Significant decreases in VMO activation in ACL deficient patients statistically significant group (control: pre=0.24±0.11, post=0.25 who undergo a 2 week rehabilitation differences immediately following the ±0.13; High PFPS: pre=22.05±30.73, program augmented with TENS or first exercise session for normalized post=16.64±19.15, Low PFPS: cryotherapy. Design: Clinical trial. MVIC (P=0.10, d[95%CI]: Exerc: pre=41.69±58.68, post=32.74±35.61, Setting: Orthopaedic clinic and sports 0.26[-0.62,1.14] TENS: 0.67[- P=0.010) and VL (control: pre= medicine laboratory. Patients or 0.23,1.57] CRYO: 0.59[-0.31,1.48] ) 0.20±0.11, post=0.21±0.11; High Other Participants: Thirty patients or CAR (P=0.30, d[95%CI]: Exerc: PFPS: pre=10.22 ±7.74, post= (20 males, 10 females, 31.6± 0.31[-0.57,1.19] TENS: 0.58[- 9.00±7.00, Low PFPS: pre=12.40± 13.0years, 172.8±10.0cm, 75.8± 0.31,1.48] CRYO: 0.68[-0.22,1.58]). 9.32, post=11.05±9.11, P=0.021) 13.0kg) with MRI-confirmed ACL There was no statistically significant activation were observed in PFPS deficient knees consecutively group differences after the 2-week patients who reported increased pain recruited from a single orthopaedic intervention for MVIC (P=0.92, post exercise. Conclusions: When surgery clinic. Interventions: All d[95%CI]: Exerc: 0.84[-0.07,1.75] PFPS patients experience pain during patients attended 4-sessions of TENS: 1.27[0.31,2.24] CRYO:0.78[- exercise, a reduction in quadriceps supervised quadriceps strengthening 0.13,1.69]) or CAR (P=0.94, activation was observed, however, in exercises over 2-weeks, prior to d[95%CI]: Exerc: 0.83[-0.08,1.75] the absence of pain proximal reconstruction surgery. Patients were TENS: 1.09[0.15,2.03] CRYO: adaptations occurred; specifically a randomly allocated (n=10/group) to 0.95[0.03,1.88]). Conclusions: reduction in GM activation. Therefore, receive exercises alone (Exerc), Quadriceps strength and central clinicians should consider the current exercise while wearing a sensory activation in ACL-deficient patients level of pain when tailoring a TENS device on the knee joint for the can be improved with exercises.

Journal of Athletic Training S-103 Although the addition of TENS and orthopedic practice. Participants: discreet phenotypes characterized by Cryotherapy did not result in Twenty-two knee OA patients with distinct biochemical characteristics, significant differences compared to moderate-severe radiographic OA in clinical findings, and clinical trial exercise alone, strong magnitude EF group (n=11, age: 62.9±5.2 years, outcomes. Biochemical distinctions effect sizes and 95%CI that don’t body mass index [BMI]: 34.2±7.6 kg/ suggest that these patients should be cross zero in the TENS and CRYO m2) or in NE group (n=11, age: stratified in analyses based on groups only suggest potential benefit 66.1±9.3 years, BMI: 33.6±6.4 kg/m2) biochemical profiles, rather than to patients. Interventions: Each subject disease status, to more accurately completed a health history form, the understand disease progression, 11181DOCE Likert version of the Western Ontario selection of treatments, and efficacy Analysis Of The Biochemical and McMaster Universities of interventions. Future studies may Environment Of Effused And Non- (WOMAC) OA Index Score to assess enable identification of more OA Effused Osteoarthritic Knees three subscales of function (pain, phenotypes, which may allow for Cattano NM, Driban JD, Sitler MR, stiffness, and functional limitations), earlier diagnosis and interventions of Balasubramanian E, Barbe MF, Amin and had their synovial fluid protein at risk patients, as well as the M: Department of Orthopaedic concentrations analyzed with a custom identification of optimal interventions Surgery and Sports Medicine, Temple human SearchLight Proteome for at-risk of existing OA patients. University, Philadelphia, PA; Multiplex Protein Array. Proteins Department of Sports Medicine, were measured in pg/µg of total protein 11223DOBI West Chester University, West content. The independent variable was The Effects Of Neuromuscular Chester, PA; Division of group (EF vs. NE). Main Outcome Fatigue On Knee Biomechanics Rheumatology, Tufts Medical Measures: Dependent variables of And Muscle Activity In ACL Center, Boston, MA; College of interest were knee synovial fluid Reconstructed Patients Health Professions and Social protein concentrations of eight Klykken, LW, Thomas, AC, McLean, Work, Temple University, specific proteins (pro-inflammatory, SG, Palmieri-Smith, RM: University Philadelphia, PA; Department of protective, catabolic-associated or of Michigan, Ann Arbor, MI, and Orthopaedic Surgery and Sports anabolic-associated with cartilage University of Colorado-Denver, Medicine, Temple University, ossification). Mann Whitney U tests Aurora, CO Philadelphia, PA; Department of were used on all protein Anatomy and Cell Biology, Temple concentrations and functional scores Context: Neuromuscular fatigue University, Philadelphia, PA to determine group differences alters lower extremity biomechanics (p≤.006), which is reported as the and muscle activation, potentially Context: Osteoarthritis (OA) has median [95% confidence interval]. increasing anterior cruciate ligament reached epidemic proportions in the Results: EF had significantly higher (ACL) injury risk. Altered United States, affecting over 27 million concentrations of tissue inhibitors for neuromechanics post-ACL recon- United State adults (ages 24-74). metalloproteinases (TIMP)-1 (NE= struction (ACLr) may precipitate re- Traumatic knee injuries (anterior .519388 [0.000000-13.457844], injury, though the effects of fatigue on cruciate ligament or meniscal tears) EF=52.008696 [38.851239- individuals following ACLr remain increase the likelihood of early 80.618044]; p<.001), TIMP-2 (NE= unknown. As individuals returning to development of OA. Understanding the . 340405 [0.000000-2.521999], EF= activity following ACLr likely biochemical environment of OA is 4.471101 [3.758427-5.662756]; p= experience neuromuscular fatigue, fundamental for understanding the .002), interleukin (IL)-10 (NE= understanding how fatigue impacts early pathophysiologic events and for .000017 [.000007-.000039], EF= knee biomechanics and muscle the identification of “at-risk” OA .000054 [.000037-.000184]; p=.003), activation seems imperative so patients. Several interventions have and matrix metalloproteinase (MMP)- strategies to counter the effects can be shown to be palliative among patients 3 (NE=.131 [0.000-6.932], EF= implemented. Objective: Determine the with knee effusion; however, not every 81.236 [0.000-334.058; p<.001). No effects of neuromuscular fatigue on patient with OA has clinical effusion. other synovial fluid protein knee biomechanics and muscle There is potential for overgeneralization concentrations were significantly activation patterns post-ACLr. Design: of results since it is unclear if effused different. No significant differences Case-Control. Setting: University and non-effused joints are in functional scores were determined Laboratory. Patients or Other biochemically distinct. Objective: To between effused and non-effused knee Participants: Eight individuals 7-10 measure and compare the biochemical OA groups. Conclusions: Bio- months post-ACLr (3 male, 5 female; environment of effused (EF) and non- chemical differences between effused age 20.7±5.9years; 1.7±0.1m; mass 75.9 effused (NE) OA knees. Design: Cross- and non-effused knees further verifies ±14.3kg) and eleven controls (3 male, 8 sectional. Setting: Outpatient that these two subsets represent female; age: 22.6±4.2years; 1.7±0.1m;

S-104 Volume 46 • Number 3 (Supplement) May 2011 mass 68.6±12.1kg) participated. non-contact ACL injury mechanism. joint laxity (AP) using a KT-1000 knee Interventions: Fatigue was induced These biomechanics adaptations arthrometer, and knee joint alignment via repetitive sets of double-leg squats suggest a need for fatigue-resistance (ALIGN) using an electrogoniometer (N =8), which were interspersed with training within ACL injury prevention in their affected extremity. Main sets of single-leg landings (N =3), and post-operative rehabilitation Outcome Measures: Total anterior- until squats were no longer possible. programs. posterior tibial displacement (mm), Three-dimensional sagittal plane knee knee joint alignment (°), and global biomechanics and electromyography 11F15FOMU pain, stiffness and function scores data were recorded throughout fatigue Knee Joint Laxity And Alignment from the WOMAC Osteoarthritis during the single-leg landing trials. The In Patients With Early Stage Knee questionnaire were measured. single-leg landings consisted of a Osteoarthritis Results: No significant multivariate double-leg take-off, single leg landing Hicks-Little CA, Peindl RD, group by gender interaction occurred onto a force platform immediately Hubbard TJ, Scannell BP, Springer for all variables combined [Wilks’ followed by an aggressive lateral hop BD, Fehring TK, Odum SM, Cordova =0.89, F(7,26)=0.47, P =0.85]. to the opposite side. Main Outcome ML: Department of Exercise and Significant main effects for group Measures: Sagittal plane knee angles Sport Science, University of Utah, [Wilks’ =0.30, F(7,26)=8.58, P< at initial contact (IC) and peak stance Salt Lake City, UT; Department of 0.0001] and sex [Wilks’ =0.23, (PS) and external moments at PS were Orthopaedic Surgery, Carolinas F(7,26)=12.35, P< 0.0001] were calculated during landing using a Medical Center, Charlotte, NC; found when all variables were standard inverse dynamics approach. Department of Kinesiology, combined linearly. Specifically, knee Quadriceps and hamstrings (QH) and University of North Carolina at OA patients demonstrated greater quadriceps and gastrocnemius (QG) Charlotte, Charlotte, NC; Knee and Global WOMAC Osteoarthritis EMG co-contraction was determined Hip Center, OrthoCarolina, questionnaire scores (34.83±17.50), from IC to peak vertical ground reaction Charlotte, NC compared to the healthy matched force. Pre- and 50%-fatigue trials were controls (0.00±0.0; P<0.0001). Knee analyzed via 2x2 (time x group) repeated Context: Knee osteoarthritis (OA) is OA subjects did not differ from measures ANOVAs. Bonferroni multiple a debilitating disease that affects an healthy controls on ALIGN (P=0.49) comparison procedures and univariate estimated 27 million Americans. or total AP (P=0.66). When comparing F tests were used for post hoc analyses. Changes in lower extremity alignment sex differences, males exhibited Results: ACLr patients were less flexed and joint laxity have been found to greater knee joint valgus alignment at IC pre-fatigue (-10.8°±1.61) than at redistribute the medial and/or lateral (178.0±4.1) compared to females 50% fatigue (-14.4° ±1.79; P=.018). Both loads at the joint. Further, both joint (175.0±4.4, P=0.05). Additionally, no groups demonstrated less flexed PS space narrowing and malalignment sex differences were observed on the knee postures at 50% fatigue than pre- have been found to be related to laxity. ALIGN and total AP measures. No fatigue (ACLr pre=-44.5°±2.70, 50%=- Objective: To compare knee joint laxity, significant relationship was identified 14.1°±2.27; Control pre=-57.1°±2.30, knee alignment and a global subjective between WOMAC scores and ALIGN

50%=-13.6°±1.94; Pd”.001). ACLr pain, stiffness and function score in (rxy=-0.41, P=0.87) and total AP patients experienced a smaller external early stage knee OA patients to healthy (rxy=0.22, P=0.38), as well as ALIGN flexion moment (ACLr pre=-1.20Nm/ matched controls. Design: Case- and total AP measures (rxy=0.19, kg*m±.089, 50%=-1.45Nm/kg*m±.096; controlled, repeated measures design. P=0.45) in the knee OA group. Control pre=-1.78Nm/kg*m±.076, post=- Setting: Biodynamics Research Conclusions: These data demon- 1.49Nm/kg*m±.082; Pd”.001) than Laboratory. Patients or Other strates that early onset knee OA controls regardless of fatigue state. QH Participants: Eighteen subjects with directly influences subjective pain, and QG EMG co-contraction were knee OA (7 males, 11 females, age joint stiffness and function outcomes; greater pre-fatigue than at 50% 60.17±9.98 yrs, mass 90.27±16.73 kg, ht however, knee joint alignment and joint regardless of group (LQH [pre= 168.41±9.92 cm) and 18 healthy laxity remains unaffected. Moreover, .367±.048, 50% = .210±.035; P matched controls (7 males, 11 these data provide evidence that knee =.006] LQG [pre=.620±.159, 50%= females, age 60.28±10.66 yrs, mass joint laxity and knee joint alignment .620±.159; P=.026]). Conclusions: 81.12±21.21 kg, ht 168.28±11.95 cm) are not the primary determinants Our results indicate that in a fatigued participated in the study. associated with the patients reporting state, subjects across both groups Interventions: The independent pain, stiffness and functional disability. landed with reduced knee flexion angles variables were group (knee OA, Other factors such as diminished and smaller knee flexion moments. healthy) and sex (male, female). muscle inhibition could be associated Landing in a more knee extended Subjects completed the WOMAC with this decreased ability to perform position places higher strain on the Osteoarthritis questionnaire, and were activities of daily living. Further ACL, and has been implicated in the tested for total anterior-posterior knee investigation is needed to identify the

Journal of Athletic Training S-105 11225MOCE mechanisms underlying subjective Exercise intensity was manipulated Tibiofemoral Osteoarthritis pain and disability and overall quality using standardized sling positions, by After Surgical And Non-Surgical of life in the early stage knee OA an experienced clinician, allowing Treatment Of The Anterior Cruciate patients. Funded by the Doctoral participants to perform pain free but Ligament Rupture: A Systematic Research Grant Program of the NATA challenging exercise. Vibration of the Review

Research & Education Foundation. supporting ropes during SETV was Harris KP, Driban JB, Sitler MR, performed at 30Hz. The control group Cattano NM, Balasubramanian E, 11036MOTE lied quietly on a treatment table with Hootman J: Biokinetics Research Effect Of Sling Exercise Therapy the involved leg suspended in the sling Laboratory, Athletic Training With And Without Vibration On for five minutes. Main Outcome Division, Department of Kinesiology, Quadriceps Activation In Partial Measures: Quadriceps activation was Temple University, Philadelphia, PA; Meniscectomy Patients assessed isometrically at 70°of knee Division of Rheumatology, Tufts Huggins RA, Pietrosimone BG, Saliba flexion using the CAR, at baseline, 0, Medical Center, Boston, MA; S, Weltman A, Ingersoll CD: 10, and 30 minutes post intervention. A Department of Sports Medicine, West University of Connecticut, Storrs, CT; 3x4 analysis of variance with repeated Chester University, West Chester, PA; University of Toledo, Toledo, OH; measures on time was used to assess Department of Clinical Orthopedic University of Virginia, Charlottesville, group differences over time. Surgery, Temple University, VA; Central Michigan University, Mt. Appropriate post hoc analyses were Philadelphia, PA; Division of Adult Pleasant, MI used and an a priori level of and Community Health, Centers for significance was set at P < 0.05. Disease Control and Prevention, Context: Quadriceps weakness and Results: Significant differences in CAR Atlanta, GA volitional activation deficits have been (F3,66= 26.526, P< .001 ) were detected reported following meniscectomy. Sling over time, but there was no significant Context: Surgical and non-surgical exercise therapy (SET) and SET in interaction or differences between treatment options exist for anterior conjunction with vibration (SETV) have groups. Planned comparisons showed cruciate ligament (ACL) rupture the been hypothesized to increase muscle higher SET CARs at posttest 0 efficacy of which to prevent post- function via Ia afferent neural (78.6%±17%, t7= -5.654, P=.001), 10 traumatic tibiofemoral osteoarthritis pathways, yet no research has (78.15±16.4%, t7= -5.677, P=.001), and remains unclear. Objective: Conduct a determined if SET and SET will increase V 30-minutes (80.1%±15.6%, t7=-5.457, systematic review to assess the quadriceps activation in patients P=.001) compared to baseline scores prevalence of osteoarthritis in ACL following meniscectomy. Objective: (70.3%± 18%). SETV CARs were rupture patients who either had Determine the effect of a single significantly higher at posttest 0 reconstructive surgery or were treated intervention of SET and SET on V (83.29%± 8.01%, t7= -3.123, P=.017), 10 non-surgically. Data Sources: A quadriceps central activation ratio (78.1%±17%, t7= -6.202, P<.001), and 30- comprehensive literature search was (CAR) in post meniscectomy patients. minutes (80.1%±16.6%, t7= -3.883, conducted in October 2009. Databases Design: Single blind, randomized P=.006) compared to baseline scores searched: Academic Search Premier, controlled trial. Setting: Laboratory. (78.9%±7.2%). Control CARs were CAB abstracts, CINAHL, Education Patients or Other Participants: significantly elevated at 30-minutes Research Complete, Education Twenty-five participants, SET n= 7M/ (79.3%±11.5%, t8= -2.658, P= .029) Resources Information Center, 1F (38.13±17.39yrs, 174.56± 11.31cm, compared to baseline (71.5%±13.6%). MEDLINE, SPORTDiscus with full text, 90.66±20.3kg, 51.66± 54.89weeks post- Conclusions: Quadriceps CAR Research Starters-Education, Cochrane op), SETV n= 5M/3F (40.00± 19.03yrs, increased at all posttests compared to Database of Systematic Reviews, ACP 174.00±7.12cm, 86.43±17.79kg, baseline following both SET and SETV, Journal Club, Database of Abstracts of 29.27±20.14weeks post-op), Control n= while control CAR was only increased Reviews of Effects, Cochrane Library 5M/4F (37.33±14.27yrs, 172.93±12.03cm, at 30-minutes following the Central Register of Controlled Trials, 77.46±19.97kg, 42.96± 38.54weeks post- intervention. Although, there was no Cochrane Library Methodology op) with a baseline CAR less than 85% difference in posttest CARs between Register, Cochrane Library Health were included in this study or each the groups, SET and SETV CAR Technology Assessment, Cochrane group. Interventions: Independent increased from baseline immediately Library Economic Evaluation Database, variables included exercise group (SET, following the intervention, while the Journals@Ovid, Global Health, and SETV or control) and time (baseline 0, control CAR did not increase until the Ovid MEDLINE. Keywords were (ACL 10 and 30-minutes post intervention). 30-minute posttest. or anterior cruciate ligament) and SET and SETV participants performed (osteoarthritis or osteoarthrosis or 4 sets of 4 knee extensions in a prone degenerative joint disease or arthritis position while suspended in slings. or coxarthritis or gonarthrosis) and

S-106 Volume 46 • Number 3 (Supplement) May 2011 11217MONE (reconstructi* or repair or surgery or Relationship Between Spinal to maximal Muscle Responses (H:M replacement) and (meniscus or menisci Reflexive And Cortical Excitability Of ratio). Bilateral quadriceps cortical or tear or torn or injury or injuries or The Quadriceps In Individuals With excitability was evaluated with active injured). Study Selection: Studies were Unilateral Anterior Cruciate motor thresholds (AMT), derived using included if: a) treatment outcomes Ligament Reconstructions Transcranial Magnetic Stimulation focused on a direct comparison of Lepley AL, Ericksen HM, Gribble PA, (TMS), while participants performed surgical versus non-surgical treatment Pietrosimone BG: University of knee extension at 5% of their maximal of ACL ruptures, b) prospective or Toledo, Toledo, OH capabilities. AMTs were defined as the retrospective cohort study design, c) lowest TMS intensity that elicited a reported tibiofemoral osteoarthritis Context: Alterations in lower extremity measurable (> 100µV) motor evoked prevalence, and d) written in English. neuromuscular control are common potential in five out of ten consecutive Of 799 articles identified through the following anterior cruciate ligament trials. Higher H:M ratios denote literature search, 5 met the inclusion reconstruction (ACLr). These increases in spinal excitability, while criteria. Data Extraction: Two neuromuscular alterations may be higher AMTs indicate decreased independent investigators assessed the influenced by spinal reflexive and cortical excitability. Results: quality of the studies using the cortical level neural pathways. Significant, positive moderate Newcastle-Ottawa Scale (NOS). Data Understanding how spinal and cortical relationships were found between H:M on surgical procedure, non-surgical pathways interact with the quadriceps ratio and AMT in both the injured treatments, subject characteristics, following ACLr may provide important (r=0.606, P=0.04) and uninjured leg frequency, odds ratios (OR), etc were information regarding the genesis of (r=0.619, P=0.038) in the ACLr group, then extracted and summarized. Data these altered neuromuscular control while no significant relationships were Synthesis: Prevalence 95% confidence strategies that may influence disability found in the matched injured (r=0.148, intervals (CI) were calculated for following ACLr. Objective: Investigate P=0.35) and uninjured leg (r=0.470, treatment groups (surgical, non- the relationship between spinal and P=0.10) of healthy controls. surgical). Non-overlapping CIs for cortical quadriceps excitability in both Conclusions: The moderate positive prevalence were statistically significant legs of individuals with unilateral ACLr correlations between AMT and H:M (p<.05). CIs excluding the null value and healthy matched controls. Design: ratio in the ACLr group indicate that (1.0) were considered significant Case-control. Setting: A controlled those with low H:M ratio (low spinal (p<.05). Four retrospective and 1 research laboratory. Patients or Other reflex excitability) have lower AMT prospective cohort studies were Participants: Nine unilateral ACLr (3 (which denotes higher cortical identified (n=252 surgical; n=178 non- males/6 females, 24.3± 5.27years; excitability), while no systematic surgical). The mean NOS score was 4.4 173.9±10.8cm, 70.45±14.8kg, 67.5±42.6 relationship between these neural out of 10 points (range: 2 to 6 points). months post surgery) and nine healthy pathways was found in healthy Osteoarthritis prevalence for surgically matched control (3 males/6 females, controls. This suggests that if spinal treated patients ranged from 29.7 to 25.0±5.20years; 171.9±10.4cm, quadriceps excitability is inadequate, an 51.2% (overall=38.9%; CI=32.9-44.9) 68.1±11.9kg) participants were included ACLr individual may compensate by up- and for non-surgical patients ranged in this study. Interventions: Measures regulating cortical quadriceps from 24.5 to 46.22% (overall=32.0%; of spinal reflex excitability and cortical capabilities, or may up-regulate spinal CI=25.2-38.9). Unadjusted ORs excitability were tested in the vastus excitability in the presence of cortical ranged from 0.49 to 2.37 (overall medialis bilaterally in ACLr and control insufficiency. This provides evidence OR=1.35; CI=0.90-2.02) Con- participants. The order of both that spinal and cortical neural pathways clusions: Osteoarthritis prevalence measures, as well as leg tested, was may interact in injured populations, was slightly higher in surgically- randomized. The legs in the healthy which may influence neuromuscular treated than in non-surgically treated group were matched to an ACLr control following ACLr. ACL patients at 11 years follow-up, but counterpart using leg dominance. Four the difference was not statistically separate Pearson product moment significant. There is no definitive correlations were performed to assess evidence to support surgical or non- the relationship between spinal and surgical treatment after ACL injury to cortical excitability in the injured and prevent post-traumatic osteoarthritis. uninjured quadriceps of the ACLr and Current studies are limited by small matched control group. Alpha level was numbers, low study quality, and lack of set a priori at P<.05. Main Outcome data on confounders. Measures: Bilateral quadriceps spinal reflex excitability was assessed using maximal Hoffmann Reflexes normalized

Journal of Athletic Training S-107 11171OODI A Method To Analyze Synovial ventions: Knee effusion was defined non-effused knees but investigators Fluid Biomarker Concentrations based on a physical knee examination should evaluate correlations between In Non-Effused Knees and a successful synovial fluid normalized and raw concentrations to Driban JB, Cattano N, aspiration without injecting saline by ensure the data are representative of Balasubramanian E, Sitler MR, Amin a board-certified orthopaedic raw concentrations. This technique M, Glutting J, Barbe MF: Division of surgeon. Aspiration of effused knees may be valuable for examining post- Rheumatology, Tufts Medical Center, was performed with a standard protocol traumatic osteoarthritis onset and Boston, MA; Department of Sports by inserting a needle into the lateral progression. Medicine, West Chester University, suprapatellar region. For participants West Chester, PA; Department of with non-effused knees, similar Orthopaedic Surgery, Temple procedures were followed but the University Hospital, Philadelphia, needle was inserted with a prefilled- PA; College of Health Professions saline syringe (2 or 15 mL). After and Social Work, Temple University, saline was injected, the physician Philadelphia, PA; Department of attempted to aspirate synovial fluid. If Anatomy and Cell Physiology, the aspiration was not successful then Temple University School of another syringe of saline was injected Medicine, Philadelphia, PA; and the aspiration procedures were School of Education, University repeated. Samples were stored at of Delaware, Newark, DE -80ºC until assayed. Main Outcome Measures: The dependent variables Context: Post-traumatic osteo- were 7 raw and normalized synovial arthritis is an increasing concern fluid biomarker concentrations: among athletes requiring more interleukin (IL)-1β, IL-10, IL-13, research exploring its onset and matrix metalloproteinase (MMP)-3, progression. Aspirated synovial fluid tissue inhibitor of MMPs (TIMP)-1, may be a source of biomarkers, but TIMP-2, and osteoprotegerin (OPG). there are limited methods to analyze Biomarkers were assayed by an synovial fluid from non-effused knees, independent laboratory using a which are needed for longitudinal multiplex enzyme-linked immuno- studies of post-traumatic joints. sorbent assay (SearchLight Assay Objective: To evaluate the Services). Spearman rank correlations relationship between raw biomarker were performed (p≤.05). Results: In concentrations (pg/ml synovial fluid) effused knees, normalized concentra- and normalized biomarker con- tions of 6 biomarkers had strong centrations (raw biomarkers divided by correlations (r≥.80) to raw total protein content) in effused concentrations (r=.80 to .99, p<.001; osteoarthritis (requiring no saline to IL-13: r=.77, p<.001). In non-effused aspirate) and non-effused (requiring knees normalized concentrations of 5 saline lavage) knees. These analyses biomarkers had strong correlations to will test the validity of a method to raw concentrations (r=.88 to .98; assess synovial fluid from non-effused p<.001; IL-1β: r=.73, p=.025; IL-13: knees. Design: A retrospective r=.58, p=.029). Except for IL-1β, analysis of two cross-sectional associations between normalized and studies. Setting: Outpatient ortho- raw concentrations were consistent paedic clinic. Patients: Volunteers between effused and non-effused (age=63.1±8.4 years; 16 females, 14 knees (based on 95% confidence males; body mass index=32.9±6.8 kg/ intervals of correlation coeffi- m2) were recruited to evaluate synovial cients).Conclusions: The associ- fluid biomarkers in knees with ations between normalized and raw moderate-severe radiographic biomarker concentrations were evidence of osteo-arthritis with consistent between effused and non- (n=15) or without effusion (n=11), effused knees, except for IL-1β. The and normal knees (n=4; no saline-assisted aspiration of synovial osteoarthritis or effusion). Inter- fluid is a valid technique for assessing

S-108 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Thematic Poster: Ankle Taping & Bracing Wednesday, June 22, 2011, 3:00PM-4:30PM, Room 219; Moderator: Thomas Kaminski, PhD, ATC 11004FOPR Effects Of Ankle Stabilizers On differing agility run times (p = .03; external support at the ankle could Vertical Jump, Agility, And Dynamic CONT = 13.6 + 1.4 s, TAPE = 14.1+ influence the transfer of force up Balance Performance 1.5 s, SWED = 14.1 + 1.4 s, CAST = through the kinetic chain leading to Ambegaonkar JP, Redmond, CJ, 14.1 + 1.4 s). Bonferroni paired more severe injuries throughout the Winter C, Guyer SM, Thompson B, comparisons on agility scores did not lower extremity. Objective: Determine Cortes N: Sports Medicine reveal any significant differences if a lace –up ankle brace reduced the Assessment Research and Testing across the four conditions. However, severity of acute lower extremity Laboratory, George Mason standardized effect sizes (d), indicated injuries in high school basketball University, VA, and Department of that compared to the control condition, players. Design: Randomized (cluster) Exercise Science and Sport Studies, wearing any ankle stabilizer increased control trial. Setting: 46 Wisconsin Springfield College, Springfield, MA agility run times (TAPE: d = 0.33, high schools (n = 21 braced group, n = SWED: d = 0.40, CAST: d = 0.43) 25 control group) during the 2009-2010 Context: Ankle sprains are among the Conclusions: Ankle stabilizers did basketball season. Participants: most common athletic injuries. not affect vertical jump or dynamic Fourteen hundred and sixty female and Prophylactic ankle stabilizers have been balance, but negatively affected agility male (720 control group and 740 braced shown to reduce ankle sprain incidence performance as compared to not group) interscholastic basketball and severity by reducing injurious wearing any ankle stabilizer. Since players (age: 16.0±1.1 yrs, Ht: excessive ranges of ankle motion participants primarily required sagittal 174.2+15.1 cm, Wt: 67.0+12.3 kg.). during activity. Still, limited research plane motion when jumping vertically Intervention: Each subject in the has examined their effects on physical and had relatively slow directional braced group wore a McDavid Ultralight performance measures. Objective: To changes in the dynamic balance test, 195 lace-up ankle brace on each ankle compare the effects of ankle stabilizers wearing ankle stabilizers may not have for the entire season. Main Outcome on vertical jump, agility, and dynamic hampered performance in these tests. Measures: Athletic trainers at each balance performance. Design: However, all ankle stabilizers hindered school recorded all athlete exposures Crossover Setting: Controlled the participants’ ability to perform the as well as the incidence and time lost Laboratory Participants: 10 quick directional changes required in for ankle injuries (lateral, medial, recreationally active volunteers (4M, the agility test. Although ankle syndesmotic sprains, fractures), knee 6F; 25.6 ± 2.8 yrs, 167.8 ± 13.7 cm, 61.4 ± stabilizers may successfully reduce injuries (ACL tears, medial collateral 10.7 kg) Interventions: Participants harmful ankle ranges of motion, ligament sprains, patellar instability, performed the Sargent Vertical jump test athletes should be aware of their meniscus tears, hyperextensions) and (height, cm), the Right-Boomerang Run influences on performance during other lower extremity injuries Agility test (completion time, s), and the sport. (metatarsal fractures, foot sprains, Modified Bass Test of Dynamic Balance lower leg and upper leg muscle strains). (score) in a randomized order 11131SOPR Dependent variables included the days The Effect Of A Lace-Up Ankle twice(scores averaged) when wearing lost due to the injury. The Wilcoxon Brace On The Severity Of Lower three ankle stabilizers: athletic tape Rank Sum Test was used to compare Extremity Injuries In High School (TAPE), semi-soft (Swede-O Ankle Lok, the severity (median days lost, Basketball Players th th SWED), rigid (Air-Cast Air-Stirrup, interquartile ranges [IQR]: 25 and 75 ) McGuine TA, Brooks MA, Hetzel SJ, CAST), and a nonsupport control of the injuries that occurred in the Sigl J: University of Wisconsin- (CONT) bilaterally. Main Outcome braced and control group. Results: Madison; Madison WI Measures: Separate one-way ANOVAs One hundred seventy five injuries (n = (p < 0.05) compared the ankle stabilizer 70 braced group, n =105 control group) conditions across the vertical jump, Context: External ankle support in the were recorded. There was no difference dynamic balance, and agility tests. form of lace up ankle braces are used in the severity (p = 0.223) of ankle Results: Participants had similar by many high school basketball players injuries (n = 26 braced, 5.0 days [3.0, vertical jump heights (p = .27; CONT = in the US to reduce the incidence of 8.25]) compared to the control group (n 41.4 + 11.9 cm, TAPE = 37.9 + 7.9 cm, ankle injuries. There are limited data = 78, 6.0 days [4.0, 11.0]). There was no SWED = 34.4 + 1.4 cm, CAST = 39.3 + however on whether lace-up ankle difference (p = 0.994) in the severity of 10.8 cm), and dynamic balance scores braces reduce the severity of ankle acute knee injury in the braced group (p = .08; CONT = 92.5 + 2.5, TAPE = 91.6 injuries in these populations. In (n = 15, 59.0 days [16.5, 180.0]) compared + 3.5, SWED = 96 + 5.3, CAST = 89.4 + addition, laboratory research has to the control group (n = 13, 60.0 days 6.1) across all conditions but had shown that limiting motion through [13.0, 180.0]). There was no difference

Journal of Athletic Training S-109 11247MOPR (p = 0.696) in the severity of the lower dorsiflexion, maintaining that position The Effects Of Ankle Taping On extremity injury between the braced for 5 seconds; and then instructed to Dynamic Postural Control, Perceived group (n = 30, 5.0 days [3.0, 8.0]) and move into 20° plantar flexion, Confidence And Pain In Patients the control group (n = 14, 5.0 days [3.0, maintaining that position for 5 With Acute Ankle Sprains 13.7]) in the control group. seconds. This series was repeated Haynes MB, Vela LI, Liu T, McCurdy Conclusions: Using a lace-up ankle three times, after which subjects were K: Texas State University, San brace did not reduce the severity of passively moved to neutral (0°). From Marcos, TX lower extremity injuries sustained by neutral, subjects were instructed to high school basketball players. reposition their foot into dorsiflexion Context: Ankle sprains are the most to where they believed their foot was common lower extremity injury in sports 11112UOPR when the machine stopped them and accounting for as much as 15% of all Effects Of Kinesio® Taping On signal researchers when there; this sports related injuries. Most individuals Ankle Proprioception In Healthy angle was recorded. Subjects were with ankle injuries (80%) in Individuals then instructed to reposition their foot intercollegiate sports return to sports Burningham DS, Berry DC: Weber into plantar flexion where they less than 10 days after injury. Often State University, Ogden, UT, and believed the machine stopped them ankles are braced and/or taped in order Saginaw Valley State University, previously, and signal researchers to give additional external support University Center, MI when there; this angle was recorded. during the time period when athletes This series of dorsiflexion to plantar return to physical activity and ligament Context: Kinesio® tape has flexion RJPS was repeated a second tensile strength is compromised. reportedly been used by healthcare time. Subjects were allotted a 3 minute Objective: To identify the effects of providers in reducing edema, window wherein they were either taped injury and ankle taping on dynamic strengthening muscles, decreasing or untaped before repeating the test postural control (DPC) in participants pain, and relieving abnormal muscle sequence. Data was analyzed using a with acute lateral ankle sprains. In tension. Product manufacturers also paired t-test. Significance was set a addition, confidence using the Injury- advertise the tape’s ability to increase priori at p<0.05. Main Outcome Psychological Readiness to Return to proprioceptive awareness. However, Measures: Pre and post RJPS angle Sport (I-PRRS) Questionnaire and pain, research examining this property is measurements were recorded for assessed with the Graphic Pain Rating limited. Objective: To determine the ankle dorsiflexion and plantar flexion. Scale (GPRS), were assessed in both efficacy of Kinesio® tape on ankle Dependent variables were relative and taped and non-taped conditions. joint proprioception. Design: A single absolute error for ankle dorsiflexion Design: Crossover controlled trial. blinded, randomized, counter-balanced and plantar flexion joint angles using Setting: All tests were completed in the model. Setting: Human performance the means of the two trials. Results: university athletic training room. laboratory. Participants: Healthy Testing revealed a significant Participants: Twenty-one, physically subjects (age= 23.68±4.65 years, difference in the relative error for active, adult volunteers (16 males, 5 mass=76.69±16.32 kg, height ankle RJPS of 26° dorsiflexion (tape females; age= 20.43±1.54; mass=81.37kg =175.43±9.73 cm) meeting the M=6.57±5.07, no-tape M=3.89±5.97, ±20.72; height= 178.21cm ±8.6), who had following inclusion criteria: 1) 18-45 p=.027). There were no significant sustained a unilateral, acute, mild or years of age, 2) right foot dominant, 3) differences for the absolute error moderate lateral ankle sprain without foot or ankle abnormalities, and (p=.131) for dorsiflexion, or in the participated in the study within 5 days 4) without foot or ankle injury in the relative (p=.847) or absolute error of injury. Interventions: Participants past 9 months. Intervention: (p=.730) for 20° plantar flexion. were tested under two conditions, taped Subjects were randomly allocated into Conclusions: The significant and non-taped, on both the affected and tape first or no-tape first groups difference in the dorsiflexion relative unaffected leg. Main Outcome (independent variable). Ankle error suggests Kinesio® tape hinders Measures: DPC was calculated using proprioception was determined by ankle RJPS in this movement. The lack the Star Excursion Balance Test (SEBT) subjects’ active reproduction of joint of significant differences in all other in the anterior, posterior medial, and position sense (RJPS) for 26° measurements is supportive of posterior lateral reach directions on dorsiflexion and 20° plantar flexion. previous work suggesting that both injured and un-injured limbs under Data was collected using a Kin-Com Kinesio® tape does not likely enhance both conditions. Reach distance was 125AP (Isokinetic International, proprioceptive awareness in active normalized to leg length and averaged Harrison TN). The subjects were ankle RJPS in healthy adults. across three trials for each condition blindfolded with the right forefoot and direction, The I-PRRS (Cronbach’s strapped to the footplate. Subjects = 0.78, r = 0.82) and GPRS were were instructed to move into 26° administered after the SEBT under each

S-110 Volume 46 • Number 3 (Supplement) May 2011 condition on the affected leg. DPC Participants: Twenty-one college- equally effective in providing scores in the three directions for each age male and female students (12 prophylactic support to the ankle joint. leg and condition were analyzed using males, 9 females; mean age = 21.3 ± a doubly multivariate MANOVA. Pain 1.6 years, height = 170.78 + 10.8 cm, 11124MOPR and confidence were analyzed on the mass = 75.81 + 17.51 kg) participated The Effect Of External injured limb under both conditions in this study with no past surgery or Prophylactic Support On Ankle using a paired t-test. Results: Ankle acute injury to right ankle. Inter- Laxity In Healthy, Unstable, And taping (2.24 ± 1.81) was found to ventions(s): The independent Previously Sprained Ankles significantly decrease pain (t(20)=-2.37, variables were conditions (no tape, Following Functional Activity p=0.028) when compared to the non- cloth tape, and self-adherent tape) and Miller HE, Needle AR, Swanik CB, taped condition (2.9 ± 1.94). Taping time (before and after exercise). Gustavsen G, Kaminski TW: (86.77 ± 12.05) increased confidence Participants were asked to perform University of Delaware, Newark, DE (t(20)=2.83, p=.010) during the SEBT three drops on an inversion platform when compared to no support (79.0762 before and after exercise for three Context: Ankle sprains account for ± 21.49525). Injury significantly taping conditions. An exercise 15 percent of athletic injuries and decreased overall DPC (F(3,18)=3.855, protocol consisting of four exercises nearly 850,000 annual emergency p=.027), anterior DPC (F(1,20)=9.721, was used to simulate athletic room visits. To both prevent and p=.005), and posterior lateral DPC movement. An inversion platform accelerate recovery and return-to-play (F(1,20)=7.893, p=.011). DPC was rotating 36 degrees activated by a from ankle sprains, clinicians not significantly affected by the use of magnetic quick release was used to frequently employ the use of external ankle tape while completing the SEBT. create an inversion motion. Data was prophylactic support (EPS), such as Conclusions: This study indicated collected using Modus Video capture taping and bracing, in order to address that the use of ankle tape on an acute system. Main Outcome Measure(s): A insufficiencies of the passive support lateral ankle sprain has the potential to two-within (condition x time) repeated structures. While common practice decrease pain and increase confidence measures ANOVA was performed on the clinically, research has been while not significantly affecting DPC. dependent variables, maximum inconclusive in demonstrating the Although taping did not greatly affect inversion range of motion, time to effectiveness of EPS on restricting performance, athletic trainers should maximum inversion range of motion, and laxity throughout athletic activity, as consider the psychological benefits of maximum velocity. Results: The well as its efficacy in restricting ankle taping. repeated measures ANOVA for maximal laxity in patients with complaints of inversion range of motion showed a functional ankle instability (FAI) and 11003SOPR those with a history of previous ankle main effect for time (F1,19 = 12.72, p < Comparison Of Self Adherent .002) and a main effect for condition sprain. Objective: To investigate the And Cloth Tape On Dynamic Ankle effectiveness of EPS type (Tape, (F2,39 = 53.02, p < .001). Maximum Inversion Before And After Exercise inversion increased 1.2 + 0.6° for the Brace, None) on ankle laxity before Knight BD, Oney JR, Miller MG, no tape condition, 1.5 + 0.1° for cloth and after exercise in subjects with Gyorkos AM: North Carolina tape and 1.5 + 1.1° for self-adherent complaints of instability (FAI), Wesleyan College, Rocky Mount, tape. There was a condition by time subjects with a history of ankle sprain, NC; IncreMedical, Michigan City, interaction for time to maximum but no instability (SPR), and a control IN; Western Michigan University; group (CON). Design: Pre-test/post- inversion (F2,38 = 4.142, p < .024). Post Kalamazoo, MI hoc testing showed that no tape (0.362 test design with control group. + 0.045 seconds) was significantly Setting: Human performance Context: Ankle sprains are the most faster than the cloth tape (0.405 + 0.050 laboratory. Patients or Other common injury sustained during seconds) after exercise. There was a Participants: Ankles from twenty- athletic competition and new taping condition by time interaction for four participants (20.6±1.6yrs, products are being manufactured that maximum inversion velocity for self- 173.6±8.3cm, 72.8±12.2kg) were are purported to provide more support. placed into one of three groups; FAI, adherent tape (F2,40 = 3.586, p < .037). Objective: To determine if self-adherent Post hoc testing showed that no tape SPR, CON. Interventions: Ankle tape provides more structural support (648.674 + 98.478 º s – 1) was sig- laxity was assessed on subjects before of the ankle by decreasing inversion nificantly different from cloth tape and after the application of one of the range of motion as well as range of (508.203 + 51.620 º s – 1), as well as no three EPS-types utilizing a reliable and motion velocity when compared to the tape was significantly different from self validated ankle arthrometer (Blue Bay cloth tape before and after exercise. adherent tape (565.485 + 118.426 º s – 1) Research, Inc., Milton, FL). Subjects Design: Crossover experimental study. after exercise. Conclusions: What can then completed a 20-minute functional Setting: Human performance research be gained from this study is that the exercise protocol (FEP) consisting of laboratory. Patients or Other self-adherent tape and cloth tape were sprinting, cutting, and jumping

Journal of Athletic Training S-111 11F02MOPR maneuvers. The FEP was designed to The Effect of Kinesio Taping on and AROM IR30°, ER 45°, 75°. Result: simulate sport-like activities and Proprioception in Shoulder A significant interaction exists between intensity. Following the FEP, ankle Impingement Syndrome the tape application and health status laxity was again assessed before and Takaoka A, De La Torre L, Ransone variables, F(1,27) = 9.98, p= .004. For after removal of the EPS. Subjects JW: Texas State University, San the healthy subjects the response was were tested using a counterbalanced Marcos, TX higher with the KT (6.83 ± 4.85°) than order on 3 separate days, with each day without it (6.39 ± 4.86°). However, for utilizing a different EPS. Main Context: Shoulder impingement the SIS subjects, the mean response Outcome Measures: Ankle anterior syndrome (SIS) is most common cause with the KT (5.38 ± 3.26°) was lower displacement (ANT), inversion of shoulder pain in young athlete with than without it (7.45 ± 5.93°). This effect rotation (INV), and eversion rotation over-head activities. Theoretically, was consistent across all angles tested, (EVR) measured under three Kinesio tape may improve sensorimotor since the interaction among tape, health conditions (Tape, Brace, None) and in control by proprioceptive feedback and status, and angle failed to achieve three groups (FAI, SPR, CON). A 3- facilitate muscle activities. Objective: To significance, F(3,81) = 0.51, p = .677. way repeated measures ANOVA was determine if Kinesio tape increase Conclusion: The study reported AAAE utilized to analyze differences between shoulder proprioception in SIS to significantly lower in SIS group after the groups and within EPS type and pre- subjects. Design: Randomized Kinesio tape application. This suggests post exercise. An alpha level of 0.05 controlled trial. Setting: Controlled, Kinesio tape may improve shoulder was set a priori. Results: Taping and laboratory setting. Participants: Fifteen proprioception in SIS population. bracing each decreased laxity from healthy subjects (6F, 9M; F; 22.5 ±1.9 pre-application (ANT=6.1±2.0mm; years, 157.5 ±5.5cm, 63.1 ±6.7kg, M; 22.9 11240FOXX INV=25.0±6.9°; EVR= 17.5±7.0°) to ±1.4 years, 174.4 ±7.4cm, 88.5 ±14.4kg) The Stabilizing Effect Of Soft pre-exercise (Tape: ANT= 2.9± and fifteen SIS group (7F, 8M; F; 23.3 Shell Ankle Bracing On .96mm, INV=11.3±3.9°, EVR= ±3.4years, 161.8 ±7.6cm, 65.1 ±16.7kg, Combined Talocrural-Subtalar 7.6±3.1°; Brace: ANT=3.0±1.4mm, M; 24.9±2.9 years, 180.9±7.1cm, Joint Motions INV=12.6±5.4°, EVR=8.4±4.0°; 84.0±9.2kg) Inclusion criteria were 1) Gurchiek LR, Kovaleski JE, Hollis JM, p<.05) and post-exercise (Tape: positive Hawkins-Kennedy or Neer’s Heitman RJ: Andrews Institute, Gulf ANT=4.1±1.1mm, INV=14.0±4.2°, test and 2) weakness or reproduction Breeze, FL; Blue Bay Research, EVR=9.1±3.5°; Brace: ANT= of pain during Empty Can Test. All Navarre, FL; University of South 3.8±1.6mm, INV=16.8±6.4°, EVR= subjects did not have surgeries within Alabama, Mobile, AL 10.9±4.9°; None: ANT=6.3±2.3mm, the past two years. Interventions: The INV=26.1±6.9°, EVR= 17.61±4.6°; Biodex 4 isokinetic dynamomoter Context: External ankle support p<.05). Tape provided greater (Shirley, NY) measured both passive appliances are constructed of various restriction post exercise in inversion and active joint position sense. materials depending on the design. and eversion rotation (p<.05). Subjects were asked to wear a blindfold Conventional ankle bracing may be Additionally, the FAI group and earplugs to minimize their visual and constructed of thermoplastic polymer demonstrated significantly greater auditory senses throughout each material (e.g., semirigid). Recent ANT post-exercise after removal of the testing session. The emergency stop technology in ankle brace design brace compared to other groups button was utilized when subjects incorporates PerformathaneTM soft- (FAI=7.3±1.6mm, SPR=5.5±2.5mm, believed their shoulder reached a shell technology (Zoom, Ultra Athlete) CON=5.8±1.8mm p<.05). Con- previously designated target angles. as an alternative. Objective: To clusions: The use of EPS at the ankle Target angles evaluated passive ER75°, compare the effects of a soft-shell appears to significantly decrease ankle active ER (AER) 45°, 75° and active hinged ankle brace with those of a laxity before and after physical activity IR30°. Neutral shoulder position was hinged semirigid shell ankle brace (Ultra as compared to a control no tape/brace set at 90° flexion and 90° abduction Ankle 2) on rotary displacements of the condition. While neither taping nor with 90° elbow flexion. Subjects had foot. Design: Repeated measures bracing was more effective than the three attempts on each target angle in study. Setting: Research laboratory. other, bracing appeared to cause a randomized order, and investigators Participants: Six normal fresh- greater increase in post-exercise laxity recorded the angles, which each subject frozen cadaver ankle specimens. in subjects with complaints of ankle reproduced. Average absolute angular Interventions: The specimen was instability. error (AAAE) is an average of angular mounted to a jig proximally via a tibial error (the difference between target rod cemented into the tibial medullary angle and reproduced angle among cavity and distally via an athletic shoe three trials. Main Outcome Measures: fixed to a mounting plate of the testing AAAE was recorded at PROM ER75° machine. The specimens were loaded

S-112 Volume 46 • Number 3 (Supplement) May 2011 to 2 Nm in internal-external rotation nature of passive support when using at 0° plantar-flexion (PF), as well as 4 ankle braces for their athletes. Nm inversion-eversion rotation at 15° PF. Exercise consisted of dorsi- plantar flexion cycling to ± 1.5 Nm for 10 minutes. Each trial involved testing the ankle before the application of a brace, pre-exercise braced, and after exercise with the brace still present on the ankle. Brace type was randomly assigned prior to testing. Data was obtained from two trials (semirigid and soft-shell) across three support conditions (no braced (NB), pre- exercise braced, and post-exercise braced) and analyzed with separate two by three repeated measures ANOVA’s. Post-hoc analysis was performed with Bonferroni multiple comparisons. Significance was set a priori at P < .05. Main Outcome Measurements: The dependent variables were total internal-external rotation and inversion-eversion (I-E) rotation (° ROM) of the ankle complex. Results: A significant condition main effect was found for inversion-eversion rotation λ ( = .12, F2,4 = 14.33, P = .015). Be- fore exercise, application of either brace produced significant reductions in ROM (semirigid brace [37.3 ± 10.0°, P < .001] and soft-shell brace [41.44 ± 10.8°, P = .008]) when compared to the NB condition (62.51 ± 17.4°). No differences (P > .05) were found between pre-post exercise conditions for either the semirigid brace (38.38 ± 9.9°) or soft-shell brace (43.04 ± 13.1°), despite the semirigid brace demonstrating greater restriction (-4.7 ± 3.2°). A significant trial by condition interaction was found for internal-external rotation (λ = .18,

F2,4 = 9.02, P = .033). Post-hoc analyses showed no statistical differences between brace support pre- exercise (semirigid: 31.3 ± 14.9°, soft-shell: 35.5 ± 12.8°, P = .104) or post-exercise (semirigid: 33.9 ± 15.6°, soft-shell: 34.56 ± 12.7°, P = .793). Conclusions: Our data indicate that both semirigid and soft-shell ankle brace supports are similarly effective in restricting motion before and after exercise. Clinicians may be assisted by objective data on the amount and

Journal of Athletic Training S-113 Free Communications, Poster Presentations: Undergraduate Poster Awards Monday, June 20, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11015UOMU 11125UOXX Reliability And Validity Of instrument at each testing position, the The Effects Of Ankle Kinesio Measuring Scapular Upward upward rotation measurements were Taping® On Ankle Stiffness And Rotation Using An Electrical averaged. Validity and reliability were Dynamic Balance Inclinometer analyzed at all four arm positions. Fayson SD, Needle AR, Kaminski Ingram RL, Tucker WS: University Validity of the two instruments was TW: University of Delaware, of Central Arkansas, Conway, AR analyzed using Pearson Product Newark, DE Moment correlation coefficients. Context: Numerous techniques have Intraclass correlation coefficients Context: Ankle sprains are a leading been proposed to qualitatively and (ICC) (3,1), 95% confidence intervals cause of time-loss in athletics. Taping quantitatively measure upward rotation (CI) and standard errors of the mean and bracing are commonly used in both of the scapula. These techniques are (SEM) were used to analyze the the treatment and prevention of ankle limited by expense or an inability to reliability of the electrical inclin- injuries to improve mechanical be synchronized with other ometer. Main Outcome Measures: stability along with balance/ measurements, such as muscle activity Mean upward rotation at rest, 60°, 90 proprioception. Recent interest in and force output. Implementing and 120°. Results: Significant Kinesio Taping® has forced athletic accurate and practical assessment correlations existed between the trainers to examine its’ efficacy in both techniques for the scapula is electrical inclinometer and digital providing mechanical support to a joint imperative for clinical diagnosis and protractor at rest (r=0.989; p<0.001), and improving proprioception over an treatment of shoulder dysfunction. 60 (r=0.996; p<0.001), 90 (r=0.989; extended period of time. Objective: Objective: To assess the reliability p<0.001) and 120 (r=0.996; p<0.001). To examine the immediate effects of and validity of a modified two- The ICC (3,1) values for the electrical Kinesio™ tape application to the ankle dimensional electrical inclinometer inclinometer demonstrated good to joint on ankle stiffness and balance, (Noraxon USA, Inc, Scottsdale, AZ) to excellent reliability at rest (0.892), 60 and to compare this effect following measure scapular upward rotation (0.956), 90 (0.954) and 120 (0.975). 24 hours of use. Design: A single during static humeral elevation. The 95% CI results at rest, 60ˆ, 90 group, pre-test-post-test. Setting: A Design: Test-retest. Setting: and 120 were 0.785-0.947, 0.911- climate-controlled biomechanics Controlled laboratory environment. 0.979, 0.906-0.978 and 0.949-0.988, laboratory. Patients or Other Patients or Other Participants: respectively. The SEM values at rest, Participants: 30 healthy female Thirty healthy male subjects, 11 60°, 90 and 120 were 1.8°, 1.5°, 1.6° subjects (age=20.4±1.1yrs; mass= athletes (21.1±1.2 yrs, 181.0±7.0 cm, and 1.1°, respectively. Conclusions: 61.9±8.3kg; height =165.0 ±7.6cm) 84.6±16.3 kg) and 19 non-athletes The modified electrical inclinometer with no previous ankle pathology (22.4±2.7 yrs, 177.7±6.6 cm, demonstrated good to excellent volunteered for this study. Inter- 88.0±12.6 kg). Interventions: For validity and intrarater reliability when ventions: An instrumented ankle validity testing, scapular upward measuring upward rotation of the arthrometer was used to apply an rotation was measured on the dominant scapula at all four positions of humeral anterior translational force at the ankle arm with a digital protractor and elevation. The results of this study and record corresponding force and electrical inclinometer while subjects support the use of the electrical displacement. Dynamic balance was were at rest and at 60ˆ, 90 and 120 of inclinometer to measure scapular measured using time-to-stabilization humeral elevation in the scapular upward rotation. These findings (TTS) during a 10-second interval plane. Three trials were performed at provide clinicians and researchers with following a hopping task onto a force each position. During each trial, a practical instrument that can plate. Data from a total of 3 trials separate static measurements were accurately measure scapular upward involving 4 different jump tasks were taken with both instruments at each rotation in synchrony with other recorded. Data were collected and position. There was a thirty second rest measurements, such as electro- analyzed using custom LabVIEW period between each trial. Order of myography and isokinetic data. (National Instruments Corporation, position and instrument were Austin, TX) software. All subjects randomized. For reliability testing, participated in stiffness and balance either 20 minutes before or 20 testing prior to Kinesio Taping® minutes after validity testing, subjects application, immediately after the performed the testing positions while application of Kinesio Taping®, and measurements were taken with the after 24-hours of tape use. The ankle electrical inclinometer only. For each Kinesio Taping® Method was

S-114 Volume 46 • Number 3 (Supplement) May 2011 11136UOBI employed using Kinesio® Tex Gold™ Changes In Multi-Segment Foot (Natick, USA). RFEV (degrees) was (Kinesio Holding Company, Biomechanics Between Molded measured as frontal plane movement Albuquerque, NM). Main Outcome And Non-Molded Semi-Custom of the rearfoot relative to the shank. Measures: Anterior stiffness (N/mm) Foot Orthotic Devices MLAD (degrees) was modeled as a measurements were analyzed using a Benson BA, Ferber R: Faculty of triangle from medial calcaneus, first 2-way repeated measures analysis of Kinesiology, University of Calgary, metatarsal head, and navicular markers. variance (ANOVA) with 2 within- Calgary, AB, Canada PFS is a unitless measure calculated subjects factors (Force, Condition). by approximating the plantar fascia as TTS values (sec) were compared using Context: Semi-custom foot orthoses spanning between the first metatarsal a 3-way repeated measures ANOVA are thought to be a cost-effective head and calcaneus and determined as with 3 within-subjects factors alternative to traditional custom-made change in relative marker position. (Condition, Hop Direction, GRF orthoses. However, the few studies that Between-condition differences were Component). An a priori significance have investigated these products all determined using 1 (group) x 3 level was set at alpha=0.05. Results: involved pre-fabricated and non- (condition) repeated measures The use of Kinesio® Tex Gold™ moldable orthoses and only measured ANOVAs and a priori post-hoc testing caused a significant increase in ankle rearfoot biomechanics. Objective: To (P<0.05). Results: There were no stiffness from baseline (13.2±0.9N/ determine changes in multi-segment significant differences (P=0.34) in mm) to immediately after initial foot biomechanics while walking in peak RFEV between NO (4.44± application (16.5±0.6N/mm, p=.006) semi-custom orthoses (SCO), direct 1.58deg) and SCOm (4.18±1.60deg) and following 24-hours, (15.5±0.7N/ from the packaging and non-molded or between SCOm and SCOn mm, p=.01). There was a significant (SCOn), and following a heat-molding (4.63±1.51deg: P=0.49). There were effect of hopping direction on GRF process (SCOm), compared to a no- no significant differences (P=0.48) component (F6,108=323.9, p=.001); orthotic (NO) condition. We for peak MLAD between NO however, there was no significant hypothesized the SCO would reduce (205.40±8.07deg) and SCOm (205.30 effect of tape application on TTS peak rearfoot eversion (RFEV), medial ±7.72deg) or between SCOm and

(F2,36=.03, p=.97). A statistical trend longitudinal arch deformation SCOn (205.62±6.87deg: P=0.45). was observed demonstrating a potential (MLAD), and plantar fascia strain PFS was significantly (P=0.03) effect of condition on GRF (PFS), in both the molded and non- reduced for SCOm (0.07±0.02) component and hop direction (F12,216 molded condition, compared to NO. compared to NO (0.08±0.01) but not =1.7, p=.08). Conclusions: Kinesio Design: Crossover, repeated different (P=0.10) between SCOm and Taping® caused an increase in anterior measures. Setting: Clinical research SCOn (0.07±0.02). Conclusions: A stiffness at the ankle joint immediately laboratory. Patients or Other semi-custom molded orthotic does following initial application and Participants: Twenty healthy not control peak rearfoot eversion or following 24-hours of use. This individuals (9 males, 11 females: medial longitudinal arch deformation, evidence supports the use of this tape age=24.6 ±4.9yrs, height =176.5± but does, however, reduce plantar fascia for providing additional mechanical 8.6cm, mass=75.9±11.7kg) volunteer- strain compared to walking without an support over an extended period of ed through informed consent. orthoses. Heat-molding the orthotic time. However, the Kinesio™ tape Interventions: Retroreflective device does not have an effect on any application did not affect dynamic markers were placed on the right limb biomechanical variables compared to balance as measured through TTS. to represent forefoot, midfoot, the non-molded condition. This study While no effect was observed on this rearfoot and shank segments. 3D was supported, in part, by a charitable dynamic task, further research is kinematics were recorded using an 8- donation from SOLE Inc. and the warranted as to the effects Kinesio camera motion capture system (Vicon, University of Calgary PURE Award. Taping® has on postural stability as Oxford, UK: 120Hz) placed around a well as other direct measures of treadmill while subjects walked at 1.1 proprioception. m/s. Visual 3D (C-Motion Inc., USA) software calculated all variables of interest during the stance phase. Data were collected for three conditions: SCOn, SCOm, and NO, using a neutral lab running shoe (New Balance, USA) and the order was randomized. Main Outcome Measures: 3D marker trajectories were calculated using custom-written Matlab software

Journal of Athletic Training S-115 11146UOMU 11280UOIN Reliability Of Various Methods average of 3 measurements for CM Does Lower Extremity Alignment For Assessment Of Static Lower and DP and the average measurement Predict Hip And Knee Kinematics Extremity Alignment across a 5-second static trial for EMTS During A Single Leg Landing? Hartley EM, Boling MC, Nguyen were used for analyses. Intraclass Slye CA, Nguyen A, Parisi GL,

AD, Slye CA, Parisi GL: University correlation coefficients (ICC2,k) and Boling MC, Rozzi SL: College of of North Florida, Jacksonville, FL, standard error of measurements Charleston, Charleston, SC, and and College of Charleston, (SEM) were calculated between CM University of North Florida, Charleston, SC and DP for each investigator to Jacksonville, FL determine the inter- and intra-tester Context: Altered static lower reliability, and between CM, DP, and Context: Altered static lower extremity alignment (SLEA) is thought EMTS. Results: Both investigators extremity alignment (LEA) has been to predispose athletes to knee injuries. had good to excellent test-retest theorized to contribute to dynamic In order to prospectively examine risk reliability (ICC2,k=0.84-0.99) for malalignment, thereby increasing the factors in large cohorts, accurate and measures of PA, QA, TFA, FL, and TL. risk of knee injuries. Limited research efficient measurement methods are The novice investigator had good has been performed to quantify the essential. Objectives: To determine consistency and precision in measures relationship between LEA and dynamic the measurement reliability of SLEA of GR (ICC2,k=0.87, SEM=1.1°), joint motion, particularly during between clinical measures (CM) and however, this was lower in the trained functional tasks, which are common in digital pictures (DP) within and investigator (ICC2,k=0.70, SEM= sports where lower extremity injury between a trained and novice 1.4°). Fair to excellent agreement rates are high. In addition to this, there investigator, and also between CM, DP, (ICC2,k=0.75-0.95) was observed is a lack of research investigating the and an electromagnetic motion between investigators in measures of influence of LEA on dynamic joint tracking system (EMTS). Design: QA, TFA, GR, FL, and TL, with poor motion in males and females Reliability. Setting: Research agreement in the measure of PA separately. Objective: To determine laboratory. Patients or Other (ICC2,k=0.43-0.59). Fair to excellent the influence of static LEA on frontal Participants: Seventeen individuals agreement (ICC2,k=0.69-0.95) was and transverse plane hip and knee joint (10 females, 7 males: 21.3±1.8yrs, observed between CM and DP for QA, excursions during a single leg landing 172.2±9.2cm, 70.3±9.9kg) partici- TFA, FL, and TL with lower agreement (SLL) task in males and females. pated in study 1 that examined the in the measure of PA (ICC2,k=0.56- Design: Descriptive cohort. Setting: reliability between CM and DP within 0.69) and GR (ICC2,k=0.56-0.89). Research laboratory. Patients or (intra-tester) and between (inter- When comparing CM and DP to Other Participants: Forty females tester) a trained and novice EMTS, good to excellent reliability (21.0±1.7yrs, 167.3±6.0cm, 64.2± investigator. Sixteen individuals (11 was observed in measures of QA, TFA, 9.5kg) and forty males (21.9±1.8yrs, females, 5 males: 22.3±1.6yrs, FL, and TL (ICC2,k=0.80-0.98) while 179.7±7.0cm, 78.4±12.1kg), with no 170.3±6.9cm, 72.9±16.4kg) partici- lower reliability was observed in current or previous lower extremity pated in study 2 that examined the measures of PA (ICC2,k=0.38-0.60) injury that would alter LEA or detract Con- reliability between CM, DP, and an and GR (ICC2,k=0.65-0.91). from the ability to perform a SLL, EMTS. Interventions: Measures of clusions: The use of DP and an EMTS volunteered to participate in this pelvic angle (PA), quadriceps angle appear to be accurate, efficient, and investigation. Interventions: Pelvic (QA), tibiofemoral angle (TFA), genu reliable methods that can be used by angle (PA), femoral anteversion (FA), recurvatum (GR), femur length (FL), minimally trained investigators to hip internal rotation range of motion and tibia length (TL) were evaluated. assess measures of frontal plane knee (HIR), hip external rotation range of CM were assessed by a single alignments and limb length measure- motion (HER), genu recurvatum (GR), examiner, with previously established ments. (Funded by University of tibial torsion (TT), and navicular drop North Florida Student Mentored reliability (ICC2,k>0.87). For the DP, (ND) were measured during three trials reflective markers were adhered to Academic Research Team Grant) on the dominant stance limb by a anatomical landmarks. Frontal and clinician with known reliability sagittal plane views were taken using a (ICC2,k>0.87). All LEA measures were digital camera on two separate recorded to the nearest degree or occasions by two investigators centimeter. The SLL task consisted of (trained and novice), and ImageJ participants landing onto a force software was used to calculate SLEA. platform from a height of 45cm. A For the EMTS, anatomical landmarks three-dimensional motion analysis were digitized to calculate SLEA. system was used to assess kinematics Main Outcome Measures: The of the hip and knee during five SLL

S-116 Volume 46 • Number 3 (Supplement) May 2011 trials on the dominant stance limb. Main Outcome Measures: Frontal and transverse plane hip and knee joint excursions were calculated by subtracting the initial contact joint angle from the peak angle determined during the deceleration phase, which was defined as the time period between initial contact (GRF>10N) and peak knee flexion. LEA values were averaged over the three data collection trials and joint excursions were averaged over the five SLL trials. Step- wise linear regressions were performed to determine the extent to which the LEA measures predicted frontal and transverse plane hip and knee joint excursions in males and females. Results: Increased FA was a predictor of increased hip internal rotation excursion in females, explaining 21.7% of the variance (P=0.039). No other LEA variables were predictive of joint motion in males or females during the SLL task (all P>0.05). Conclusions: Structural deformity of the hip (FA) appears to be an important alignment factor contributing to transverse plane excursion of the hip during a SLL task in females. While the other LEA variables were not predictive of dynamic joint motion in males and females, future research should examine the influence of LEA on other variables influencing dynamic motion, such as muscle activity and joint moments.

Journal of Athletic Training S-117 Free Communications, Poster Presentations: Master Poster Awards Monday, June 20, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11048 11172MOBI Quantification Of Knee Load ACL injury during their competitive Differences In Active Range Of Associated With Increased Risk seasons. Interventions: Logistic Motion Among Individuals With For Specific Knee Injury regression analyses determined Functional Ankle Instability, Incidence threshold knee abduction moment cut- Copers And Healthy Controls Myer GD, Ford KR, Hewett TE: scores that provided the maximal Goldberg JS, Letchford EC, Wright Cincinnati Children’s Hospital sensitivity and specificity for CJ, Arnold BL, Ross SE: Virginia Medical Center, Cincinnati, OH; prediction of PFP and ACL injury risk. Commonwealth University, University of Cincinnati, Cincinnati, Incidence rates were expressed per Richmond, VA OH; Ohio State University Sports 100 athlete competitive seasons. Main Medicine, Columbus, OH Outcome Measure: Positive PFP and Context: While ankle ligamentous ACL injury status. Results: The laxity has been studied extensively, few Context: Patellofemoral dysfunction cumulative incidence rate for new PFP researchers have examined the and the resultant pain symptoms (PFP) incidence was increased 2.2 (95% CI difference in ankle active range of affects up to 30% of people aged 13- 1.11 to 4.34) relative to ACL injury motion (AROM) between healthy 19 years. PFP symptoms lead three- when normalized per 100 athlete individuals and those with functional quarters of affected patients to limit seasons (PFP 9.7 vs ACL 4.4). ankle instability (FAI). To our recreational activities or to cease Regression analysis indicated that PFP knowledge, there is no research on physical activity altogether. Injuries to risk increased in athletes who AROM in individuals who have the Anterior Cruciate Ligament (ACL) demonstrated >15.4 Nm of knee experienced a single ankle sprain but result in the greatest time lost from abduction, while ACL injury risk no subsequent instability (copers). sport and recreational participation by increased with peak landing knee Objective: To determine if there are young athletes. Interestingly, there is abduction torque >25.3 Nm. AROM differences in the sagittal a similar sex disparity in both Conclusions: Females who (plantarflexion/dorsiflexion) and conditions, as adolescent females and demonstrate >15 Nm of knee frontal planes (inversion/eversion) young women are affected with PFP abduction during landing may be at between FAI individuals, copers, and and ACL injury 2-10 times more often increased risk for the development of healthy individuals. Design: A three- than their male counterparts. Altered PFP and those who demonstrate >25 group cross-sectional study. Setting: or reduced motor control during Nm of knee abduction during landing A controlled sports medicine research physical activities result in excessive may be at increased risk for both PFP laboratory. Participants: Sixty-five knee abduction joint load in females. and ACL injury. The increased individuals volunteered to participate. This neuromuscular dysfunction incidence of PFP relative to ACL Participants included 23 healthy appears to increase risk of acute ACL injury is likely associated with the individuals without history of ankle injury and chronic PFP in females. reduced threshold of knee abduction sprain (age=23.17±4.01years, height= Objectives: The purpose of this study associated with increased risk of PFP. 1.72±0.08m, mass= 68.78± 13.26kg, was to compare incidence rates and Focused pre-season exercise Cumberland Ankle Instability Tool threshold knee abduction load during intervention may be warranted for [CAIT]= 28.78±1.78), 21 copers with landing associated with increased risk females who land with greater than 15 a history of one ankle sprain without of PFP and ACL injury. Design: Nm of knee abduction, while those giving-way (GW; age= 23.48±3.80 Prospective cohort study. Setting: females who land with >25 Nm of knee years, height= 1.71± 0.07m, Controlled laboratory. Patients or abduction may benefit from increased mass=69.62 ±14.62kg, CAIT=27.86 Other Participants: Middle and high treatment dosage gained from both pre- ±1.71), and 23 FAI individuals with a school female athletes (n=145) were season and in-season neuromuscular history of >1 ankle sprain and 2 or evaluated by a physician for PFP and training protocols aimed to reduce more give-ways in the past year for landing biomechanics prior to their knee abduction and PFP/ACL injury (age=23.30±3.84years, height= basketball season and monitored by incidence. 1.70±0.11m, mass=68.66±14.60kg, certified athletic trainers for PFP CAIT=20.52±2.94, GW/month= during their competitive seasons. 5.81±8.42). Interventions: During a Likewise, 205 high school female single visit, each participant completed volleyball, soccer and basketball the CAIT questionnaire to quantify athletes were evaluated for landing functional limitations and one AROM biomechanics prior to their trial captured with a 12-camera motion competitive season and monitored for analysis system at 100Hz (Vicon,

S-118 Volume 46 • Number 3 (Supplement) May 2011 11231MOIN Oxford, UK). For motion capture, Comparison Of Patient And Proxy are scored on a 5-point Likert scale, reflective markers were placed on the Reporting Of Health-Related with total scores ranging from 0-100 subjects’ foot and shank consistent Quality Of Life In Adolescent and higher values indicative of better with the Oxford Foot Model. A trial Athletes Who Suffer A Sport- HRQOL. Both the patient self-report consisted of maximal AROM in each Related Injury That Requires and parent-proxy versions of the direction (plantarflexion, dorsiflexion, Orthopaedic Consultation PedsQL are valid and reliable inversion, eversion) repeated two Swank EM, Snyder AR, Hansen ML, (ICC=0.88 and 0.90, respectively). times. Trials were recorded while Valovich McLeod TC: A.T. Still Means and standard deviations (SD) participants were seated with University, Mesa, AZ, and CORE were calculated for all scores and approximately 45° of knee flexion. Institute, Gilbert, AZ comparisons between patient-self Main Outcome Measures: Total report and parent-proxy ratings of rearfoot AROM in sagittal plane Context: Increased attention has been HRQOL were made for the PedsQL (calculated as the difference between given to the impact of sport-related total score and subscales using maximum plantarflexion and injury on the health-related quality of Pearson Product Moment correla- maximum dorsiflexion) and frontal life (HRQOL) of adolescent athletes. tions (r). Data are reported as plane (calculated as the difference Traditionally, HRQOL is measured (mean±SD). Correlations were between maximum inversion and through patient self-report. However, evaluated using the following scale: maximum eversion) for the involved there are instruments, including the 00-.50=little-to-fair correlation, .50- (sprained) side. For healthy Pediatric Quality of Life Inventory .75=good correlation, and >.75= individuals a sham-involved side was (PedsQL), that allow proxy reporting excellent correlation. Results: designated. A priori we defined 2 of HRQOL. Proxy reporting is Pearson Product Moment correla- orthogonal contrasts, with the first defined as someone close to the tions showed little-to-fair, comparing the healthy and coper patient completing the health status insignificant (p>.05) relationships groups, and the second comparing the assessment instead of the patient. between the patient self-report and the FAI group to the pooled healthy and Limited information exists comparing parent-proxy report of the PedsQL for coper groups (stable). Contrasts were patient and proxy reporting of HRQOL the total score (patient: 63.6±18.6; performed separately for sagittal and following sport-related injury in parent: 77.7±13.8; r=-.09) and all frontal planes. Results: In the sagittal adolescent athletes. Objective: To subscales: physical (patient: 46.5± plane, the healthy and coper groups compare patient ratings and parent- 31.7; parent: 68.0±29.8; r=.10), were not different (t= -1.349, df=63, proxy ratings of HRQOL in adolescent emotional (patient: 62.7±25.8; parent: p=0.182; Healthy: 39.50± 6.43°, athletes who suffer musculoskeletal 77.5±20.6; r=.40), social (patient: Coper: 42.51±7.64°). However, injuries requiring orthopaedic 84.5±16.0; parent: 91.1±10.4; r= .10), individuals with FAI had significantly consultation. Design: Retrospective and school functioning (patient: less AROM than the pooled healthy and study. Setting: Orthopaedic practice. 68.9±22.3; parent: 80.4±17.9; r= .10). coper group (t=2.322, df=63, Patients: Thirteen consecutive Conclusions: Our results indicate a p=0.023; FAI: 36.62±7.81°, Stable: adolescent patients (age: 15.9±1.2 lack of agreement between adolescent 40.97±7.13°). In the frontal plane years; height: 177.8±8.9 cm; weight: patient and parent-proxy ratings of there were no significant differences 74.3±20.0 kg) who suffered a sport- HRQOL, with adolescents rating their (first contrast: t= -1.260, df=63, related musculoskeletal injury that HRQOL lower than their parent. These p=0.212; Healthy: 27.70± 7.18°, required orthopedic consultation and data suggest that patient perception of Coper: 30.58±7.02°; second contrast: one of their parents. Intervention: HRQOL may be most accurate and t=0.392, df=63, p=0.696; FAI: Adolescent patients with a sport- supports the use of patient-rated 28.38±8.17°, Stable: 29.11±7.17°). related musculoskeletal injury and HRQOL in patient evaluation. Conclusions: Although FAI and presented to an orthopaedic practice Assessments of HRQOL made by copers have both experienced an ankle were asked to complete the PedsQL proxies, even those close to the patient, sprain, only individuals with FAI and the patient’s parent was asked to may not adequately represent the displayed reduced sagittal plane complete the parent-proxy version of patient’s health status. Further AROM. It is unclear whether reduced the PedsQL. Testing occurred on the investigations into clinician proxies AROM is a causative factor in FAI, or initial patient visit in the physician’s are warranted to determine if if reduced AROM is a mechanism by office. Main Outcome Measure: healthcare providers better which individuals with instability The PedsQL is a pediatric generic approximate patient HRQOL. attempt to increase stability. outcome measure that consists of 23- items, composed of a total score and four sub-scales: physical, emotional, social, and school functioning. Items

Journal of Athletic Training S-119 11237MOSP 11F16MONE Effects Of Weight-Cutting Tactics (BL, PRE, and POST). We observed An Examination Of Proximal On Sideline Clinical Concussion high intratester reliability using a Tibia Anterior Shear Force And Measures In Division I Collegiate subset of 20 baseline BESS videos re- Neuromuscular And Wrestlers evaluated after the completion of the Biomechanical Characteristics In

Friedline AV, Mihalik JP, Register- study (ICC3,1=0.95; SEM=1.22). The Lower Extremity During A Mihalik JK, Mays S, Prentice WE, Results: A significant difference in Vertical Stop-Jump In Individuals Guskiewicz KM: The University of SCAT2 total scores across test session With Chronic Ankle Instability

North Carolina, Chapel Hill, NC was observed (F2,62=13.91; P<0.001) Terada M, Pietrosimone BG, such that PRE (90.2±5.0) and POST Armstrong CW, Gribble PA: Context: Wrestlers cut weight several (87.9±6.4) scores were significantly University of Toledo, Toledo, OH times throughout a season to reach worse than BL (93.1±3.9) measures. competition weight. Since the risk of We also observed a significant Context: A kinetic chain relationship concussion is high in wrestling and difference in GSC severity score between anterior cruciate ligament symptom overlap exists between across test session (F2,62=16.54; (ACL) injury and previous ankle sprain concussion and dehydration, there is a P<0.001), with wrestlers reporting has been proposed. There is currently need to examine the effects of cutting higher symptom severities at PRE little evidence that has quantitatively weight on clinical measures of (5.4±9.8) and POST (12.7±13.8) assessed neuromuscular and bio- concussion. Objective: To evaluate compared to BL (1.0±2.9). Further, mechanical factors associated with the effects of cutting weight on GSC symptom severities were greater ACL injury risk, such as proximal tibia clinical concussion measures in at POST compared to PRE (P=0.003). anterior shear force (PTASF) and Division I wrestlers. We hypothesize We further observed a significant kinematic and muscle activation knee cutting weight will result in clinical difference in BESS total error score stabilization strategies in individuals deficits. Design: Quasi-experimental across test session (F2,62=5.68; with chronic ankle instability (CAI) prospective cohort. Setting: Research P=0.005). The number of errors during high risk functional activities laboratory. Patients or Other committed was higher during POST for an ACL injury. Identifying an Participants: Thirty-two Division I (18.8±6.7) compared to BL underlying relationship of the presence collegiate male wrestlers (age= (15.7±5.1). Conclusions: Our data of CAI to biomechanical and 20.0±1.4 years; height= 175.0±7.5 cm; suggest that weight-cutting tactics neuromuscular risk factors for ACL baseline mass= 79.2±12.6 kg) affect several sideline clinical injury may help clinicians to develop participated in this study. Inter- measures of concussion commonly a more effective intervention protocol ventions: Participants com-pleted a employed by certified athletic trainers. to minimize subsequent proximal joint preseason concussion baseline (BL) In general, our PRE and POST injury in those with CAI. Objective: battery that included 3 sideline clinical measures of symptom severity and To investigate the influence of CAI on measures of concussion. Participants balance were lower than BL measures. the amount of peak PTASF as well as were instructed to begin cutting weight The most important finding of our study neuromuscular and biomechanical the day prior to a scheduled practice is that baseline testing should be characteristics in the lower extremity (38.6±3.6 days post-BL). A test battery conducted while the athlete is properly during a stop-jump task. Design: Case was performed before the start of the hydrated, and not during a period when control study. Setting: Research subsequent practice (PRE), and wrestlers are cutting weight. Since the laboratory. Patients or Other repeated following the end of that results of clinical testing while Participants: Twenty participants session (POST). Separate one-way athletes are cutting weight may be with self-reported unilateral CAI within-subjects repeated measures difficult to interpret, we recommend (10M, 10F; 20.15±3.59 yrs; ANOVA were completed for each implementing sideline evaluations 176.59±9.37 cm; 74.90±17.18 kg), dependent variable across the three test once athletes have been properly and 20 healthy control participants sessions (3 in total). In the event of a rehydrated. (10M, 10F; 21.60±4.56 yrs; significant omnibus finding, Tukey 171.22±9.34 cm; 70.53±14.68 kg) post hoc comparisons were employed. volunteered. Interventions: Partici- Main Outcome Measures: Sport pants performed 5 double-leg vertical Concussion Assessment Tool 2 stop-jump tasks on each limb in a (SCAT2) total score, Balance Error randomized order. Biomechanical and Scoring System (BESS) total error neuromuscular variables were assessed score, and Graded Symptom Checklist with an electromagnetic tracking (GSC) symptom severity score served system interfaced with a non- as our dependent variables. Our conductive force plate and an 8- independent variable was test session channel telemetered electro-

S-120 Volume 46 • Number 3 (Supplement) May 2011 myography (EMG) system. Main Outcomes: Peak PTASF was calculated during landing of the stop- jump. Knee flexion angle was measured at peak PTASF. The integrated EMG (IEMG) was calculated for the vastus medialis oblique (VMO), vastus lateralis (VL), semitendinosus (ST), and biceps femoris (BF) muscles during 100 ms before and after the initial contact and was normalized by the peak ensemble EMG. A 2 × 2 (Group, Side) repeated- measures ANOVA was used for each dependent variable. Significance was set a priori at P < 0.05. Cohen’s d effect sizes with associated 95% confidence interval (CI) were calculated using the pooled standard deviations. Results: A group by side interaction existed for pre-landing

IEMG of VMO (F1,36=8.698, P=0.006). Participants with CAI demonstrated significantly higher pre- landing IEMG of VMO in the injured limb compared to the matched limb of control participants (CAI= 52.03± 11.00%·ms, Control= 43.57± 10.32%·ms, d=0.79, 95% CI; 0.13, 1.42). Although statistically significant differences were not observed for knee flexion (F1,36 =1.326, P=0.257), we found a moderate effect size between the injured limb of CAI and matched limb of control group (d=-0.68, 95% CI; -1.30, -0.03), indicating CAI participants had less knee flexion at peak PTASF (CAI=26.20±8.72°, Control= 32.47±9.67°). There were no significant results for peak PTASF or the other EMG measures. Con- clusion: We found altered neuromuscular control patterns at the knee in the CAI group. These findings may provide insight regarding injury mechanisms and potentially correctable functional deficits that may be associated with contributions to CAI. Funded by the Master’s Grant Program of the NATA Research & Education Foundation.

Journal of Athletic Training S-121 Free Communications, Poster Presentations: Doctoral Poster Awards Monday, June 20, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11144DOBI 11157DOBI Sagittal Plane Ankle Motion ankle dorsiflexion DSP and 3- Trunk Position Is Associated With Affects Frontal And Transverse dimensional hip and knee joint DSP Combined Knee Loading During Plane Motion At The Knee And values. Results: Lesser ankle An Athletic Cutting Task Hip During A Jump-Landing dorsiflexion DSP (-41.60± 14.62) was Frank BS, Bell DR, Norcross MF, Begalle RL, Walsh MC, McGrath associated with greater frontal plane Goerger BM, Blackburn JT, Padua ML, Boling MC, Blackburn JT, knee varus DSP (5.03±8.23, r=0.520, DA: Sports Medicine Research Padua DA: Sports Medicine P=0.011) and greater transverse plane Laboratory, University of North Research Laboratory, University hip internal rotation DSP (7.43±6.45, Carolina, Chapel Hill, NC; of North Carolina, Chapel Hill, NC; r=0.482, P=0.020). Ankle dorsiflexion Wisconsin Injury in Sport University of Nebraska at Omaha, DSP was not associated with knee Laboratory, University of Omaha, NE; University of North flexion DSP (68.43±13.53, r=0.326, Wisconsin, Madison, WI; Florida, Jacksonville, FL P=0.077), transverse plane knee Neuromuscular Research rotation DSP (8.08±8.62, r=0.098, Laboratory, University of Context: Ankle dorsiflexion P=0.656), hip flexion DSP North Carolina, Chapel Hill, NC displacement serves as an effective (-24.32±9.94, r=-0.384, P=0.070), or energy absorption mechanism when hip adduction DSP (3.59±4.98, r= Context: Triplanar knee loading landing from a jump. Decreased -0.234, P= 0.283). Conclusions: induces high stress in the anterior dorsiflexion displacement may alter Results of this study indicate that cruciate ligament (ACL). Trunk energy absorption strategies and result limited sagittal plane ankle motion is position influences lower extremity in compensatory knee and hip motions. associated with greater frontal plane biomechanics during landing tasks. Objective: To determine the motion at the knee and transverse plane However, the relationship between relationship between ankle dorsi- motion at the hip. Sagittal plane flexion trunk position and triplanar knee loads flexion displacement and knee and hip of the ankle, knee and hip joints work during an athletic cutting task (CUT) joint displacement during a jump- in synchrony to absorb forces upon has not been examined. Objective: To landing task. Design: Cross-sectional landing. Restriction in one joint, such examine the relationship between correlation. Setting: Research as limited ankle dorsiflexion DSP, may trunk position and triplanar knee loads laboratory. Participants: Twenty- result in greater compensatory associated with ACL injury risk during three recreationally active volunteers movement at other joints or in other an CUT; a mechanism of ACL injury in (9 males, 14 females, age 21.63±2.10 planes of motion. These motions at athletics. Design: Cross-sectional years, height = 176.41 ±11.84cm, the knee and hip are believed to correlation analysis. Setting: Sports mass = 75.50±14.82kg) who were increase the risk of knee injury, such Medicine Research Laboratory. injury free at the time of testing and 6 as ACL injury, patellofemoral pain Participants: 30 healthy, physically months prior with no history of lower syndrome and osteoarthritis. active subjects (15 male, 15 female, extremity surgery. Interventions: Identifying ankle joint restrictions and age: 20.5±2.5 yrs, mass: 67.50±11.39 Kinematic data were collected during improving sagittal plane ankle range of Kg, height: 173.78±9.28 cm) 5 jump-landing trials using an infrared motion may be an important participated in this study. Inter- motion capture system. The jump- component of injury prevention ventions: Triplanar trunk kinematics landing task consisted of jumping programs aimed at improving knee and and knee kinetics were collected using from a 12” box to a forward target area hip motion control. Support provided an infrared motion capture system and placed at a distance of 50% of their by the National Academy of Sports force plate during the first 50% of the standing height. Participants were Medicine and National Basketball stance phase of the side-step CUT on instructed to land on the target and Athletic Trainers Association. the subject’s dominant leg. The CUT immediately jump in the air for task involved performing 3 running maximal vertical height. Main steps, jumping over a 17 cm high Outcome Measures: Joint hurdle before cutting 60° in the displacement (DSP) values were opposite direction of the dominant calculated for the ankle, knee, and hip plant leg (5-trials). Average peak as the difference between joint angles triplanar trunk angles and knee kinetics at the time of peak knee flexion and during the CUT were used for analysis. angles at initial contact. Pearson Pearson product-moment correlation correlational analyses were performed coefficients were calculated among to determine the relationship between peak trunk angles and external knee

S-122 Volume 46 • Number 3 (Supplement) May 2011 11160DOBI kinetics. Main Outcome Measures: Ankle Dorsiflexion Range Of during descent phase of double leg Peak triplanar trunk angles (°) were Motion Is Associated With Hip squat was averaged across 5-trials and used as predictor variables while knee Muscle Activation then normalized to each muscle’s kinetics served as criterion variables. Goto S, Bell DR†, Padua DA: Sports maximal voluntary isometric Peak external knee moments (Nm) of Medicine Research Laboratory, contraction (MVIC). Co-activation flexion, valgus, internal rotation, and University of North Carolina, Chapel ratios between the GMED and ADD external rotation were normalized to Hill, NC, and Wisconsin Injury in (GMED/ADD) were calculated as the the product of body weight and height. Sport Laboratory, University of mean GMED amplitude divided by the Anterior tibial shear force (N) was Wisconsin, Madison, WI mean ADD amplitude (ratios less than normalized to body weight. Results: 1 indicate the ADD was more active Greater trunk rotation away from the Context: Frontal plane knee alignment than GMED). Separate Pearson stance limb (6.92°±8.24) was is associated with increased risk of correlation analyses were performed associated with greater knee valgus injuries such as patellofemoral pain between the each criterion (DFKF, moment (0.010±0.005, r=0.371, syndrome and ACL rupture. Knee DFKS) and each predictor variable p=0.043). Greater lateral trunk flexion position can be influenced by the (GMED, ADD, GMED/ADD) (a< toward the stance limb (6.80°±2.82) proximal and distal joints. For 0.05). Results: There was no was associated with greater external example, previous research significant correlation between DFKF tibial rotation moment (0.032±0.013, demonstrates that gluteus medius (17.41±6.95°) and GMED (10.93± r=0.562, p=0.001) and internal tibial (GMED) and hip adductor (ADD) 5.67 %MIVC) (r=0.310, p=0.079), or rotation moment (0.012±0.010, activation influence lower extremity ADD (28.59±17.28 %MVIC) (r= r=0.387, p=0.034). Greater forward (LE) kinematics. Restricted ankle -0.28, p=0.11). Similarly, no signi- trunk flexion (36.80°±9.45) was range of motion (ROM) is theorized ficant correlation between DFKS associated with greater external tibial to influence the LE kinematics by (9.66±5.68°) and GMED activation rotation moment (r=0.400, p=0.028). increasing frontal plane knee (r=0.26, p=0.15) or ADD (28.59± No significant relationships were alignment. However, the relationship 17.28 %MVIC) activation (r=-0.19, observed between trunk kinematics and between GMED and ADD activation p=0.30) was noted. However, GMED/ sagittal plane knee kinetics. Con- and ankle ROM has not been ADD co-activation was significantly clusions: Subjects with greater trunk investigated. Objective: To determine correlated with DFKF (0.50±0.45) forward flexion, lateral flexion toward the relationship between ankle (r=0.43, p=0.02) and DFKS (r=0.40, the stance limb, and rotation away from dorsiflexion ROM with GMED and p=0.03). Conclusion: Ankle dorsi- the stance limb exhibited greater ADD activation. Design: Cross- flexion ROM was not related to transverse and frontal plane knee sectional correlational. Setting: activation of individual hip muscles. kinetics associated with ACL injury. Research laboratory. Patients or However, lower GMED/ADD co- The lack of association between trunk Other Participants: Thirty-seven activation ratio was associated with kinematics and sagittal plane knee healthy subjects (Males=8, Females decreased ankle dorsiflexion ROM. kinetics may be attributed to the nature =29, Ht:167.0±8.5 cm, Mass: Interventions to improve GMED and of the CUT versus landing tasks in 65.4±11.8 kg, Age:20.8±2.1 years) ADD neuromuscular control, which previous methodology. Multiplanar participated in this study. Subjects had may alter frontal plane knee loading of the knee imparts greater no history of lower extremity injury kinematics, may benefit from stress in the ACL, compared to single within the past 3 months or history of increasing ankle dorsiflexion ROM. plane loading. Greater trunk motion surgery within the past 1 year. The influence of increasing ankle during CUT is associated with Interventions: Ankle dorsiflexion dorsiflexion ROM and improving combined knee loading in the frontal ROM with the knee straight (DFKS) GMED and ADD neuromuscular and transverse planes. Interventions and flexed (DFKF) were measured control on knee valgus alignment focused on improving control of trunk using a goniometer. Surface EMG requires further study. Supported by position during athletic tasks may amplitude of the GMED and ADD the National Academy of Sports decrease ACL injury risk. Support were collected during the descent Medicine and National Basketball provided by the National Academy of phase of 5 separate double-leg squat Athletic Trainers Association. Sports Medicine and the National trials. All measurements were taken Basketball Athletic Trainers from the dominant leg (leg used to kick Association. a ball for maximal distance). Main Outcome Measures: DFKF and DFKS ROM values were averaged across 3-trials and used for analyses. Mean GMED and ADD amplitude

Journal of Athletic Training S-123 11168DOMU 11F01DOMU Validation Of A Recalibrated an inclusion criteria for any group. Relationships Between Various Cumberland Ankle Instability Interventions: Participants com- Strength Measures and Energy Tool Cutoff Score For Chronic pleted the CAIT during a single session Absorption During Ankle Instability using a customized computer program Landing Wright CJ, Arnold BL, Ross SE, (Access, Microsoft, Redmond, WA). Montgomery MM, Shultz SJ, Pidcoe PE: Virginia Commonwealth CAIT scores can range from 0-30 Schmitz RJ: The University of University, Richmond, VA points, with higher scores indicating North Carolina at Greensboro, greater function. Main Outcome Greensboro, NC Context: The Cumberland Ankle Measures: CAIT score of the involved Instability Tool (CAIT) is a 9-question (sprained) limb was used for analysis. Context : Decreased thigh muscle ankle function questionnaire that has For controls, a sham-involved limb was strength is thought to relate to stiffer been used to discriminate between designated. A receiver operating curve landings and a lesser ability to perform individuals with and without chronic (ROC) was calculated using CAIT eccentric work to safely decelerate the ankle instability (CAI). Recently, a score and CAI group membership as body. Maximal isometric contractions recalibrated CAIT cutoff score was the test variables. Area under the curve are often measured because they are proposed. Using the new value, a score (AUC) and asymptotic significance easier to perform reliably, but are also of d”25 points indicates likely was used to identify a significant ROC criticized as they are not reflective of presence of CAI. However the curve. Sensitivity, specificity, positive the muscular demands during landing. recalibrated cutoff has yet to be likelihood ratio (LR+), negative Little is known regarding the validated on an independent data set. likelihood ratio (LR-), false positives relationships between the various Additionally, it is unknown whether and false negatives were calculated muscle contraction types or their this cutoff score can adequately using the recalibrated cutoff score comparative associations with ≤ discriminate between CAI and ( 25). Results: The AUC was eccentric work performed (i.e. energy individuals with a history of ankle significant (AUC=0.988, P<0.001). absorption) during landing. Objective sprain but without subsequent re-injury The recalibrated cutoff score had a : Determine the relationships between or symptoms of giving way (copers). sensitivity of 96.6%, specificity of various maximal muscle contraction Objective: To cross-validate the 86.8%, LR+ of 7.318, LR- of 0.039. types and which contraction type is recalibrated cutoff score for There were 7 false positives (1 control, most predictive of the eccentric work discriminating individuals with and 6 copers) and 1 false negative (1 CAI). T performed during landing. Design : without CAI on an independent data The average CAIT score by group was: Descriptive Cohort. Setting : set. Design: A 3 group observational healthy=28.93±1.69, coper= 27.31± Controlled Laboratory. Patients or cross-sectional design. Setting: 2.02, CAI=19.59±4.15. Conclu- Other Participants : Male (n=15; University sports medicine research sions: The recalibrated CAIT score 21.2±3.6yrs; 1.78±0.1m; 74.2± laboratory. Participants: Eighty-two demonstrated high sensitivity, high 11.0kg) and female (n=15; 22.3± individuals from a large metropolitan specificity, high LR+ and low LR- 3.6yrs; 1.69±0.8cm; 65.7.±8.0kg) area volunteered to participate. Specifically, these characteristics are athletes. Interventions : Partici- Participants included 27 individuals all improved from the original cutoff. pants performed maximal isometric with no history of ankle sprain or Clinicians and researchers using the (MVIC), concentric (Con60, Con180) instability in their lifetime (Controls: CAIT should utilize the recalibrated and eccentric (Ecc60, Ecc180) 14 males, 13 females, age= 22.89 cutoff score to maximize test isokinetic (60°/s and 180°/s) ±3.78yrs, height =1.71±0.08m, characteristics. Caution should be contractions of the quadriceps (Quad) weight=69.33±13.90kg), 26 indi- taken when using this score with and hamstrings (Ham) on an isokinetic viduals with a history of a single ankle copers, as these individuals had a dynamometer and completed 5 drop sprain and no subsequent episodes of higher rate of false positives. jump landings from a 0.45m height instability (Copers: 12 males, 14 while instrumented for biomechanical females, age= 23.35± 3.50yrs, analysis . Main Outcome Measures height=1.71±0.07m, weight= 69.81± : Normalized average peak torque 13.65kg), and 29 individuals with a (Nm/kg) over 3 trials was recorded history of e•1 ankle sprain and at least during MVIC, Con60, Con180, Ecc60, 2 episodes of giving-way in the past and Ecc180 for Quad and Ham. Total year (CAI: 15 males, 14 females, T (hip + knee + ankle) normalized age=23.31±3.53yrs, height= 1.72± energy absorption (TEA) (J*N*kg) 0.10m, weight= 75.12± 19.52 kg, was calculated from the kinematic and monthly episodes of giving- kinetic data during the initial deceler way=4.99±7.75). CAIT score was not ation phase of the drop jump landing.

S-124 Volume 46 • Number 3 (Supplement) May 2011 Pearson-product correlations examined relationships between each mode and speed of torque values. Multiple linear regressions determined the extent to which each mode and speed of Quad-Ham torques (including Ecc-Con, and Con-Ecc) predicted TEA. Results : In females, correlations among Quad torque values ranged from 0.589–0.750, with the strongest correlation between MVIC and Con60 (r=0.750, p=.001); correlations among Ham torques ranged from 0.692-0.873, with the strongest correlation between MVIC and Ecc180 (r=0.873, p<.001). In males, correlations among Quad and Ham torques ranged from 0.622-0.788 and 0.370-0.571, respectively, with the strongest correlations noted between MVIC and Ecc60 for Quad (r=0.788, p=.001) and Con60 for Ham (r=0.571, p=.026). The predictive ability of each combination of quadriceps and hamstring torques ranged from R=0.392-0.611 in females. Quad2Con60-Ham Con60 and Quad Con180-Ham Con180 were strong predictors of TEA (R =0.611, p=.003 and R =0.569, p=.004, respectively) as were Quad Ecc60- Ham 2 Con60 (R =0.600, p=.004) and Quad Ecc180-Ham Con180 (R =0.580, p=.005). MVIC was least predictive of TEA (R =0.392, p=.051). For males, none of the thigh torques 2 were predictors of TEA (R range=0.163-0.279, p>.140). Con- clusions : Quad and Ham 2 MVIC torques were strongly correlated with Con and Ecc torques. However, Con and Ecc appear to be somewhat more reflective of the dynamic muscle actions performed during landing. The sex-dependent findings suggest that strength may be a more important determinant in deceleration ability in females vs. males. Funded by the Doctoral Research Grant Program of the NATA Research & Education Foundation.

Journal of Athletic Training S-125 Free Communications, Poster Presentations: Injury & Therapeutic Treatment Monday, June 20, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11030MOTH 11044DOTH The Anesthetic Effect Of primary tester returned and assessed Effects Of Cold Water Immersion Lidocaine After Phonophoresis skin sensation via Semmes Weinstein On Subsequent Performance: A Treatments Of Varying Times Monofilaments (SWM) at the Systematic Review Donovan L, Selkow NM, Rupp KA, specified times: pre-test, post-test, 20 Rupp KA, Selkow NM, Saliba S: Saliba E, Saliba S: University of minutes, 40 minutes, and 60 minutes. University of Virginia, Virginia, Charlottesville, VA Main Outcome Measures: SWM Charlottesville VA scores, a unitless measure of skin Context: Phonophoresis is a sensitivity with larger values indicating Context: Cold-water immersion treatment technique that utilizes a greater reduction in sensation. A 4x5 (CWI) is a recovery modality used to ultrasound to enhance the penetration repeated measures ANOVA was used maintain performance over multiple of medication through intact skin. to analyze the anaesthetic effect over exercise bouts. Currently, the Research on phonophoresis has used time. Results: There was a significant effectiveness of this intervention on various parameters and medications time main effect for SWM scores performance is unclear. Objective: To resulting in inconclusive results. The (p<.001). Baseline measurements systematically review existing ultrasound dosage is determined by the were similar (3.00±.53) and were literature to determine the clinical frequency, intensity, duty cycle and significantly lower than any other time effectiveness of CWI greater than 5 time. It is not known whether point (p=.006). Immediate post minutes on subsequent exercise tasks manipulating the duration and duty measurements (3.63±.44) were measured by physical performance cycle affects the absorption of the significantly larger than any other time outcomes. We hypothesized that CWI medication with phonophoresis. A point for all conditions (p<.001).There after an initial exercise bout would longer duration with a pulsed duty was no difference between inter- have a clinically meaningful effect on cycle was hypothesized to enhance ventions. Conclusion: Although all subsequent performance when drug delivery. Objective: To conditions resulted in a significant treatments times were greater than five determine the anesthetic effect on the anaesthetic effect immediately post minutes. Data Sources: A com- anterior forearm following 5 and 10 treatment, no condition resulted in a puterized search for pertinent articles minute phonophoresis interventions of greater reduction in skin sensation. was performed using PubMed, 1MHz at 1.5 W/cm2 using lidocaine. Therefore, the phonophoresis CINAHL, and Web of Science from The duty cycle was adjusted so that treatments did not have a greater 1970 through 2010 using temporal average intensity was phonophoretic effect than either of the combinations of pre-defined MeSH constant with both treatments. Design: two sham conditions, nor was either terms: cold temperature, immersion, Double-blinded, crossover. Setting: treatment method superior. The cryotherapy, athletic performance, Laboratory. Patients or Other treatment effect was too small to recovery of function, and sports Participants: Twenty-two healthy detect a change between conditions. medicine. Search limits included all subjects participated (13 Female, 9 Future studies investigating the effect adult, human, English. Study male, Age: 23.0±3.2 years, Height: of ultrasound time of phonophoresis Selection: Original research studies 169.1±7.2 cm, Weight: 70.9±13.9 kg). should use a longer contact time of the were included if they met pre-defined Interventions: All subjects received drug and skin, using ultrasound criteria including: CWI greater than or four interventions on 4 different days parameters such as a 10% or 20% duty equal to five minutes, water separated by 48 hours: Short: cycle with durations of 50 min or 20 temperature between 10°C and 15°C, 1MHz,1.5 W/cm2, 5 minutes,100% min, respectively. Our results concur trained subjects who performed an duty cycle with lidocaine gel; Long: with some clinical trials that did not initial exercise bout with at least one 1MHz, 1.5W/cm2,10 minutes, 50% support phonophoresis used with short subsequent exercise bout performed duty cycle with lidocaine gel; durations. after intervention, and comparison to Lidocaine Sham: no ultrasound for 10 a control group. Twelve of 64 minutes with lidocaine gel; and True identified studies met criteria for Sham: no ultrasound for 10 minutes inclusion, and 9 studies reported mean with ultrasound gel. Conditions were and standard deviation of dependent randomly assigned. Prior to each variables. Data Extraction: Three treatment, the primary tester cleaned investigators independently reviewed the skin and marked the treatment area the 9 studies meeting inclusion with a template. A secondary tester criteria, and study quality evaluated by administered the condition, then the the Physiotherapy Evidence Database

S-126 Volume 46 • Number 3 (Supplement) May 2011 (PEDro) scale was 6±0. Data of stationary cycling, hot pack, and heating via stationary cycling is better Synthesis: Separate analyses were continuous shortwave diathermy on than either passive heating technique performed for common outcome deep quadriceps intramuscular at raising the intramuscular measures including cycling peak temperature. Design: Within repeated temperature of the deep quadriceps. performance (PP, n=2), cycling total measure designs. Setting: Controlled However, by 15 minutes, both active work (TW, n=3), heart rate (HR, n=4), laboratory setting. Participants: 6 heating and passive heating via CSWD and muscle soreness (MS, n=2), then males (n=2) and females (n=4) (age = were superior to the conductive heat compared between studies using effect 20±1 years, mass = 68±10 kg, height produced by the hot pack. Therefore, size (ES) and 95% confidence intervals = 164± 11cm, thigh skinfold = clinicians who desire to raise tissue (CI). A positive effect size favors CWI 19.1±6.5mm) volunteered for study. temperature to therapeutic levels are while a negative effect size favors the All had no current injury involving their advised to use active heating or passive control condition. Values are thighs or knees. Interventions: A diathermy when the target tissue is presented as a range of ES (lower 95% thermocouple was inserted into their deep. Further research is recom- CI to upper 95% CI). PP ranged from proximal vastus medialis using a mended to clarify time course and -1.14 (-1.87 to -0.42) to -0.55 (-1.44 1.88in 20g catheter needle to an magnitude of various therapeutic to 0.35). TW ranged from -1.20 (-1.93 absolute depth of approximately 4 cm warm-up protocols. to -0.47) to 0.28 (-0.53 to 1.08). HR from the skin surface (4.0±0.1cm; ranged from -0.28 (-1.0 to 0.44) to range 3.9-4.1cm). Therefore, the 11192MOTE 2.35 (3.28 to 1.42). MS ranged from thermocouple was approximately 3cm Instrument Assisted Soft Tissue -0.73 (-1.68 to 0.23) to 2.0 (0.98 to deep in the muscle. The thermocouple Mobilization Decreases Pain As 3.02). Conclusions: CWI after an was interfaced to a desktop computer Measured By The Visual Analog initial exercise bout appears to have through an Isothermex®. Three Scale And Pressure Pain little beneficial effect on subsequent conditions were compared including Threshold exercise performance outcomes. The (1) stationary cycling (CYC) at heart Langemaat J, Donahue M, Docherty temperatures, duration, and depth of rates progressing from 40-50% (10 CL, Schrader J: Indiana University, the CWI varied among studies, as did minutes) and 60-70% (10 minutes); 20 Bloomington, IN the timing of the subsequent exercise. minutes hot pack (HP); (3) 20 minutes PP worsened after CWI when Rebound™ continuous shortwave Context: Research on the use of compared to a control group, while TW, diathermy (CSWD). HP was applied to Instrument Assisted Soft Tissue HR, and MS show inconclusive results thigh in standard terry cloth cover with Mobilization (IASTM) for the with ES and CI crossing zero. Although 3 layers of thin towels for comfort and treatment of soft tissue related pain is some individual studies included in the CSWD was delivered at 13.1 MHz limited, but clinical evidence suggests review show a statistically significant using standard thigh sleeve. Main it may be beneficial. Objective: benefit with CWI, the effect sizes Outcome Measures: Baseline (TB) Evaluate the effect of IASTM on soft ranged from strongly unfavorable to and intramuscular (TIM) temperatures tissue related pain. Design: Repeated strongly favorable, and there is little (°C). A 3 x 5 (condition x time) Measures Setting: Research evidence that CWI improves repeated measures ANOVA with five Laboratory Participants: Forty-five subsequent exercise performance levels of time (Start, 5, 10, 15, 20 healthy subjects (16 males, 29 when used as a recovery intervention minutes) investigated changes in TIM. females, 23.0±5.0years, 78.2±27.7kg, Alpha set apriori at 0.05. Results: and 174.6 ±17.1cm) volunteered to 11107MOTH There was no difference (p=0.32) in participate in this study. Subjects were Deep Quadriceps Intramuscular TB across conditions (37.1± randomly assigned to one of three Temperature With Active And 0.2°C).There was a condition x time groups: control, IASTM, and sham. Passive Heating Modalities interaction for TIM (p=0.011). CYC10 Interventions: All subjects completed Schweitzer MS, Trowbridge CA: min (38.2±0.5°C) was significantly a series of eccentric dumbbell The University of Texas at Arlington, warmer than HP10 min (37.4±0.3°C) contractions on the non-dominant Arlington, TX (p<0.05). CYC15 min (38.7±4°C) and biceps brachii muscle to induce CSWD15 min (38.1±0.1°C) were delayed onset muscle soreness. Context: Heating deep tissue for pain/ significantly warmer than HP15 min Subjects returned a minimum of 36 spasm relief or improvement in tissue (37.5±0.2°C) (p<0.05). CYC20 min hours later (Day 1) to receive compliance is often a goal of both (38.8±0.4°C) and CSWD20 min treatment. Subjects in the IASTM active and passive heating techniques. (38.3±0.2°C) were significantly group received a six minute treatment However, the most optimal method of warmer than HP20 min (37.6±0.2°C) consisting of distal to proximal obtaining increases in tissue (p<0.05). Conclusions: Our sweeping and fanning strokes using the temperature is unknown. Objective: preliminary investigation demon- Graston Technique instruments To examine the effect of 20-minutes strates that at 10 minutes, active (TherapyCare Resources, Inc.

Journal of Athletic Training S-127 Indianapolis, IN). Subjects in the sham treatment option to assist in the analyzed with Photoshop. We group received a six minute ultrasound reduction of soft tissue related pain. calculated average pixel values of cyan, treatment but the intensity was never magenta, yellow, black, and luminosity increased so no treatment was 11233FOTH for the treatment and control limbs. administered. Subjects in the control Is Tennis Ball Induced Bruising A These data were used to calculate the group simply rested for five minutes. Useful Acute Injury Model? overall color difference. Limb (2) and Subjects completed two days of Hawkins JR, Knight KL: Brigham day (6) served as independent, within treatment with 24 hours between Young University, Provo, UT, and subjects variables. Treatment type (4) sessions. Pain was evaluated using the Illinois State University, Normal, IL served as the independent, between Visual Analog Scale (VAS) and subjects variable. A 2 x 4 x 6 mixed Pressure Pain Threshold (PPT). For Context: Research conducted on model ANOVA with Bonferroni post VAS, subjects were asked to mark their injured subjects is needed to hoc comparisons was computed to current level of pain on a 10cm line. understand how therapeutic modalities determine treatment effect. Alpha PPT was measured using a digital physiologically mitigate the level set at P≤.05. During pilot data pressure algometer (Wagner Force inflammatory process. A human injury work, bruising was not different One FDIX Force Gage Greenwich, model will facilitate this research. between legs of 10 individuals

Connecticut). As the rubber tip of the Objective: To determine if a bruise (F1,6=.007, P=.933). This data served algometer was pressed against the induced by being struck with a tennis as our reliability measure for this biceps brachii subjects were instructed ball is a valid injury model. We study. Main Outcome Measures: to report when the sensation changed hypothesized that bruise color would Overall color difference, the from “pressure” to “pain”. Pain gradually resolve over time, with difference between the treatment and measurements were obtained on four resolution being augmented by control legs as calculated from the occasions: prior to inducing muscle different treatments. Design: average pixel values, was the dependent soreness (Baseline), Day 1 PreTest, Randomized, controlled, blinded trial. variable. Results: All subjects bruised.

Day 1 PostTest, and Day 2 PostTest. Setting: Research laboratory. No treatment (F3,60=.47, P=.70) or

Main Outcomes Measures: The Patients or Other Participants: limb (F1,60=.04, P=.84) effect was dependent variables were VAS (cm) and Sixty-four males (height: 180.2 observed; a significant day effect 2 PPT (kg/cm ). For the VAS, a mixed ±6.4cm, mass: 78.0±16.2kg, age: (F3.9,234.5=6.82, P<.001) was observed. factor repeated measures analysis of 22.1±2.8yrs), randomly assigned to 4, Overall color difference values variance was conducted. For PPT, the 16 person treatment groups, (mean±SE) were greater on Days 4 percent change from baseline was volunteered for participation. All were (16.6±10.5) and 6 (16.3±10.1) than 0 calculated and then a univariate free from cardiovascular ailments. (12.3±8.5) and 10 (14.6±9.8), and Day analysis of variance was conducted. Further, no anti-inflammatory 4 (16.6±10.5) was greater than Day 2 Tukey Post Hoc analysis was medications/painkillers were taken at (15.2±9.5; Bonferroni <.05). No performed on all significant findings. least 3 days prior to or during the significant interactions were present. Results: For the VAS data, a study. Interventions: Bilateral Conclusions: This model results in an significant interaction was identified anterior thigh bruises were induced via acute injury, but its severity was

(F6, 126=3.77, p=0.01). The IASTM a tennis ball fired from a tennis ball insufficient to measure treatment group demonstrated lower VAS values machine (distance: 31cm, ball speed: outcomes. Future models need at Day 1 PostTest (2.7±1.9cm) and 30.84±.32m/sec). Within 5 minutes greater trauma and additional Day 2 PostTest (2.0±1.5cm) compared of injury, subjects received 1 of 4 dependent variables in order to be to Day 1 PreTest (4.5±2.0cm). No assigned treatments on an assigned considered a valid injury model. differences were identified in the thigh: cryotherapy and compression sham or control groups. For the PPT (ice for 30 minutes every 2hrs for data, a significant difference was 10hrs, continuous compression for 2 identified between the groups after one days), compression alone (continuous treatment (F=4.17, p=0.02). The compression for 2 days), a tobacco IASTM group had a 13% reduction poultice (poultice for ≥12hrs, in pain compared to the sham (3%) continuous compression for 2 days), and control (2%) groups. or the SportsWrap® (continuous Conclusions: Only subjects in the application for 2 days). The untreated IASTM group had a significant leg served as the control. Digital reduction in perceived pain photographs were taken of the trauma following treatment. IASTM may sites immediately before and on days provide clinicians with another 2, 4, 6, 8, and 10 post-trauma and were

S-128 Volume 46 • Number 3 (Supplement) May 2011 11249MOMU The Effect Of Experimental visual analogue scale (VAS) for condition during sports competition Delayed Onset Muscle Soreness present pain, night pain, sleep quality, and athletic trainers (ATs) continue to On Recovery And Sleep: A and fatigue. Sleep efficiency based on search for a best practice treatment Preliminary Report wake-quiet activity, was computed strategy. Ice massage produces rapid Onofrio MC, Dover GC, Nashed A, using the AS. Results: A significant decline in muscle temperature and Lavigne G: Concordia University, decrease in internal ROM (ROM pre= controls the pain-spasm-ischemia Université de Montréal, Montréal, 61.3°±11.8; post= 52.7°±14.1; p = cycle. To assess potential treatment QC .005) and a significant increase in pain efficacy, an accepted and validated was noted after exercise (VAS(mm) electrical stimulation muscle cramp Context: A reduction in normal sleep pre= 0.23±0.59; post= 29.2±20.2; p < (ESMC) model was used to quantify decreases performance. The effects of .001). In addition there was a the effect of ice massage on ESMC. experimentally induced delayed onset significant decrease in function Objective: To determine the effects muscle soreness (DOMS) on (DASH pre= 0.89±1.1; post= of a 5 min ice massage on the perceived and measured sleep quality 22.3±12.9;p <.001). There was a trend amplitude and duration of electrical are unknown. Objective: To measure toward less pain felt at night versus stimulation induced muscle cramps. the effect of DOMS on self report and during the day (VAS night= 9.4 ±14.1; Design: Crossover design. Setting: quantitative sleep parameters. Design: day=16.9±19.3; p=.086). There was a This study was performed in a A single group pre-post test study. trend towards a decrease in sleep controlled research laboratory. Setting: DOMS testing was quality on day three compared to Patients or Other Participants: completed in a research laboratory, baseline (VAS 77.1±25.2; 64.7±19.6; Seven, healthy individuals (3 male, 4 while the sleep measures occurred at p =.084). There was a trend for an female; age, 23.4 ± 1.0 years; height, the participants’ homes using increase in fatigue on day three (VAS 172.7 ± 10.1 cm; weight, 86.7 ± 8.2 actigraphy. Participants: Thirteen 22.6±20.7; 38.6±20.2; p=.079). There kg) volunteered. Intervention(s): healthy students (5 males and 8 was no significant difference in sleep Surface electromyography (sEMG) females, height = 171.9±89.1cm, efficiency as measured by the AS median frequencies were recorded mass = 69.5±9.2 kg, age = 21.3±1.9 (pre%=87.8±4.1; post%=89.2±1.5; during induction of an electrical years) volunteered for the study. p=.093). Conclusions: DOMS was stimulated muscle cramp (ESMC) in Participants were involved in a larger successfully induced in all subjects. the abductor hallucis muscle. The study. Interventions: The participants All subjects reported more pain during participants endured two treatment wore the Actiwatch Score (AS), and the day and at night after exercise. sessions on subsequent days, a 5-min completed a sleep diary for three days While there was no significant effect rest and a 5-min ice massage. to obtain baseline measures. For the on sleep efficiency, trends in self- Following the 5-min condition, DOMS induction, measures of right reported measures indicate a decrease induction of an ESMC was again shoulder range of motion (ROM), and in perceived sleep quality and fatigue. attempted. Main Outcome pain were recorded at baseline. These preliminary findings suggest Measure(s): sEMG measurements Participants then completed an that perceived sleep may be relevant were taken pre-cramp and post-cramp eccentric exercise protocol involving for athletes who are injured and induction (frequency and median right shoulder external rotation using receiving rehabilitation. frequency). Elapsed time following the an isokinetic dynamometer and rest session was compared to the time exercised until they could generate 11258MOTH that elapsed following the ice Ice Massage Minimizes The only 50% of their maximum voluntary massage. Visual analog (VAS) and Magnitude Of Electrical isometric muscle contraction. DOMS McGill pain scales (MPQ) were used Stimulation Induced Muscle post-test measures were recorded 48 to assess the level of discomfort Cramping hours after the exercise. The AS was associated with ESMCs. Urine Eusea J, Krause BA: Hahnville High worn during the three days of exercise specific gravity and urine color were School, Boutte, LA, and Division of testing in addition to completing the collected to assure hydration status Athletic Training, School of Applied sleep diary. Paired sample t-tests and was comparable between treatment Health Sciences and Wellness, separated repeated measures ANOVAs sessions. Results: Individual 2x2 Interdisciplinary Institute for were used to analyze shoulder ROM, repeated measures AMOVAs were Neuromusculoskeletal Research, pain, function, and all sleep variables computed to compare sEMG College of Osteopathic Medicine, (α=0.05) Main Outcome Measures: frequency and median frequency Ohio University, Athens, OH A goniometer was used to measure across time and treatment. No shoulder ROM. The DASH significant changes in the cramp questionnaire was used to measure Context: Exercise associated muscle sEMG frequency or median frequency function. The sleep diary included a cramps (EAMC) are a common existed (p>.05). The most meaningful

Journal of Athletic Training S-129 observation was that mean elapsed time controlled basic science laboratory the TA is stretched to a lesser extent, to visible cramping following ice setting. Participants: Consisted of 4 but from the plateau. The final lengths massage was significantly longer than Male New Zealand white rabbits to which the sarcomeres are actively following rest (ice massage = 451.3 ± (4.57±0.12kg). Interventions: The strained are similar, and thus so are the 35.3sec; rest = 126.0 ± 15.8sec; p < hindlimbs of anesthetized rabbits were indices of damage. Funded by the .05). Mean VAS and MPQ scores were instrumented bilaterally with nerve Doctoral Research Grant Program of significantly lower following the ice cuff electrodes on the peroneal nerves the NATA Research & Education massage (VAS = 4.4 ± 2.3; MPQ = and sonomicrometry crystals within Foundation. 13.0 ± 6.2) when compared to the rest one fascicle of the TA and EDL condition (VAS = 5.96 ± 1.9; MPQ = muscles. A custom fabricated E-type 11F12MOTH 19.5 ± 11.3; p<.05). Conclusions: force buckle transducer was placed on Effects of Premodulated sEMG readings following ice massage the tendon of the TA. Rabbits were Electrical Stimulation on showed no significant decrease in placed supine in a sling with one foot Muscular Blood Flow in the magnitude, however, the longer elapsed strapped to the foot plate attached to a Gastrocnemius time for ice massage relative to rest torque sensor and cam of a Cavett HL, Miller MG, Cheatham reinforces that ice massage is the servomotor. A pre-exercise isometric CC, Holcomb WR: Western clinically appropriate treatment. torque-angle relationship was Michigan University, Kalamazoo, Cryotherapy can counteract the measured prior to subjecting the MI, and University of Nevada Las abnormal neuromuscular drive and dorsiflexor muscles to EEX. Vegas, Las Vegas, NV break the pain-spasm-ischemia cycle Afterwards, a post-exercise torque associated with EAMC. angle relationship was determined to Context: Electrical stimulation assess reduction in torque from fatigue continues to be a popular modality that 11F03MOCE and damage. Main Outcomes: is used for multiple purposes such as Fiber Strain Magnitudes And Differences between TA and EDL increasing local muscular blood flow. Exercise-Induced Muscle Damage muscle isometric force reduction as a Objective: To determine intra- In Synergist Muscles: The Role Of measure of damage was assessed via muscular and surface blood flow Architectural Properties Student’s t-test. Differences in TA and before, during, and after a Matus J, Butterfield TA: University EDL fiber strains during EEX sets were premodulated electrical stimulation of Kentucky, Lexington, KY assessed with a 2x5 factorial ANOVA. treatment. Design: Within-subjects Results: There was a significant main repeated measures design. Setting: Context: Eccentric exercise (EEX) effect of muscle architecture on active Human Performance Research creates high muscle tension and strain during the exercise bout, as EDL Laboratory. Participants: Fourteen muscle damage. Although the fibers strained to a greater magnitude healthy subjects (8 males, 6 females, relationship between exercise- compared to the strain of TA fibers age = 22.9 ± 1.2 years, height = 175.0 induced muscle damage and severe, (p=0.003). This difference was ± 12.7 cm, mass = 81.7 ± 17.8 kg, calf clinical muscle injury remains exacerbated with set number skinfold = 18.9 ± 7.0 mm, calf girth= unknown, several previous studies have (p=0.002), and resulted in a 36.9 ± 2.8 cm) with no history of concluded that eccentric exercise quantitative interaction effect of set trauma to the leg, recent leg injuries induced muscle strain injury may begin and muscle (p=0.001). The reductions within the past 6 months, infection and with mechanical disruption, due to in peak isometric force following the vascular or nervous conditions. excessive sarcomere strain. Sub- exercise bouts were not significantly Interventions: MVIC of the sequently, synergist muscles of different between the TA (39.6±7.1%) gastrocnemius was measured by Kin- different architecture would be and the EDL (43.6±4.6%, p=0.729), Com dynamometer (Chattanooga expected to exhibit greater damage and illustrating a similar response to the Group, TN). Premodulated electrical disruption following EEX when exercise bout. Conclusions: Al- stimulation (Vectra Genisys, compared to its synergist based on though fiber strain magnitudes of the Chattanooga, TN) was applied for a 10 mechanical design. Objective: EDL are greater than the fiber strain second on/20 second off ratio for 15 Investigate the differences in fiber magnitudes of the TA during EEX, minutes at 10% MVIC. A 10% MVIC dynamics and muscle damage during there are no differences in muscle was based upon pain tolerance using EEX between two architecturally damage. We hypothesize the simi- premodulated current for the calf. distinct synergist muscles: The long- larities in damage are due to the Surface blood flow and intramuscular fibered tibialis anterior (TA) and the architectural and functional differ- blood flow were measured in the left short fibered extensor digitorum ences between the muscles. The short posterior gastrocnemius. Intra- longus (EDL). Design: Cross-over to fibered EDL is strained to a greater muscular blood flow was measured at control design. Setting: This magnitude, but from the ascending limb a depth of 55-60 mm into the experiment took place within a of the force-length relationship while gastrocnemius using a laser-Doppler

S-130 Volume 46 • Number 3 (Supplement) May 2011 needle probe (Moor Instruments Inc, DE) that was threaded through a 20- guage hypodermic needle. The surface Doppler probe was attached on the surface of the gastrocnemius between the electrodes. Surface and intramuscular blood flow were measured throughout a 10 minute baseline, during treatment, and 10 minute recovery. Treatment was split into 3 different periods of 9 contractions. Blood flow was then averaged for the last minute of baseline, during contractions 1-9, contractions 10-18, and contractions 19-27. The recovery was split into 3 time intervals which consisted of the initial minute, minute 5, and minute 10. Main Outcome Measures: An analysis of variance (ANOVA) with repeated measures was used to analyze blood flow for the designated time periods. Statistical significance was set a priori at p < 0.05. Results: For surface blood flow, there was a significant main effect for time

(F2.45,31.90 = 8.35, p < 0.001). Compared to baseline (26.82±10.99 flux), skin blood flow was significantly greater for contractions 1-9 (36.70±13.82 flux) and contractions 10-18 (35.54±14.34 flux). For intramuscular blood flow, there was a significant main effect for time (F1.9,25.1=3.99, p=0.032). Muscle contractions 1-9 (54.73±52.98 flux), contractions 10- 18 (37.27±27.38 flux), and contractions 19-27 (29.54±17.02 flux) were significantly higher compared to the last minute of recovery (20.06±14.49). Con- clusions: Our findings revealed that premodulated electrical stimulation was an effective treatment modality for increasing surface blood flow with minimal increases in intramuscular blood flow compared to baseline.

Journal of Athletic Training S-131 Free Communications, Poster Presentations: Upper Extremity Assessment & Exercise Monday, June 20, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11019DOBI 11025OOBI Response To A Secondary a larger project and only two trials Scapular Kinematics And Cognitive Task During Unstable were performed to prevent any Subacromial Impingement Sitting Differs Between Males potential fatigue. Main Outcome Syndrome: A Meta-Analysis And Females Measures: Center of pressure (CoP) Timmons MK, Thigpen CA, Seitz SL, Goerger BM, Frank BS, Cavanaugh in the anterior-posterior (AP) and Kardun a AR, Arnold BL, Michener JT, Padua DA: Sports Medicine medial-lateral (ML) direction was LA: Department of Veterans Affairs- Research Laboratory, The University recorded using a conductive force Hunter Holmes McGuire VA of North Carolina at Chapel Hill, plate during the unstable sitting trials. Medical Center, Richmond, VA; Chapel Hill, NC, and University of Approximate entropy (ApEn) of CoP Virginia Commonwealth University, New England, Portland, ME fluctuations in the AP and ML Richmond, VA; Duke University direction was calculated in anticipation School of Medicine, Durham, NC; Context: Deficits in neuromuscular of needing to detect subtle changes in University of Oregon, Eugene, OR trunk control have been previously unstable sitting during a secondary linked with lower extremity injuries cognitive task. Values were calculated Context: Subacromial impingement that occur more frequently in females for each trial and averaged within syndrome(SAIS) is a common source than males. Gender-specific changes subject for each condition. The of shoulder pain. Extrinsic mech- in neuromuscular trunk control under dependent variables of ApEn_AP and anisms of SAIS have been associated dual task conditions may indicate the ApEn_ML were compared using two with scapular kinematics. However importance of attention for 2x2 (test x gender) ANCOVAs with inconsistencies are reported in understanding this issue. Objective: height and mass as covariates. An alpha scapular kinematic deficits during arm To compare between genders the level of 0.05 was set a priori to elevation in SAIS patients using three- effect of a secondary cognitive task on determine significance. Results: CoP dimensional(3D) analysis. Objective: neuromuscular control of the trunk. in the posture-only condition (Males: Determine through meta-analysis if Design: Repeated measures design ApEn_AP: 0.768±0.026, ApEn_ML: consistent differences in 3D scapular Setting: Sports Medicine Research 0.801±0.042; Females: ApEn_AP: kinematics occur between SAIS and Laboratory Patients or Other 0.733±0.030, ApEn_ML: 0.785± controls during arm elevation. Data Participants: A volunteer sample of 0.049) and dual task condition (Males: Source: A published literature search twenty-seven physically active ApEn_AP: 0.786±0.036, ApEn_ML: was carried out in the Medline/ individuals participated (Males: n=15, 0.788±0.037; Females: ApEn_AP: Pubmed, Science Direct and Ovid Age: 21±1.61 yrs, Height: 179.04 0.794±0.026, ApEn_ML: 0.912± databases up to March, 2010; key ±8.93 cm, Mass: 76.29±9.15 kg; 0.042) indicated that COP fluctuations terms shoulder, human, kinematics, Females: n=12, Age: 22±3.73 yrs, were relatively complex. A significant scapula and SAIS. Study Selection: Height: 170.67±8.64 cm, Mass: interaction effect was found for Computerized search identified 65 62.00±7.48 kg). Interventions: The ApEn_ML (p=0.037) but not for studies; review of the abstracts of the unstable sitting task required ApEn_AP (p=0.383). Conclusions: 65 papers found 14 studies that met participants to maintain their balance Introducing a secondary cognitive task the criteria for full text review. The while sitting upon a seat secured atop decreased the regularity of CoP_ML 14 papers were reviewed by 2 a 30 cm polycarbonate resin fluctuations during unstable sitting in investigators for inclusion criteria: hemisphere outfitted with a foot females but not in males. This SAIS patients diagnosed by healthcare support. During the first trials, the difference may influence the gender professionals, scapular kinematics participants did not receive any discrepancy in lower extremity injury using ISB recommendation when instruction other than to maintain their and warrants further investigation. appropriate and open chain arm position on the unstable apparatus. Support provided by the National elevation. Nine papers met the criteria After successfully completing five Academy of Sports Medicine. for inclusion into the meta-analysis. initials trials, the participants Each paper was assessed for threats to performed two additional trials while validity using a 23-point quality performing a secondary cognitive assessment tool. Data Synthesis: task. The cognitive task required The sample sizes, means and standard participants to count backwards aloud deviations of scapular upward by sevens. Each trial lasted 60 seconds rotation(UR), external rotation(ER), each. This data collection was part of posterior tilt(PT), clavicular

S-132 Volume 46 • Number 3 (Supplement) May 2011 elevation(ELE) and clavicular ELE and RET for SAIS patients. moment correlations assessed retraction(RET) kinematic variables Athletes with SAIS showed greater PT relationships between static and were extracted from each paper or while overhead workers with SAIS dynamic postural control measures for from the paper’s lead author by one showed less PT during arm elevation. each extremity and pitching velocity. investigator. Extracted data was Main Outcome Measures: Static verified by a second investigator. The 11031MONE postural control was quantified by standard difference in the mean(SDM) Relationships Between Lower measuring COP velocity (cm/sec). was calculated for each outcome. The Extremity Postural Control And Dynamic postural control was Z statistic was used to determine if the Pitching Velocity In College expressed as a percentage by overall group differences for each Baseball Players normalizing each subject’s SEBT reach kinematic variable was different from Fruechte B, Cross K, McGuire B, distances (cm) to their leg length (cm) zero. If the Q statistic was significant, Hertel J, Sauer L: University of and multiplying by 100. Maximum indicating heterogeneity, a random- Virginia, Charlottesville VA pitch velocity (m/s) was measured effects model was used. Moderator during game participation. Results: variables were plane of arm Context: Lower extremity postural Mean and standard deviation for each elevation(PLANE), level of arm control is believed to be an important dependent variable were: COP velocity elevation(ARM) and population(POP). factor in providing proximal stability (EO stance=4.8±0.78 cm/s, EO Quality assessment results were; mean for dynamic tasks such as baseball stride=4.68±0.88 cm/s, EC stance score 70.8%±14.02%. Compared to pitching. A relationship between stance =11.88 ±1.95 cm/s, EC stride= controls, SAIS patients had leg static postural control and 11.33±1.75 cm/s), anterior reach significantly less UR(z= 3.08,p= maximum pitching velocity has been (stance=70.0±6.4%, stride =70.3± 0.002,ES=0.26) and ER(z= 2.33,p= previously reported, however, the 6.9%), posteromedial reach (stance= 0.020,ES=0.21), greater ELE(z=3.93, relationship between stride leg 87.8±8.1%, stride= 90.2±8.2%), p<0.001,ES=0.31) and RET(z= postural control and pitching velocity posterolateral reach (stance= -3.858,p< 0.001,ES=-0.26), but no has not been previously examined. 84.9±9.2%, stride =84.9± 9.2%), and differences in PT(z=1.38,p=0.17). Objective: To determine the maximum pitching velocity (39.6±1.7 Moderator variable analysis showed relationship between lower extremity m/s). There were no significant significant differences in PLANE, static and dynamic postural control and correlations between pitch velocity ARM and POP. In the frontal PLANE baseball maximum pitching velocity. and COP velocity in the stride leg (EO: SAIS subjects showed greater PT(z= Design: Descriptive study. Setting: r=0.22, p=0.45 EC: r=0.27, p=0.34) -3.04,p=0.002,ES=-0.38) and ER(z= Laboratory and field settings. Patients or the stance leg (EO: r=0.10, p=0.73, -2.11,p= 0.035,ES=-0.26) and in the or Other Participants: Fifteen EC: r=0.08, p=0.78). There were also scapular PLANE SAIS patients showed NCAA Division I college baseball no significant correlations between less UR(z=4.12, p<0.001,ES=0.47) pitchers (Age=19.8±1.2 years, maximum pitch velocity and anterior and ER(z=2.68,p= 0.007,ES=0.39) height=191.3±5.0 cm, mass=90.1±5.1 reach (stride: r=-0.20, p=0.50, stance: than controls. SAIS patients showed kg) participated. Interventions: Static r=-0.10, p=0.74), posterolateral reach less UR(z=3.36,p= 0.001,ES=0.50) at postural control was assessed in the (stride: r=-0.02, p=0.95 stance: r= low ARM, and greater ELE(z= 4.03,p< laboratory with three 15-second trials -0.14, p=0.62) or posteromedial reach 0.001,ES=0.46) and RET(z=-3.853, of single leg balance on a force plate (stride: r=0.18, p=0.54 stance: r=0.01, p<0.001,ES=-0.30) at high ARM. In during both eyes opened (EO) and p=0.96). Conclusions: No significant the SAIS group, athletes and overhead closed (EC) conditions. Dynamic relationships existed between static or workers showed less UR(z=3.99,p< postural control was measured with dynamic postural control measures 0.001,ES=0.70), athletes showed three trials of the star excursion and maximum baseball pitch velocity. greater PT(z=-3.37,p=0.001,ES= balance test (SEBT) in the anterior, This is in contrast to previous -0.66), and overhead workers showed posterolateral, and posteromedial literature reporting a significant less PT(z=3.51,p<0.001,ES=0.83) and directions. All postural control correlation between static postural ER(z=3.59, p< 0.001,ES=1.05) than measures were performed bilaterally. control on the stance leg and controls. Conclusions: SAIS patients The average of three trials for each maximum pitching velocity. The displayed overall decreased UR and postural control measure was used for difference between these results may ER, increased ELE and RET. SAIS analysis. Pitching velocity was be due to the pitch velocity patients have less UR at low ARM and recorded with a radar gun during measurements being gathered during greater clavicular motion during intercollegiate games. For each games in our study as compared to sagittal PLANE while elevation in the subject, the average velocity of their laboratory simulations in previous frontal plane showed differences in three fastest pitches during their first research. scapular motion. In sagittal and home game pitching participation was scapular PLANE, there was increased used for analysis. Pearson product

Journal of Athletic Training S-133 11032FOMU Comparison Of Five Clinical in front (56.7°±9.0°), half-kneeling maneuver (ADIM). However, it is Measures Of Thoracic Spine rotation bar behind back (52.4° unknown how well individuals with Rotation Range Of Motion In ±10.6°), half-kneeling rotation bar in recurrent LBP activate the TrA during Healthy Adults front (62.8°±10.4°), and a lumbar- a stabilization LBP exercise Grindstaff TL, Johnson KD, Kim locked unilateral extension in a progression. Objective: To compare KM, Yu BK, Hertel J, Saliba S: quadruped position (42.5°±13.2°). TrA activation during a side bridge Creighton University, Omaha, NE, Correlation coefficients for measures exercise progression in recurrent LBP and University of Virginia, in seated and half-kneeling positions (rLBP) participants and healthy Charlottesville, VA (both bar in front and back) were all controls. Design: Case-control. strong (r= .75 to .90, P < .001), while Setting: Laboratory. Patients or Context: A variety of reliable the lumbar-locked unilateral extension Other Participants: Twenty-three measurement techniques exist to technique had weak to moderate subjects with rLBP (M=8, F=15, Age: quantify thoracic spine rotation range correlations (r= .20 to .32, P = .03 to 24.0±5.4 years; Height: 171.1±10.6 of motion (ROM). It is unknown if .25) when compared to all seated and cm; Mass: 71.6±12.8 kg; Oswestry these techniques provide related half-kneeling positions (both bar in Score: 17.6±11.9%) and 24 healthy information, thus reducing the need front and back). Conclusions: controls (M=2, F=22, Age: 21.0±1.3 for multiple measurement techniques. Thoracic spine rotation ROM values years; Height: 169.7±8.2 cm; Mass: Objective: To examine the obtained in this study were similar to 68.0±9.3 kg) volunteered. At the time relationship between five clinical previously reported values. The strong of testing, those in the rLBP group measures of thoracic spine rotation correlations for the seated and half- were not experiencing current pain. range of motion (ROM). Design: kneeling techniques (both bar in front Interventions: All subjects performed Descriptive laboratory study. Setting: and back) suggest these positions may the ADIM and side bridge exercises Laboratory. Patients or Other provide similar information, while the with clinician feedback using verbal Participants: Forty-six healthy adults lumbar-locked unilateral extension cueing to ensure proper contraction (15 male, 31 female; age= 23.6 ± 4.3 technique provides information which techniques. Each participant per- years; height= 171.0 ± 9.6 cm; mass= is distinctly different from the other formed the side bridge exercise with 71.4 ± 16.7 kg). Intervention(s): four methods. When measuring ADIM in a progression of 5 levels Thoracic spine rotation ROM was thoracic spine ROM clinicians and while 3 ultrasound (US) images were measured using five measurement researchers should consider utilizing taken when the subject was in full techniques; seated rotation bar behind any one of the seated or half-kneeling contraction at the end of each exercise. back, seated rotation bar in front, half- techniques in conjunction with the Each exercise level was more kneeling rotation bar behind back, half- lumbar-locked unilateral extension challenging and subjects were only kneeling rotation bar in front, and a technique. progressed if they successfully lumbar-locked unilateral extension in completed the previous level. Main 11035MOTE a hands and knees position, sitting on Outcome Measures: The thickness of Transversus Abdominis Activation heels. Measurements were obtained by the TrA was measured in the rested and During Side Bridge Exercises In a single examiner and testing order and contracted states at each level to find People With Recurrent Low Back side were counterbalanced using a the activation ratio (TrA contracted/TrA Pain And Healthy Controls Latin-square design. A standard 8-inch rest). TrA thickness was measured Himes M, Selkow NM, Hart JM, goniometer was used for both seated from superior fascial border to inferior Saliba S: University of Virginia, and half-kneeling measurements and a fascial border. Separate ANCOVAs Charlottesville VA bubble inclinometer was used for the were used to analyze TrA activation lumbar-locked position. Main ratio differences between the groups Outcome Measures: Each technique Context: Low back pain (LBP) is a at each level and within each level was performed three times per side, debilitating condition with a high rate using the lowest level of the with the average between the right and of recurrence. Dysfunciton of the comparison as the covariate. Results: left sides used for data analysis. transversus abdominis (TrA) has been There were no differences in the TrA Pearson product-moment correlation implicated as part of the cause of LBP activation ratio between groups at each coefficients were calculated to recurrence. In people who suffer from level (rLBP vs healthy); Level 1: examine relationship between the five recurrent LBP, deficiencies in the TrA 1.64±.52 vs 1.57±.40 (p=.76); level 2: measures of thoracic spine ROM. have been reported, even in the 1.68±.70 vs 1.52±.63 (p=.40); level 3: Results: Means and standard absence of pain. LBP prevention 1.53±.55 vs 1.43±.42 (p=.88); level 4: deviations for each measurement were programs often target the TrA using 1.51±.58 vs 1.46±.49 (p=.66); level 5: as follows; seated rotation bar behind exercises such as the side bridge 1.38±.68 vs 1.24±.57 (p=.92). back (46.2°±9.1°), seated rotation bar exercise with abdominal drawing-in Conclusions: There were no

S-134 Volume 46 • Number 3 (Supplement) May 2011 11047MOTE differences between groups at any counterbalanced using a Latin-square Effects Of Side-Lying Sling-Based level indicating both the rLBP and design. Testing was conducted over Bridging Exercise On Transverse healthy participants were able to two days 48-72 hours apart. During Abdominis Activation In contract the TrA with verbal cueing Day 1, two examiners each obtained Individuals With And Without during a side bridge exercise two sets of measurements (Session 1 Recurrent Low Back Pain progression. Verbal cueing with one- & 2) to determine the within session Starliper M, Harrison BC, Selkow on-one instruction may be enough to intertester reliability and the within day NM, Saliba S, Weltman A, Grindstaff allow rLBP patients to perform side intratester reliability. During Day 2, TL: University of Virginia, bridge exercises with ADIM correctly one examiner obtained measurements Charlottesville VA, and Creighton with proper contraction of the TrA. (Session 3) to determine the intratester University, Omaha, NE Therefore, the side bridge progression reliability between days. Main may be used to facilitate exercise of Outcome Measures: Each technique Context: Individuals with recurrent the TrA in rLBP patients as part of a was performed three times per side, low back pain (rLBP) experience stabilization program. with the overall average between sides dysfunction of the local stabilizing used for data analysis. Reliability was muscles of the trunk, such as the 11037MOMU determined using an intraclass transverse abdominis (TrA). Sling- Reliability Of Thoracic Spine correlation coefficient (ICC) and based (SB) exercise has been shown Rotation Range Of Motion associated confidence intervals (95% to activate the TrA in simple bridging Measurements In Healthy Adults CI). Calculations were also made for positions, but the effect during more Johnson KD, Kim KM, Yu BK, Saliba the standard error of measurement complex exercises has not been S, Grindstaff TL: University of (SEM) and minimal detectable change examined. The SB system is a system Virginia, Charlottesville, VA, and (MDC). Results: Mean ROMs and of ropes and slings that supports the Creighton University, Omaha, NE standard deviations for each technique limbs and/or pelvis during exercise to were as follows; seated rotation bar provide an unstable environment with Context: The reliability of clinical behind back (41.6°±8.7°), seated the distal extremity in a weight bearing measurement techniques to quantify rotation bar in front (55.4°±9.2°), half- position. Objective: To identify thoracic spine rotation range of motion kneeling rotation bar behind back differences in TrA activation during a (ROM) has not been previously (48.2°±10.7°), half-kneeling rotation SB side-bridge exercise progression evaluated. Objective: To determine bar in front (60.6°±10.8°), and lumbar- between individuals with and without the intratester and intertester locked rotation (40.8°±10.9°). The rLBP. Design: Case control, reliability of five variations of thoracic within session intertester ICC values descriptive laboratory study. Setting: rotation measurements. Design: for all techniques ranged from 0.85- Laboratory. Patients or Other Descriptive laboratory study. Setting: 0.94. The SEM ranged from 1.03°- Participants: 45 subjects [21 Laboratory. Patients or Other 2.25° and the MDC ranged from subjects with rLBP (age 24.0±5.4yrs, Participants: Forty-six healthy adults 2.84°-6.25°. The within day intratester height 171.1±10.6cm, weight 71.6± (15 male, 31 female; age= 23.6 ± 4.3 ICC values for all techniques ranged 12.8kg) and 24 healthy subjects (age years; height= 171.0 ± 9.6 cm; mass= from 0.86-0.95. The SEM ranged from 21.0±1.3yrs, height 162.5 ±8.1cm, 71.4 ± 16.7 kg) with no spine, rib, hip, 0.76°-2.12° and the MDC ranged from weight 67.8±9.2kg)] participated. knee, or shoulder pathology within the 2.10°-5.89°. The between day Intervention(s): Baseline measures last 6 months. Intervention(s): intratester ICC values for all of TrA thickness were obtained using Thoracic rotation ROM was measured techniques ranged from 0.84-0.91. real-time ultrasound during an using 5 techniques; seated rotation bar The SEM ranged from 1.39°-2.00° and abdominal drawing-in maneuver behind back, seated rotation bar in the MDC ranged from 3.85°-5.55°. (ADIM) prior to initiating the sling- front, half-kneeling rotation bar behind Conclusions: Thoracic spine rotation exercises. TrA thickness was measured back, half-kneeling rotation bar in ROM values obtained in this study as the distance between the superior front, and lumbar-locked rotation in a were similar to previously reported edge of the deep fascial line and the quadruped position while sitting on values. All techniques had good inferior edge of the superior fascial heels. Measurements for seated and intratester and intertester reliability line. Subjects performed a five-level half-kneeling techniques were taken and low measurement error. Therefore progression of side-lying SB bridging using a standard 8-inch goniometer, the techniques described can be used exercises on their left side following and a bubble inclinometer was utilized to document changes in thoracic spine multiple practice repetitions with for the lumbar-locked technique. All rotation in a clinical setting. elastic assistance to become proficient measurements were obtained in the movement. Images were taken bilaterally, and testing order between of the right TrA prior to bridging and sides, techniques, and clinicians were during bridging. Main Outcome

Journal of Athletic Training S-135 Measures: The dependent variables commonly used to perform a p=0.127). There was no group x were the activation ratio of the TrA maximum voluntary isometric position interaction (F3,84=0.258; (contracted thickness (mm)/resting contraction. Design: One-between p=0.856). Conclusions: It does not thickness (mm)) at baseline and at each (sex), one-within (position) repeated appear that sex influences the exercise level. Independent t-tests measures. Setting: Controlled activation of the upper trapezius during were used to compare TrA activation laboratory setting. Patients or Other manual muscle testing as males and between groups at baseline and at each Participants: Fifteen healthy, females elicited similar levels of progression level. Results: TrA recreationally active females muscle activation. The ABHD position activation ratio was not different (20.0±1.81yrs, 163.75±6.66cm, 63.8 was found to elicit the greatest level between groups during the ADIM ± 9.65kg) and 15 healthy, recreation- of upper trapezius activation. The two (Healthy: 1.50 ± 0.42, rLBP: 1.54 ± ally active males (21.1± 1.53yrs, positions involving shoulder abduction 0.97, p=0.86), nor at any exercise 178.17±5.58cm, 79.07± 12.38kg). elicited greater upper trapezius level: Level 1 (Healthy: 1.49 ± 0.48, Interventions: Subjects performed activation compared to the two rLBP: 1.44 ± 0.59, p=0.75), Level 2 three separate 5-second maximum positions involving shoulder elevation. (Healthy: 1.35 ± 0.59, rLBP: 1.67 ± voluntary isometric contractions for An increase in upper trapezius 0.65, p=0.09), Level 3 (Healthy: 1.44 the upper trapezius against manual activation was evident when head and ± 0.65, rLBP: 1.48 ± 0.65, p=0.86), resistance during four different neck resistance was applied to Level 4 (Healthy: 1.39 ± 0.84, rLBP: testing positions: Resisted shoulder shoulder elevation and shoulder 1.21 ± 0.77, p=0.45) or Level 5 elevation (EL), resisted shoulder abduction. Clinicians and researchers (Healthy: 1.15 ± 0.84, rLBP: 0.94 ± elevation with additional resistance to should consider these findings when 0.81, p=0.45). Conclusions: Healthy the head and neck (ELHD), resisted utilizing manual muscle testing to and LBP groups were able to activate shoulder abduction at 90° (AB), and assess upper trapezius muscle the TrA during sling-based side resisted shoulder abduction at 90° with function or normalize electro- bridging in a similar manner. Because additional resistance to the head and myography data. the side-lying SB exercises resulted in neck (ABHD). The order of position TrA activation, these exercises can be was randomized. There was a two 11190FOBI used during prevention and minute rest period between each Establishing A Reliable Method rehabilitation programs for core manual muscle testing trial. For each Of Measuring Scapular Anterior- stability in active individuals subject, the mean electromyography Posterior Tilt regardless of their LBP status. data for the upper trapezius were Scibek JS, Gatti JM, Carica CR: normalized to the peak Duquesne University; Pittsburgh, PA 11117MOMU electromyography recorded during Upper Trapezius Activation their manual muscle testing trials and Context: Electromagnetic tracking During Manual Muscle Testing: expressed as a percentage. The systems have enabled investigators to A Comparison Between The Sexes independent variables were sex (male examine tri-planar scapular kinematics Doster CM, Tucker WS, Howell D, and female) and position (EL, ELHD, in healthy and shoulder injured Rainey J: University of Central AB and ABHD). The dependent subjects. Clinically, modified digital Arkansas, Conway, AR variable was the normalized muscle inclinometers have been used to activation of the upper trapezius. Data quantify scapular upward rotation. Context: Manual muscle testing is were analyzed using a 2x4 between- However, a substantial amount of commonly used to assess muscle within factors 2-way ANOVA with information suggests that anterior- function and normalize electro- repeated measures. Level of posterior (AP) tilt is an important myography data for the upper significance was set at p<0.05 for all factor to consider when working with extremity. Numerous techniques have comparisons. Main Outcome shoulder injured patients. Objective: been proposed for optimal activation Measures: Normalized mean The purpose of our study was to test of the upper trapezius. It is unclear electromyography data for the upper the hypothesis that static which manual muscle testing position trapezius during the four testing measurements of scapular AP tilt elicits the greatest level of upper positions. Results: Statistically obtained with a newly validated digital trapezius activation. It is also unknown significant main effects existed for inclinometer, at various points of if there are differences in upper position (F3,84=24.995; p<0.001). The shoulder elevation, would produce trapezius activation between males and EL position (23.92±10.19%) elicited reliable results when measurements females within various testing significantly less muscle activation were made by multiple clinicians. positions. Objective: To compare compared to the AB position Design: Single group repeated upper trapezius muscle activation (34.29±13.43%) and the ABHD measures design. Setting: Study was between males and females during position (46.19±10.25). There was no performed in a controlled laboratory four manual muscle testing positions main effect for group (F1,28=2.472; environment. Patients or Other

S-136 Volume 46 • Number 3 (Supplement) May 2011 Participants: Twenty-four volunteers inclinometer in this manner will with the examiner identifying the most (20.42 + 1.41 years; 1.70 + 0.09 enhance our ability to affordably central portion of the iliac crests and meters; 70.92 + 13.96 kg; 12 males, quantify in-vivo scapular AP tilt in the classified the individual as having left, 12 females), free from any diagnosed clinical environment. neutral, or right tilt of the pelvis. upper extremity, neck and or back Following subjective visual ob- injury agreed to participate. All 11298MOMU servations, each examiner performed subjects underwent an evaluation to Subjective Visual Observations three blinded trials of each assessment ensure a healthy, dominant shoulder. Are Related To Palpation Meter with the PALM. Main Outcome Intervention: All data collection Measurements Of The Pelvic Measures: Percent agreement was involved the dominant shoulder in the Alignment obtained to determine the relationship scapular plane. Subjects performed Kowell SM, Hankemeier DA, Van between subjective visual observation three trials of 0o, 30o, 45o, 60o, 90o, Lunen BL, Quada EJ: Old Dominion and numeric PALM measurements for and 120o of humeral elevation in a University, Norfolk, VA each examiner. Intraclass Correlation randomized fashion. Scapular AP tilt Coefficients (ICC) were used to was measured using a modified Context: Alignment characteristics of determine inter-examiner (2,k) and digital inclinometer (r = 0.63 - the pelvis influence biomechanics at intra-examiner (3,1) reliability for 0.86). Two blinded examiners the knee and can be etiologic factors each assessment. Results: Good to obtained AP tilt measures. Main for patellofemoral pain syndrome excellent (65-95%) percent Outcome Measures: The dependent (PFPS). The reliability of these agreements were achieved for both variable was scapular AP tilt for each clinical measurements and subjective tests. Examiner one exhibited 65% humeral position. Two-way random visual observations of these agreement for APPT and 90% effects model intraclass correlation measurements must be determined. agreement for PHD. Examiner two coefficients (ICC(2,2)) were used to Objective: To examine the exhibited 80% agreement for APPT assess inter-rater reliability. Standard relationship between measures and 95% for PHD. ICC (2,k) results error of measure (SEM) was obtained from the PALpation Meter for inter-examiner reliability were quantified for each examiner by (PALM) (Performance Attainment .823 (APPT) and .777 (PHD). The humeral position. To evaluate intra- Associates; Lindstrom, MN) and PALM measures had good to excellent rater reliability, two-way mixed model subjective visual observations of static intra-examiner reliability for examiner intraclass correlation coefficients pelvic height difference (PHD) and one (APPT = .935, PHD = .832) and

(ICC(3,2)) were used. An = 0.05 was set anterior-poster pelvic tilt (APPT). In examiner two (APPT = .923 and PHD a priori. Results: Inter-rater addition, inter-examiner and intra- = .824). Conclusions: Clinicians’ reliability was determined to be good examiner reliability of the PALM subjective visual observations for the to excellent for each position of measures of pelvic height difference assessment of PHD and APPT are humeral elevation (ICC(2,2) 0 degrees = and pelvic tilt were assessed. Design: shown to have a good to excellent

0.92, 95% CI = 0.62 – 0.97; ICC(2,2) 30 Descriptive cohort study Setting: agreement with objective PALM degrees = 0.92, 95% CI = 0.82 – 0.97; Controlled laboratory setting. measurements. This finding allows

ICC(2,2) 45 degrees = 0.88, 95% CI = 0.72 – Participants: Twenty healthy, clinicians to utilize a visual assessment

0.95; ICC(2,2) 60 degrees= 0.85, 95% CI = college-aged participants (6 males, 14 with confidence when they may not

0.67 – 0.94; ICC(2,2) 90 degrees= 0.83, 95% females; 22.75±1.59 years; 171.45± have access to a PALM. For

CI = 0.60 – 0.93; ICC(2,2) 120 degrees= 11.59 cm; 73.32±16.34 kg) free of any documentation that requires an 0.85, 95% CI = 0.64 – 0.93). SEM current or past musculo-skeletal objective measure, our results show ranged from 1.59o to 2.67o and 1.44o pathologies volunteered for this study. that novice clinicians can use the to 2.59o for examiner One and Two, Intervention: Two novice examiners PALM to assess pelvic alignment in a respectively. Intra-rater repeatability performed the assessment on each consistent manner within a test of inclinometer measures for each participant in a single session. session. position were also determined to be Participants began each session by good to excellent (ICC(3,2)= 0.86 – creating a foot template to standardize 0.99, p < 0.001). Conclusions: foot placement between examiners. Utilizing a modified digital Subjective visual observation of APPT inclinometer to quantify scapular AP was made in the sagittal plane. The tilts resulted in acceptable levels of examiner marked the ASIS and PSIS, reliability. Clinically reasonable placed their finger on participant and measurement error as compared to classified the individual as having error associated with standard anterior, neutral, or posterior pelvic goniometric measures was also noted. tilt. Subjective visual observation of Use of the modified digital PHD was made in the frontal plane

Journal of Athletic Training S-137 11308DOMU Pain Intensity With Abduction Stepwise regression models explained Was Consistently Associated With disability at 48 (r2 = 0.295) and 96 Shoulder Disability During hours (r2 = 0.146) following muscle Recovery Of Induced Muscle Pain injury. Pain intensity with abduction Larkin KA, Borsa PA, Parr JJ, and internal rotation of the injured arm George SZ: University of Florida, were associated with shoulder Gainesville, FL disability (p < 0.001) at 48 hrs following injury. Pain intensity had the Context: Athletic trainers use strongest association with disability at measures of clinical pain and range of this time (r2 = 0.217). At 96 hours motion (ROM) in order to gauge the following injury, pain intensity with extent of recovery after musculo- abduction was the only variable skeletal injury. There is limited associated with shoulder disability (p evidence that documents whether ROM < 0.001). Likewise, only pain intensity or pain intensity measures are better with abduction at 48 hours was able to estimate disability after muscle predictive of shoulder disability injury. Objective: To determine if experienced at 96 hours (p = 0.008, r2 there is an association of self reported = 0.065). Conclusions: Following shoulder disability with pain intensity, muscle injury internal rotation ROM internal rotation, external rotation, and pain intensity with abduction were abduction and flexion of the shoulder associated with disability at 48 hours. joint, and if they have a significant Only pain intensity was associated with association with the disability disability at 96 hours. In addition, pain experienced following muscle injury. intensity during abduction was Design: Prospective study. Setting: predictive of disability during Controlled research laboratory. recovery, while ROM measures were Patients or Other Participants: One not. These findings suggest that hundred and twelve healthy, right hand shoulder disability following muscle dominant, participants (46 males: injury is more consistently associated age=25.39 ± 7.00, height= 178.93 ± with pain intensity during shoulder 7.01 cm, weight= 78.59 ± 14.04 kg; motion, as opposed to limitation in 66 females: age= 22.98 ± 6.11, shoulder ROM. Therefore, pain height= 164.64 ± 6.94 cm, weight = intensity should be routinely included 61.86 ± 11.67 kg).Interventions: in examination of muscle injuries and Participants completed a shoulder evaluated thoroughly throughout fatigue protocol on the external recovery. rotators of their dominant shoulder that caused muscle injury. Main Outcome Measures: Disability was assessed daily for 96 hours following injury using the validated QuickDASH questionnaire. Range of motion in abduction, internal rotation, external rotation and flexion were also evaluated daily. Pain ratings were also reported for pain experienced upon active abduction. Pain ratings for abduction were given on a 0-100 scale. A rating of 0 indicated no pain and a rating of 100 indicated worst pain imaginable. The QuickDASH served as the dependent variable in regression models, while the other examination variables were considered as independent variables. Results:

S-138 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Poster Presentations: Case Studies Monday, June 20, 2011, 1:00PM - 5:00PM, Outside Hall A, authors present 4:00PM - 5:00PM 11009FC Allergic Reaction In A Female intravenously. Despite this, she the SJS/TEN did trigger rheumatoid High School Softball Player continued to have fevers of 104-105 arthritis primarily in her knees and Blair DF, Michael CL, McGinness degrees F. The rash gradually increased ankles that causes considerable pain CJ: Wenatchee High School, in size (>35% skin involvement) which and dysfunction. Her vision has also Wenatchee, WA put the subject in the advanced deteriorated and she now requires category of Toxic Epidermal fluorometholone eye drops. It has also Background: Our subject is a sixteen- Necrolysis (TEN). The lesions were been estimated that she has a 95% year-old female softball player. She positive for staphylococcus aureus. chance of miscarrying due to the was taken to the emergency room on After consultation with specialists at reproductive system damage caused by June 17, 2009 for a possible drug a regional trauma center in Seattle, the SJS/TEN. Athletic trainers must be allergic reaction/interaction. She had Washington, she was transferred to the aware of SJS as a unique, severe been taking Lamictal for four weeks center’s burn unit on June 24, 2009, condition and refer suspected athletes for a diagnosis of a “possible mild after six days in the local hospital in quickly to appropriate medical bipolar disorder” and Cefadroxil for Wenatchee. Upon arrival in Seattle, she facilities. two weeks for an unknown condition was immediately taken to the operating causing cervical adenitis. She returned room where 1,000 sq/cm. of skin was 11050MC Bilateral Laminal Fracture Of to her pediatrician the following day debrided. Xenografts of pigskin were The Seventh Cervical Vertebrae with peeling of the lips and increasing used to cover the scalp, face, neck, In A Division One Collegiate Male macular rash involving the trunk. The chest, and forearms. She received daily Wrestler pediatrician recommended Benadryl wound care with daily xeroform and Peltier CE: Northern Illinois 50 mg t.i.d. On June 19, she returned bacitracin. Our subject was started on University, DeKalb, IL to the ER again. Now, she had nasogastric feeds due to the lesions in developed blisters and bullae on the the upper digestive tract. Following chest. She also had worsening lip the debridement and xenografts, some Background: This report outlines the lesions and mouth sores so severe she improvement was noted. After eleven identification and treatment of a was unable to drink liquids. She was days, the feeding tube was removed bilateral laminal fracture of the admitted to a local hospital in and the patient was given soft fruit and seventh cervical vertebrae in a college Wenatchee, Washington that day. The juices. On July 7, 2009, she was athlete. At the time of the injury the rash gradually progressed and she discharged and returned home. As the subject was a 19 YO male participating developed a fever of 105 degrees F. patient’s skin healed under the skin in wrestling at the collegiate level. Differential Diagnosis: Stevens- grafts, the pigskin dried up and The mechanism of injury is unknown, Johnson syndrome, Transdermal eventually fell off. Uniqueness: though the athlete reported neck Epidermal Necrolysis, viral ex- Stevens-Johnson syndrome is a rare stiffness and soreness for 2 weeks anthems, toxic shock/toxic strep condition, with a reported incidence of prior to diagnosis. He presented with syndrome, exfoliative erythroderma, about 2.6-6.1 per million people/year. pain and stiffness in the neck and upper staphylococcal scalded skin syn- There are still unanswered questions back from C-2 to T-5, with point drome, Kawasaki disease. Treatment: with this case including: Why was this tenderness over the T-4/5 and T-5/6 Diagnostics included a chest x-ray that reaction so severe to these disc spaces. Additionally, he reported was negative except for questionable medications? Was this a drug numbness, tingling and coldness of the perihilar infiltrate in the lungs. interaction or a single drug reaction? hands, and right sided scapular winging Urinalysis was negative. CBC was Why was the patient’s upper body and scapular disrythmia were noted. normal (WBC was on the high end of more dramatically affected than her Range of motion and strength for the normal, 10,000/cu.mm). Based upon lower body? Stevens-Johnson upper extremities were within normal the patient’s history of new syndrome is an immune-complex– limits and equal bilaterally. medications and physical signs/ mediated hypersensitivity disorder that Differential Diagnosis: Possible symptoms, the diagnosis of Stevens- may be caused by medications, viral injuries included cervical level disc Johnson Syndrome (SJS), a life- infections, and malignancies. herniation, compression fracture, or threatening skin disease that causes Pathologically, cell death results cervical nerve root impingement. rash, skin peeling, and sores on the causing separation of the epidermis Treatment: An MRI of the thoracic mucous membranes, was made. She from the dermis. Conclusion: Our spine was negative for fracture or disc was started on morphine, Benadryl, subject has recovered remarkably well pathology. X-rays of the cervical spine Cipro Zithromax, and Ativan with only minimal scarring. However, showed a flattening of the cervical

Journal of Athletic Training S-139 column and mild degeneration of the fracture of this type in the cervical however no vomiting was noted. By C-5/6 and C-6/7 discs. The MRI of vertebrae, and none that indicate an mid-December the athlete was the cervical spine showed a bilateral unconfirmed mechanism in a preparing to go home for winter break. laminal fracture at C-7. A follow-up collegiate athlete, or which became an Over this time frame the athlete had CT scan confirmed the non-displaced atrophic non-union. The spine little occurrence of symptoms. When bilateral laminal fracture. He was specialist indicated the only case like the athlete returned from break she placed in a soft collar for this he knew of was from a began having regular occurrence of approximately 4 weeks and prescribed professional football player in the symptoms once again. The athlete was Ultracet and Flexiril for his pain. Low 1950’s or 1960’s. Conclusions: This sent back to UHS later that week and impact aerobic exercise such as is a highly atypical injury, especially was diagnosed with lactose intolerance jogging in the rehabilitation pool and since it did not heal. Closer due to a high dairy diet. There she was stationary bike were permitted. Daily examination of the presentation of the prescribed lactase to take with any treatment for his pain included heat injury may be useful in future cervical meals/snacks that may contain dairy and the use of interferential electrical and thoracic spine evaluations. product. After four weeks of stimulation. A bone-stimulator was medication use, the lactase failed to also used in hopes of aiding the healing 11074MC relieve all accounts of nausea and process. As his pain level decreased Severe GI Dysfunction in a diarrhea. Athlete was sent back to he was allowed to return to weight Collegiate Volleyball Player UHS to see her physician whom asked room activities as long as cervical Dee AE, Butterfield TA: The her to log her food intake over the extension was avoided, but he was held University of Kentucky, Lexington, course of a week. After reviewing her out of wrestling activities. A repeat CT KY food logs, the physician diagnosed scan was ordered at 8 weeks post athlete with a poor diet due to poor diagnosis due to an improvement in his Background: A 20 year old collegiate food choices. The athlete was sent to pain and an increase in his pain-free volleyball player experiencing severe a nutritionist that spring and worked on range of motion. The repeat CT scan gastrointestinal (GI) dysfunction. The proper diet construction and vitamin showed no indication of bony healing. athlete was initially assessed in intake. After several weeks of closely The treating physician referred him on December 2009 after trying to monitored eating habits athlete was to a spine specialist at this time. Upon complete a weight-lifting session. She still experiencing symptoms. Athlete examination the spine specialist took presented having several bouts of was sent back to student health in April flexion/extension x-rays and diarrhea, nausea, and vomiting with of 2010 where the final diagnosis of determined that the most likely food consumption over the past 24 stress induced gastrointestinal mechanism of injury was hyper- hours. Temperature was recorded at disorder was presented. Athlete was extension of the cervical column 98.7 degrees, elevated pulse was given stress management techniques, which caused the spinous process of noted, and blood pressure was within re-educated on proper diet, and was set C-6 to compress the spinous process normal limits for the athlete. No other up with counseling appointments to of C-7 and transmit enough force to signs or symptoms were noted at the find better ways to cope with stress. cause the fracture. He ordered a initial onset of illness. Athlete was The athlete currently is still playing follow-up MRI to check the integrity held from participation until vomiting collegiate volleyball and has had no of the C-7/T-1 disc. That MRI showed subsided and until she was able to keep issues since April of 2010. a healthy disc and confirmed the food and water down. Differential Uniqueness: Gastrointestinal fracture. The physician decided to Diagnosis: Stomach influenza, food dysfunction is commonly induced present this case to a panel of fellow poisoning, irritable bowel syndrome, through physical stress in endurance surgeons to determine if surgery was lactose intolerance Treatment: The athletes, and affects up to 68% of an option and if the athlete could return athlete was sent to University Health runners and cyclists, with GI safely to play. The panel concluded Services (UHS) where she was symptoms typically occurring right that return to play was not possible, as diagnosed and treated for symptoms of after or during extreme workouts. he has an atrophic non-union, and that stomach flu and dehydration. Although stress-induced GI surgery would not increase the Symptoms of nausea, diarrhea, and dysfunction is uncommon in non- likelihood he could return safely. The occasional vomiting lasted endurance athletes, this case athlete is approximately one year post consistently for three days after initial demonstrates that psychological injury and some daily neck pain onset of illness and occurred several stress can induce similar symptoms continues. To avoid damage to the C- times per day with some occurrence throughout the day and night with no 7/T-1 disc, he is electing to have a during the night as well. After one causal relationship to exercise. cervical fusion done in December week of illness the athlete was still Conclusions: After four months and 2010. Uniqueness: There is very having nausea and diarrhea even with several diagnoses, the athlete is now little published data on a laminal the use of anti-diarrheal medication, asymptomatic and continuing her

S-140 Volume 46 • Number 3 (Supplement) May 2011 volleyball career. Similar to this case, evaluation revealed point tenderness region. Initially, this athlete had no many athletes present with physical over the greater trochanter, SI joint, and symptoms of disc disease, except LBP. symptoms when coming into the erector spinae musculature at L4-5, Nonsurgical treatment can lead to training room. While it is important pain at terminal trunk flexion, and (+) successful outcomes, and should be to attend to the physical disabilities straight leg raise (SLR) test. attempted before surgery is that may be impacting the athlete, it is Radiographs revealed reduced lordotic considered. In previous literature, also important to consider curve with no acute bony injury of the both nonsurgical and surgical psychological symptoms that may be pelvis, hip, or lumbar spine. She was treatments have yielded positive less evident. Increased psychological diagnosed with nonspecific return-to-play results. Conclusions: stress may lead to reduced musculoskeletal LBP, recommended Although disc herniations are rare in performance and somatization of the to follow-up in 2 weeks, and began adolescents, those affected often illness. Referral of high stress athletes core-strengthening rehabilitation. At continue participating based on pain to proper counseling to assist in 4 weeks, the athlete reported tolerance. Any adolescent patient, who understanding the psychological persisting pain that increased with presents with low back or leg pain, component of illness/injury may activity, no neural symptoms, a (-)SLR, poor posture, or motor and sensory prevent physical symptoms from and 5/5 strength of the lower deficits, must be thoroughly evaluated malingering and allow for a faster extremity. Rounded shoulder posture in order to appropriately determine course of recovery. and poor trunk control were noted. She course of treatment. The key initial was advised to continue rehabilitation steps are radiological evaluation and 11085MC and follow-up in 4 weeks. At 8 weeks, nonsurgical rehabilitation, but surgical Low Back Pain In A Female she was symptom free and returned to treatment may be essential. When Adolescent Softball Player full activity for the summer. At 20 chronic LPB is present, acute disc Kavanaugh CK, Hosey RG, Cassidy weeks post-injury, the fall season herniation must be included in the RC, Medina McKeon JM: University began and her LBP returned. She was differential diagnosis even when the of Kentucky, Lexington, KY referred to the physician. Upon patient is an unlikely candidate. physician evaluation, she reported Background: A 16-y.o. female “tingling” down her left leg, full trunk 11090MC softball catcher (ht=1.69m; mass range of motion in all directions, (-) Acute Elbow Pain In An =68kg) reported low back pain (LBP). SLR, (+) FABRE test for pain in SI Adolescent Football Player Her initial visit occurred 1 week after region, and 5/5 strength of all lower Ronan KA, Hosey R, McKeon injury. She stated that the injury extremities. She was again diagnosed PO: The University of Kentucky, occurred while she was rounding bases, with LBP, prescribed rehabilitation, Lexington, KY “mis-stepped”, and felt a pain in her low with a follow-up scheduled at 26 back. She was able to continue weeks. Upon 26-week follow-up, Background: A fourteen year-old participating in softball, and symptoms symptoms had not improved. male high school football player threw had partially resolved since the initial Consequently, she was referred to a a football during pre-game warm-ups injury. She reported no previous spine orthopaedic surgeon MR and immediately heard a loud pop. The history of back injury. No obvious imaging of the lumbosacral region athlete reported to the athletic trainer deformities or discoloration were revealed significant L4-L5 disc complaining of left elbow pain. Upon present. She was point tender over the herniation. After failure of 26 weeks evaluation, he described a sharp pain greater trochanter, sacroiliac (SI) of nonsurgical treatment, a surgical on the medial aspect of his left elbow joint, and erector spinae musculature discectomy and left hemilaminotomy and reported an 8/10 on a pain scale. on her left side. She had full range of were performed. Six weeks after The athlete reported a previous history motion of the trunk, and ipsilateral hip surgery (32 weeks post-injury), the of growth plate fracture in the and knee. Manual muscle testing athlete had 5/5 strength in all lower ipsilateral elbow 4 years prior to the revealed 5/5 strength with pain for extremities, and was allowed to begin injury. In addition, he admitted to an trunk flexion and extension, and 5/5 training in softball, with no batting. At insidious onset of left elbow pain strength throughout lower extremities. nine weeks post-op (41 weeks post- beginning 6 weeks prior to injury that The athlete denied any neural injury), she returned to full activity, had gone unreported. Clinical symptoms into her lower extremity, and was pain-free. Uniqueness: The evaluation presented extreme point and the neural screen was WNL. literature indicates that discectomies tenderness over the medial epicondyle, Differential Diagnosis: Erector in adolescents are extremely rare, immediate swelling, and a loss of spinae strain, SI dysfunction, muscle accounting for only 0.5-6.8% of active and passive elbow extension. spasm, or disc herniation. Treatment: discectomies performed in patients of Percussion and Compression tests The athlete was referred to a physician all ages. Disc herniations often were positive and valgus stress test was at 2 weeks post-injury. Physician present with low back pain at L4-L5 positive for pain, but not instability.

Journal of Athletic Training S-141 No obvious deformity or ecchymosis must be considered, overload failure ulnar deviation. Differential was present and no neurological of the growth plate during the late Diagnosis: Extensor carpi radialis symptoms existed. Initial treatment cocking or early acceleration phases tendinopathy, extensor carpi unlaris consisted of cryotherapy over the of throwing will likely occur before tendinopathy, ulnar styloid process injured area in combination with an actual ligament or tendon rupture fracture, ulnar collateral ligament immobilization. The athlete was then in adolescents. Also, this case is sprain, scapholunate dissociation, referred to a physician for further unique because the athlete had been TFCC tear. Treatment: Patient was evaluation. Differential Diagnosis: experiencing ipsilateral elbow pain initially treated with rest and ice and Humeral Bone Contusion, Ulnar that had gone unreported for 6 weeks. instructed to begin taking NSAIDs for Collateral Ligament Sprain, Medial Athletic Trainers often evaluate pain and inflammation. Patient was Epicondyle Avulsion Fracture. idiopathic pain that could possibly be referred to a sports medicine physician Treatment: Upon physician linked to previous injury or chronic when pain was not relieved by evaluation, radiographs of the athlete’s symptoms. If any and all symptoms conventional treatments; she was left elbow were ordered. The are reported in a timely manner, instructed to continue treatment and radiographs revealed an avulsion appropriate activity modifications can given a wrist splint to wear at night and fracture of the medial epicondyle of be made to possibly avoid further during any activities that elicited pain. the humerus with a 2mm displacement. injury. Conclusions: Avulsion When patient followed up with the The athlete’s elbow was immobilized fractures of the medial epicondyle are physician she reported a decrease in in a soft splint to avoid further unique injuries that must be kept in symptoms; shortly after she underwent displacement of the fragment. mind when dealing with adolescent a Bankart repair of her left shoulder. Radiographs were taken each week for athletes between the age of 9 and 14 She did not report recurrence of the first 4 weeks to evaluate the years. It is crucial for Athletic Trainers symptoms until she began a return to integrity of the avulsion fracture, to stress to young athletes and coaches sport specific activities 3 months later. check for displacement, and determine the importance of reporting injuries, In February of 2010 radiographs and a course of healing. Following the initial idiopathic pain, or potential injuries as magnetic resonance arthrogram (MR- 4 weeks the athlete’s arm was removed soon as possible in order to initiate arthrogram) were ordered by an from the splint but remained in the appropriate assessment, treatment, and orthopedic surgeon. MR-arthrogram sling for 2 additional weeks. Once out follow-up that can potentially prevent revealed a TFCC tear and partial tear of the sling, the athlete was prescribed a more complex injury. of the scapholunate ligament and the physical therapy, which began 6 weeks patient was referred to a hand surgeon post- injury. The initial 4 weeks of 11102MC for further evaluation. Bilateral physical therapy consisted of Bilateral Positive Ulnar Variance radiographs were ordered by the cryotherapy for pain control and active And Chronic Wrist Pain In A surgeon and revealed a +4mm ulnar and passive extension to correct a 55 Collegiate Softball Athlete variance bilaterally. An ulnar degree elbow extension deficit. In Quigg AS, Vesci BJ, Foster TE: shortening osteotomy procedure was addition, augmented soft tissue Boston University, Boston, MA recommended. Patient completed the mobilization techniques and passive softball season and an ulnar shortening stretching accompanied with moist Background: This case involves a 20 osteotomy with TFCC debridement heat were utilized to stimulate the year old, female collegiate softball was performed in June of 2010. Prior breakdown of dysfunctional tissue player. Pertinent past medical history to the surgery she suffered a right associated with the extension lag. includes bilateral shoulder sublux- shoulder subluxation with associated Strengthening exercises were added to ations with associated Bankart lesions, Bankart lesion; surgery to repair the the protocol at week 5 of physical both requiring surgical intervention, labrum was performed six weeks after therapy and a functional throwing and chronic wrist pain that was her wrist surgery to ensure that the progression began 12 weeks post previously unreported to the athletic patient was able to remain functional injury. The athlete is expected to training staff. The patient first reported throughout her activities of daily return to full football participation left wrist pain in September of 2009 living. During rehabilitation for her upon completion of the throwing during rehabilitation of her left right shoulder, the patient reported program and has reported no new shoulder subluxation. She stated that chronic wrist pain similar to that of her issues of elbow pain. Uniqueness: the pain had been persistent for the past contralateral wrist. With the Medial epicondyle avulsion fractures 6 months and was continuous knowledge of bilateral positive ulnar are dramatic acute injuries that throughout her activities of daily variance, an MR-arthrogram was typically occur as a result of acute living. Pain was located on the dorsal ordered and revealed a TFCC tear and valgus stress and aggressive flexor aspect of her left wrist proximal to the partial tear of the scapholunate muscle contraction. Although acute base of her fifth metacarpal and was ligament. The patient opted to continue rupture of the ulnar collateral ligament exacerbated by wrist extension and with shoulder rehabilitation and plans

S-142 Volume 46 • Number 3 (Supplement) May 2011 on competing in the 2011 softball central incisors of the mandible were was fitted with a fixed jaw protector season with the possibility of noticeably loose when palpated to his helmet to prevent additional undergoing another ulnar shortening individually. The patient had full trauma to the fracture site during sport osteotomy after the conclusion of the mandibular range of motion with participation. No specific jaw season. Currently, she is continuing moderate pain. There was an rehabilitation was performed as the with rehabilitation of her right approximately 1.5-inch, star-shaped patient had full range of motion and no shoulder Bankart repair and left wrist laceration at the location the puck temporomandibular joint dysfunction ulnar osteotomy; both of which are impacted the patient’s jaw, just 6 weeks after the injury when the showing promising signs of a full inferior to his lower lip and above his wiring was removed and again at 10 recovery and return to sport. chin. Mandibular special testing was weeks post injury for his final Uniqueness: The uniqueness of this not performed due to the urgent nature physician follow-up. Uniqueness: case stems from the patient having of the situation. The patient was Alveolar fractures account for less than congenital +4mm ulnar variance referred immediately to the 5% of all mandibular fractures. With bilaterally that elicited TFCC and emergency room for closure of the limited rehabilitation options, the scapholunate ligament tears due to the wound and additional diagnostic focus of patient care must be on demands of her sport; specifically testing. The wound was closed with nutritional considerations. The wrist hyperextension and rotation 21 sutures (8 cutaneous, 10 athletic trainer in conjunction with the during hitting. Also, the MR- subcutaneous, 3 intraoral). Diff- physician and available nutritionist or arthrogram radiology report noted erential Diagnosis: Alveolar dietician must develop a nutritional normal ulnar variance which the fracture, laceration, dental trauma, plan to promote appropriate caloric orthopedic hand surgeon concluded to mandibular fracture, maxilla fracture, intake. Conclusions: With the NCAA be incorrect after examining bilateral concussion. Treatment: A two-inch currently considering a switch to half- radiographs of her forearm and hand. fracture of the dentomandibular joint shield protection in men’s ice hockey, The discovery of positive ulnar was diagnosed via x-ray. This diagnosis this injury may become increasingly variance led to the recommendation of was further differentiated by the more common in competition. The an ulnar shortening osteotomy as maxillofacial surgeon as an alveolar patient may resume participation when opposed to TFCC repair. Con- fracture. The patient was referred to a the attending physician has determined clusions: This case highlights the maxillofacial surgeon for further that appropriate bony healing has importance of understanding the treatment and fixation of the occurred to limit the chance of further functional demands placed on a patient mandibular fracture. The patient was injury. Equipment considerations must and how the understanding of those treated by fixing the fracture in place be made to provide appropriate demands can aid in evaluation and with wiring. He also received root protection to the area upon return to treatment of athletic injuries. canals on the mandibular lateral and play. While athletes wearing helmets Furthermore, this case underlines the central incisors affected by the impact and face-masks will be more easily importance of immediate reporting of of the puck and alveolar fracture. He protected, an athlete who cannot wear symptoms to facilitate appropriate and was prescribed a soft diet and meal a helmet (soccer, basketball, field timely referral and improved recommendations were made to hockey) will likely miss more time outcomes. ensure caloric intake of 3000-3500 due to an inability to protect the kcal/day. Meals included soups, well- fracture site. In such cases, creative 11105SC cooked pasta, protein shakes, and meal thinking or equipment modifications Alveolar Mandibular Fracture replacement shakes. Care was taken may be necessary to adequately protect In A Semi-Professional Hockey to examine the ingredients of any the athlete during participation. Player: A Case Report nutritional supplement shakes so as to Bain M, Dodge T: Professional prevent accidentally ingesting a Orthopedic & Sports Physical banned substance, per league rules. Therapy, Springfield College, The patient was allowed to participate Springfield, MA in low-impact exercise including light biking, walking, and light resisted Background: An 18 year-old hockey exercises. Running and heavy player was struck in the mouth by a resistance training were restricted to slap-shot (estimated speed 85 miles prevent jaw-clenching that would per hour) from a teammate while potentially compromise the repair. defending against a power play in Eating foods that would require tearing practice. Upon initial inspection, there (sandwiches, pizza, etc) was also was no apparent dental fracture or loss disallowed. Upon the patient’s of teeth. However, the lateral and clearance to return to play, the patient

Journal of Athletic Training S-143 11111FC Radial Collateral Ligament secure the 4th and 5th phalanges to the while treatment is conservative it was Ruptures Of The 4th And 5th 3rd phalange to allow for MCPJ flexion effective and allowed the athlete to Metacarpophalangeal Joints In and extension while limiting abduction. continue to competitively compete. A Collegiate Male Cheerleader: The athlete was cleared for continued A Case Report participation while splinted, using pain 11123UC Hansen S, Burningham DS, Berry as his guide. Upon follow-up Lower Right Quadrant Pain In A DC: Weber State University, Ogden, examination, ten weeks post-injury, D1 Basketball Player UT, and Saginaw Valley State the 4th and 5th MCPJ RCLs were intact Bochicchio EB, Robbilard L, Johns University, University Center, MI and the athlete no longer complained L: Quinnipiac University, Hamden, of pain. The athlete’s range of motion CT Background: The purpose of this in MCP flexion, PIP flexion, and DIP case report is to document the extension of the 5th phalange; and, Background: An 18 year old female treatment and outcome of a complete MCP extension, PIP extension, PIP basketball athlete reported to the ATR rupture of the 5th metacarpophalangeal flexion, and DIP flexion of the 4th with lower right abdominal pain. joint (MCPJ) radial collateral phalange were severely limited (>10°), History revealed no apparent ligament (RCL) and partial rupture of as compared bilaterally. There was mechanism or previous abdominal the 4th MCPJ RCL of the left hand in a also a significant decrease in grip injuries. The athlete stated she began 23-year-old male collegiate strength of the left hand (M=11 kg) in noticing a throbbing pain (3/10) that cheerleader. During stunting practice comparison to the right (M=38.67 kg). morning and the pain had become a female cheerleader performed a stunt A rehabilitation protocol was progressively sharper and stronger (8/ where she was tossed too high in the developed to restore flexibility and 10) in the passing three hours. She air, causing her to over rotate in a back strength. The protocol consisted of stated she had no appetite that morning flip. Trying to compensate for the over targeting the extrinsic and intrinsic with some nausea, but no occurrence rotation, she came out of the tuck early muscles of the hand by: 1) passively of vomiting. Observation revealed no and subsequently landed on the 4th and flexing the IP while extending the ecchymosis or significant swelling. 5th phalanges of the left hand of a male MCP, 2) passively extending the IP Mild abdominal rigidity was noted in cheerleader as he attempted to catch while flexing the MCP, 3) the lower right quadrant along with her. The 4th and 5th phalanges individualized active flexion of the IP rebound tenderness. Palpation was hyperextended and abducted beyond while maintaining MCP extension, 4) painful distal to the umbilicus in the normal joint limitations. A popping individualized active flexion of the lower right quadrant. The pain was sensation, pain, and immediate MCP while maintaining IP extension, diffuse, and athlete stated “it felt like swelling were noted by the athlete. 5) MCP extensions off a flat surface, a deep pain.” Gross trunk movements Upon examination by the athletic 6) hook grip to fist grip exercises, and were painful with the athlete feeling trainer the following day, the athlete 7) tennis ball gripping exercises. The most relief from pain in a fetal was placed in a Plastalume® finger rehabilitation protocol was followed position. Further questioning revealed splint and referred to the team for four weeks, and produced a grip no behaviors out of the ordinary for physician for further evaluation for a strength increase to 78%. All joint this athlete or increased duration or 4th and 5th MCPJ sprain. Differential movements were restored within 8° or intensity of workouts. Due to the Diagnosis: Metacarpophalangeal better as compared bilaterally, except severity of the pain and other RCL sprain, metacarpophalangeal joint for DIP extension of the 5th digit which associated signs and symptoms, athlete dislocation/subluxation, metacarpal/ remained 25° less than the right hand. was withheld from practice and phalangeal fracture, strain, and The athlete continues to participate in referred to the team physician. contusion. Treatment: Upon competitive cheerleading without Differential Diagnosis: Appendicitis, examination by the team physician, restriction. Uniqueness: Metacarpo- Ovarian Cyst, Ectopic (Tubular) pain and swelling along the medial hand phalangeal RCL sprains are rare in Pregnancy, Internal Oblique Muscle were noted, along with decreased athletics with no known reported cases Strain. Treatment: Upon evaluation, flexion of the 4th and 5th phalanges. in cheerleading. In professional the team physician ordered diagnostic Varus stress tests revealed an empty football the incidence of any finger imaging including a CT scan with oral end-feel of the 5th MCPJ and a firm MCPJ sprain occurring is approxi- and intravenous contrast, a CBC, and a end-feel with moderate laxity of the mately 2% of all hand injuries. The urinalysis. Both the CBC and the 4th MCPJ. The physician’s diagnosis athlete maintained his practice routine urinalysis came back negative. After was a complete rupture of the 5th while wearing the Velcro buddy tape reviewing the CT images, the MD was MCPJ RCL, and a partial rupture of the device as the only means of support. able to rule out appendicitis, but 4th MCPJ RCL. The athlete was fitted Conclusion: The nature of this injury identified an abnormal growth on the with a Velcro buddy tape device to is highly uncommon in athletics, and athlete’s right ovary (7.4 x 6.1 x 5.4

S-144 Volume 46 • Number 3 (Supplement) May 2011 cm). Following further medical medical inquires becomes an integral blood tests were ordered by the inquiry of the images by adjusting part in the identification of such oncologist and established the contrast, the growth showed presence diseases that are a rarity. diagnosis of acute lymphoblastic of two calcifications, one 7 mm across leukemia. After consulting with the and the other 2 mm across, as well as 11161UC oncologist, the patient decided to fatty and non-fatty components. The Hematic Anomaly In A College begin chemotherapy immediately. The mass was identified as a benign ovarian Baseball Participant patient completed bi-phasic treatment teratoma of the dermal cyst variety Ames B, Rothbard, M, Dale A: for acute lymphoblastic leukemia, with a Gonzalez-Crussi grading of 0, Southern Connecticut State including induction therapy and post- indicating no malignant growths University, New Haven CT induction therapy. The aim of therapy present. Despite the low malignancy is to destroy as many acute risk of the cyst, a high risk of ovarian Background: We present a unique lymphoblastic leukemia cells as torsion existed; therefore the MD clinical case report involving the possible, improve the overall blood recommended immediate surgery. One seemingly benign signs and symptoms count, and eliminate the signs of the day S/P, athlete was asymptomatic and of a rare and potentially life disease for an extended period of time. opted to continue play. She agreed that threatening general medical condition Uniqueness: Only 5,400 people in the if significant signs and symptoms to an intercollegiate baseball United States were diagnosed with returned, surgery would be participant. A 19 year old male acute lymphoblastic leukemia in 2009. reconsidered. She completed the collegiate baseball pitcher (weight = It is the most common type of season without incident. The athlete 68 kg, height = 172.7 cm) presented leukemia in children under age 15 and returned home where she underwent to the athletic trainer with shortness has a peak incidence at three to four laparoscopic surgery for removal of of breath, unexplained weight loss (4.5 years of age. The risk of developing the mass. Two weeks post-surgery, the kg), loss of appetite, systemic joint rib acute lymphoblastic leukemia athlete reported no signs or symptoms pain, and palor. After the initial significantly decreases after age 15 and with appropriate healing of the portal evaluation by the athletic trainer, the considerably increases after age 45. insertion sites. She has returned for patient was immediately referred to a This case is unique because this her sophomore season with no primary care physician for further patient developed acute lymphoblastic anticipated complications. Unique- evaluation. The patient’s pre- leukemia despite his age, the absence ness: Germ cell derived-teratomas participation screening questionnaire of other non-modifiable and always occur on the ovaries in females indicated that he maintained a healthy modifiable risk factors, and lack of and the testes in males, while lifestyle and his previous medical previous personal or family medical teratomas derived from embryonal history was not significant for injuries history of cancer. This case is also cells occur anywhere throughout the to thorax or abdomen and illnesses to unique because most patients with body, with the most common being in the cardiovascular, endocrine, acute lymphoblastic leukemia remain the sacrococcygeal region. Overall, a respiratory, and nervous system. confined to bed rest and this patient teratoma constitutes a rare disease Differential Diagnosis: Lower actively participated in an NCAA with approximately 10,000 new respiratory infection, meningitis, Division II collegiate baseball season diagnoses per year worldwide; while mononucleosis, acute anemia, despite suffering from the adverse ovarian dermoid cysts have an neuroblastoma, non-Hodgkin lymph- effects of chemotherapy which incidence of approximately 8.9 in oma, and acute lymphoblastic included nausea, headaches, shortness every 100,000 women. Although this leukemia. Treatment: Based on the of breath, acid reflux, constipation, disease presented closely to initial physician examination, a battery insomnia, and joint pain. Due to appendicitis, a much more common of blood tests was obtained which frequent trips to the patient’s disease, it is important to expand one’s included an evaluation for the presence hometown in New York for differential diagnosis to be inclusive and morphology of lymphoblasts. The chemotherapy, transferring schools of any condition that may be indicated CBC results demonstrated an elevated closer to home was necessary for by common pain patterns. leukocyte count of more than 10 X 109/ logistical concerns. The patient Conclusion: Many conditions can L. Several metabolic abnormalities reports he is currently healthy, no present in the body similarly with were also present including increased longer receiving chemotherapy repetitive pain patterns. It is important serum levels of uric acid, potassium, treatments, and continues to remain for athletic trainers to continually phosphorus, calcium, and lactate physically active. Conclusions: The educate ourselves in general medical dehydrogenase. Complete morpho- patient’s white blood cells were conditions which are often overlooked logic, immunologic, and genetic malignant and immature and due to the abundance of musculo- examination of the leukemia cells were continuously multiplied and over- skeletal injuries. Knowing the positive and the patient was referred produced in his bone marrow. Without appropriate times to refer for further to an oncologist. A second battery of immediate recognition, referral, and

Journal of Athletic Training S-145 continuous treatment, these cells aspect of the tibial plateau and on evaluation because the reported would have spread to vital organs, anterioromedial femorial condyle. symptoms were diffuse and the eventually leading to death. The patient, The semimembranosus tendon was pathology and subsequent surgical athletic trainer, coaches, family, and completely torn and retracted 5 cm interventions forced the rehabilitation the oncologist closely monitored the from the tibial plateau. Edema deep program to follow a strict progressive patient’s condition and symptoms in and anteriorly to the MCL, protocol to reduce the pulls of the order to make appropriate athletic representing low grade tearing of the biceps femoris and semimem- participation changes when necessary. deep fibers, was present. An LCL, branosous tendons. Also, it is This case also serves as a professional biceps femoris, semimembranosus, uncommon for the vicryl used during reminder that not all issues in the and posterolateral corner recon- the surgery to be rejected. Finally, the athletic setting are orthopedic in nature struction was performed six days after two additional surgeries did not and the importance of early detection, incident. A post-operative rehabil- substantially hinder the rehabilitation, treatment, and management of a range itation program was initiated along as the patient was able to progress well of general medical conditions is with wound management of the throughout the remainder of the paramount. surgical incision. Four weeks s/p, he program. Conclusion: Prompt presented with increased soreness recognition and treatment of 11162UC secondary to rejection of the posterolateral reconstruction is Posterolateral Knee Pain In A subcutaneous sutures by the body. critical to reduce the incident of graft Collegiate Football Player Rehabilitation was reduced to the use failure. The literature reports that Napolitano J, Petrillo R, Rothbard of a stationary bike and sutures were reconstruction occurring within 2 M, Nelson C: Southern Connecticut removed as they surfaced. Six weeks weeks demonstrates better outcomes State University, New Haven, CT s/p, the patient underwent an I+D for then when surgery is performed after subcutaneous suture removal. Post two weeks. Background: An 18 year-old wide I+D, re-evaluation examination receiver was tackled and immediately revealed sutures in place, AROM 0- 170 reported right posterolateral knee pain, 90° of knee flexion, and normal Treatment Of A Female Division paresthesia, and loss of function in the neurovascular function. He was I Collegiate Soccer Goalkeeper lower extremity. Initial examination instructed to cover the wound until With Chronic Chest Pain revealed posterolateral instability with suture removal in two weeks. Eight Margulies KM, Norkus SA, Kosior an empty end feel with varus stress weeks s/p, I+D incision was healed and KA: Quinnipiac University, Hamden, testing. His medical history was not he was able to complete 0-135° of CT significant for injuries to the involved knee AROM. 12 weeks s/p, he knee or surrounding area. Diffe- complained of increased swelling, pain, Background: In June 2008, while rential Diagnosis: Fibular fracture, and decreased ROM resulting from an working at a summer camp a 21 year PCL tear, LCL tear, peroneal neuritis, infection. An additional I+D was old female division I soccer lateral meniscal tear, and biceps performed and he was seen by an goalkeeper began to experience femoris strain. Treatment: After the infectious disease specialist. The intermittent chest pain after exercise. initial evaluation, he was iced, placed patient was placed on a second round She had no previous history of chest in a straight leg knee immobilizer, of Keflex® and was cleared to continue pain or cardiac pathologies. The instructed to ambulate utilizing NWB with rehabilitation. 24 weeks s/p, he athlete was sent by the nursing staff to crutch gait pattern, and referred to the was fitted for a custom functional the Emergency Department. EKG, team orthopedic surgeon for further hinged knee brace and progressed to echocardiogram and chest radiographs evaluation. The physician diagnosed performing sport specific activities. were negative for abnormalities. The him with an LCL and a posterolateral The patient was cleared by the team physician suggested a follow up with corner knee injury, with normal physician and fully returned to athletic her primary care physician. After peroneal nerve functioning and ordered activities approximately 11 months meeting with her primary physician an MRI. MRI results indicated marked post surgery. His return to activity did she was advised to play as tolerated. medial and lateral soft tissue edema. not elicit any pain or apprehension. The athlete reported to pre-season and The LCL and biceps femoris tendon Uniqueness: Posterolateral corner while participating in soccer in late were torn at the attachment from the injuries are infrequent in athletics. August the athlete continued to fibular head and retracted 15 mm. Specifically, in this case, the experience intermittent chest pain. Discernible edema was present within combination of a grade III LCL sprain Upon evaluation by the staff ATC it was the fibular head of the soleus, and avulsion fractures of the fibula and noted the athlete was experiencing representing a partial tear. A small tibia from the biceps femoris and difficulty with deep breaths primarily knee joint effusion and mild semimembranosous tendons is rare. during exhalation, and was tender to contusions were seen along the medial This injury was difficult to diagnose palpation along the lateral boarders of

S-146 Volume 46 • Number 3 (Supplement) May 2011 the sternum over the articulations of overgrowth of the rib cartilage and is arm. Her chief complaint was pain in the 6th, 7th, and 8th ribs. At this time the the most common chest wall birth the right elbow during movement (9/ athlete was referred to the team defect. It affects one in 300 births and 10), stiffness and pain in the neck, and physician. Differential Diagnosis: is more common in males than pain and burning sensation down the Cardiac pathology, exercise induced females. Costochondritis is often an right shoulder and arm. She indicated asthma, intercostal muscle strain, rib overuse injury in athletes and can last lifting small objects, doing her hair, dislocation/subluxation, stress a few weeks to years before driving, showering, and answering the fracture, costochondritis. Treat- completely healed. This case is also phone was very painful. The pain and ment: Previous radiographs were unique given that there is no known dysfunction was significant from July reviewed and no abnormalities were specific mechanism and instead the 2010 to September 2010. Diff- identified. The athlete was cleared to sport and position as goalkeeper are erential diagnosis: A cervical disc play as tolerated, however due to the the irritants for the athlete. herniation, tennis elbow, facet joint level of discomfort experienced, a Conclusion: The athlete is still irritation, or scalene muscle spasm. second opinion was sought. A participating in soccer while tolerating Treatment: The MRI results cardiologist re-reviewed the EKG the intermittent chest pain. Her indicated a C5-C6 disc herniation. The which had no abnormal findings. A position as a goalkeeper combined with first assessment in October 2010 by rheumatologist ordered blood tests to the chest wall deformity constantly an ATC identified that the patient had identify any inflammatory diseases, puts pressure on the rib cage more limited cervical range of motion with and all blood work was normal. She was frequently irritating the costochondral right and left side bending, flexion, and then referred to a pulmonologist who joints. As athletic trainers it’s left rotation. Her strength in neck eliminated the possibility of asthma important to note that some cases may extension (4+/5) and left (4/5) and but did identify Pectus Excavatum and not have an immediate or rehabilitative right side bending (4+/5) were weak. costochondritis. The athlete was then solution. Chronic injuries and Myotomes for C5, C6, and T1 were referred to a pain management clinic conditions, especially when the athlete positive as well as ULTT1 , ULTT3, and to discuss cortisone injections. The has been predisposed can be frustrating distraction tests were positive. She athlete rejected this option. She was and limiting. Managing the athlete’s had diminished bicep brachii and tricep once again cleared to play as tolerated. pain becomes a day to day task, reflexes. Atrophy in the common Throughout the spring and summer she especially when the athletes sport is extensor origin of the right lateral chose not to play soccer, however did the irritant. epicondyle was noted. Treatment was participate in swimming and cycling, comprised of a mix of manual therapy despite chest discomfort. She returned 11174MC and exercise. The manual therapy to competitive soccer during the fall Manual Therapy And Therapeutic consisted of occipital release, neck of 2009 but was still experiencing Exercise For Treating Radiating traction, and myofascial release of the intermittent pain, and followed up with Neck Pain In A Woman upper trapezius muscle. The occipital a local physician who ordered a chest Amar V, Dover GC: Concordia release procedure decreases tension MRI. The MRI showed no structural University, Montreal, QC, Canada in the suboccipital muscles by damage and confirmed the diagnosis applying pressure in suboccipital of costochondritis. The athlete was Background: We are presenting the recess bilaterally to induce regional prescribed Indocin for inflammation. case of a 41 year old woman who had extension at the OA, C1, and C2 A cortisone injection was discussed a history of multiple disc herniations articulations. The myofascial release again with a therapeutic exercise along her spine. This office worker has treatment involved applying deep program for posture and scapular suffered from two lumbar disc pressure to the upper trapezius muscle stability. In the summer of 2010 the herniations and multiple surgeries nine while stretching. Initial cervical athlete saw another physician for upper years earlier. The patient first stretching included static stretching thoracic pain and was diagnosed with experienced pain and stiffness in her then after two treatments PNF mild scoliosis. Continued therapy for neck in January 2010, after moving stretching was incorporated. posture and scapular stability was heavy boxes. Over the next four Strengthening exercises started with recommended. Uniqueness: This case months, she noted an increase in pain isometric contractions using a blood is particularly unique with the athlete’s in her left arm and elbow. She started pressure cuff and advanced to isotonic predisposition to costochondritis due physical therapy treatments consisting strengthening while on her hands and to pectus excavatum and mild of cervical traction, and stretching of knees. In addition, extremity scoliosis. Both pectus excavatum and the neck muscles. The patient started strengthening using tubing was chostocondritus are not commonly to feel better around June 2010 but a performed standing while maintaining studied or researched in the athletic month later, she still experienced neck proper cervical lordosis. Superficial training community. Pectus Excavatum stiffness but the pain transferred to the heat and TENS was applied at the end is thought to be caused by an right elbow and spread down the right of treatment sessions. Intensity was

Journal of Athletic Training S-147 increased by increasing reps, further evaluation. At the hospital the asymptomatic for 6 months. resistance, or decreasing stability. athlete was provided a saline lock and Uniqueness: Documented cases of Within 3 weeks of treatment (2 underwent a complete physical idiopathic sixth cranial nerve palsy in sessions per week) the patient reported examination that revealed right eye collegiate athletes appears lacking. being able to perform activities of sixth nerve palsy. Differential Traumatic or ischemic sixth cranial daily life and work without pain. Diagnosis: Brain tumor, sinus lesion, nerve palsy in young adults is more Moreover, she had also stopped taking intracranial hemorrhage and/or common; however, these cases are the her pain medication. Uniqueness: aneurysm, internal carotid artery result of sustained head trauma, There are few clinical trials measuring stenosis, dural venous sinus increased intracranial pressure, and/or the efficacy of treatments for radiating thrombosis, Bell’s palsy, and multiple another underlying pathology affecting neck pain. Some studies have suggested sclerosis (MS). Treatment: The blood flow. In the older adult that a combination of manual therapy hospital examination consisted of a population (> 50 years of age), and therapeutic exercise would be complete neurological panel medical conditions or diseases such as effective in treating general neck pain. (unremarkable), stroke screen stroke, diabetes mellitus, and MS This case is an example of how manual (unremarkable), glycosylated hemo- increase the risk of developing sixth therapy techniques in combination with globin (criterion for the diagnosis of cranial nerve palsy. In this case, neither regular therapy can be effective in diabetes) (WNL), and a complete trauma to the head nor any other treating an injury that could otherwise blood count (WNL). The athlete was underlying pathology was evidenced. be regarded as a surgical case, placed on ketorolac tromethamine Conclusions: Sixth cranial nerve especially in this patient who has (Toradol®), 30 mg intravenous (IV) to palsy affects the lateral rectus muscle, received multiple surgeries for disc manage the pain associated with the impairing eye abduction, as well as herniations in the past. Conclusion: migraine. A series of diagnostic and causing diplopia and severe headaches Clinical trials are needed in the future neuro-imaging tests were conducted, when the cranial nerve is compressed. to evaluate the use of manual therapy including: radio-graphs, magnetic While sixth cranial nerve palsy is and therapeutic exercise for treating resonance imaging (MRI) without usually obvious (inability abduct the radiating neck pain in women. There contrast, and computed tomography eye), early recognition and appropriate is increasing peer reviewed evidence (CT) scans without contrast of the referral by an athletic trainer is to support the use of manual therapy brain; as well as a computed necessary to limit complications when in treatment of several conditions and tomography angiography (CTA) of the the palsy is the result of an underlying therefore may become an important head and neck. All of the diagnostic and pathology. In most cases, idiopathic tool in athletic training. neuro-imaging results were sixth cranial nerve palsy usually unremarkable. The athlete was resolves within two months. This case 11184UC diagnosed with idiopathic sixth cranial demonstrates that while many of the Idiopathic Sixth Cranial Nerve nerve palsy and was instructed to conditions suffered by athletes have a Palsy In A Female Collegiate follow a conservative treatment plan. specific mechanism of injury or nature Softball Player: A Case Report The athlete was given a prescription for of illness, there remain rare instances Potter TA, Berry DC: Saginaw Valley ibuprofen (Motrin®), 600 mg t.i.d. and where conditions arise spontaneously, State University, University Center, was instructed to follow-up with her or from an obscure or unknown cause MI primary care physician and a that should not be ignored; as the neurologist within a week. The athlete underlying causes could have Background: We present the case of was removed from athletic significant ramifications if left sixth cranial nerve palsy in a collegiate participation until symptoms resolved untreated. softball player. A 20-year-old healthy and received clearance from the National Collegiate Athletic family physician. One week following Association Division II female softball the initial diagnosis, a second MRI player (body mass = 66.3 kg, height = (following a (MS) protocol) was 172.7 cm) reported to the athletic conducted of the brain, and was trainer complaining of migraine unremarkable. Two months following headaches, diplopia, and blurred vision the initial onset of symptoms, the of the right eye. The athlete also migraine headaches subsided. Diplopia complained of periodic dizziness with and nerve palsy remained for an no reported mechanism of injury or additional month before being other known medical history. After an resolved. Once all symptoms had initial assessment by a staff athletic resolved the athlete was cleared for trainer was completed, the athlete was participation in softball by her transported to a local hospital for physician, and has remained

S-148 Volume 46 • Number 3 (Supplement) May 2011 11230UC Ulnar Impaction Syndrome In A of training she began feeling wrist deterioration of the TFCC, Female Collegiate Cheerleader instability. The patient ended her chondromalacia of the lunate and head Regan M, Rothbard M, Fliegelman gymnastics career but continued of the ulna, and attrition of the M: Southern Connecticut State cheerleading and international sailing. lunotriquetral interosseous ligament University, New Haven, CT, and To combat return of symptoms, an occurred. Conclusions: Due to the Quinnipiac University, Hamden, CT additional cortisone injection was rareness of this injury, clinicians must administered into the TFCC. The be aware of a patient’s medical history, Background: A 22 year-old female second injection was also identify the mechanism of injury, and presented with chronic pain over mid unsuccessful and an additional surgery be able to recognize symptoms that dorsal and ulnar aspects of the right was performed. The second surgery may include tremors in conjunction wrist with sliding sensations, consisted of a 3 mm osteotomy ulnar with ulnar wrist pain. paresthesia in 4th and 5th digits, and a shortening and realignment with a 7 subluxating lunate that could be self hole plate. Five days post-op, she 11248UC set. Pain quotient described as 4/10 reported severe neurological pain and Bilateral Knee Pain In A Division at rest, 8/10 with activity, and 7/10 developed forearm compartment 1 Field Hockey Player after activity. Physical examination syndrome secondary to post-surgical David S, Hobson S, Straub SJ: revealed palpable tenderness over the complications. Radiographs were Quinnipiac University, Hamden, CT TFCC, scapholunate, and lunotriquetral taken and she was placed in a long arm joints. ROM testing was WNL; cast with slits for swelling for 3 weeks. Background: At the end of pre-season however, after activity weakness was The orthopedic surgeon continued to camp, a 19 year old collegiate field present. She has a history of tight monitor complications and stated that hockey player complained of chronic bilateral forearm compartments, right additional surgical intervention may be pain and soreness in both knees. She wrist pain beginning at age 8 necessary to decrease pressure within had a history of intermittent knee pain accompanied by unusual snapping compartments. Additional radiographs that dated back to her youth. Two years sensations, and tremors in the R 4th and were taken at weeks 3, 6, 9, 15. prior, the athlete started to notice her 5th metacarpals starting at age 19. Following the second surgery, current signs and symptoms; at which Differential Diagnosis: Flexor and rehabilitation, and return to activity, time the athlete stopped figure skating, extensor carpi ulnaris tendinopathy, she reported increased neurological but she continued to play field hockey. TFCC tear, arthrosis, lunotriquetrial symptoms, but decreased wrist In high school her pain was diagnosed sprain, and ulnar impaction syndrome. symptoms. The second surgery did not as tendonitis and treated sympto- Treatment: The primary care decrease symptoms enough to handle matically. The athlete transferred to physician ordered an MRI that revealed the stress of intercollegiate the current institution from another a possible TFCC tear; however, results cheerleading; however, she was able to university where she had received were inconclusive. The patient was continue competing in international treatment but the condition did not referred to an orthopedic surgeon who sailing. A third surgery for hardware improve. During initial evaluation ordered radiographs which identified removal and to relieve compartment there was apparent inflammation in a positive unlar variance causing pressure is forthcoming. Uniqueness: both knees primarily along the patella compression of the TFCC and a Ulnar impaction syndrome can be tendon and VMO attachment. There chronic syndesmonic sprain. hereditary or caused by overuse. In this was palpable tenderness around the Translation between the distal ulna and case, repetitive upper-extremity loads lateral aspect of both patellae and radius compromised the joint leaving from gymnastics and cheerleading was along the tendon. ROM was full and a no room for the TFCC with ulnar an underlying cause, as well as the decrease in both flexion and extension deviation and ulnar impaction young age at which gymnastics was strength was noted. The structural syndrome was diagnosed. A cortisone started. The ulnar impaction syndrome integrity of the joints was intact. injection within the TFCC failed to was likely caused by excessive upper Conservative measures were taken to produce positive results upon extremity weight bearing to the open include: proper warm-up and returning to activity and the patient physes, causing the radial physis to stretching, pain and inflammation elected surgical intervention. Initial close before the unlar, resulting in the management, and a lower extremity surgery included distal ulnar scar positive ulnar variance and secondary strengthening program all while the tissue debridement, synovial and changes in the wrist that included athlete performed as tolerated at medial TFCC ligament resection, and deformation of the lunate, scapho- practice. The athlete was non- carpal menisectomy. Following lunate instability, scaring of the ulnar compliant with treatment and surgery and rehabilitation, the patient nerve, and syndesmonic changes. Wth continued to experience pain thus she felt a significant decrease in chronic impaction of the ulnar head was self limited in all activity for the symptoms; however, with resumption against the TFCC, progressive remainder of the season. During

Journal of Athletic Training S-149 winter break the athlete was to with isolated Hoffa’s disease without compartment and 30 mmHg in the continue with her rehabilitation and additional concomitant pathology can anterior compartment. Following 30 sought outside treatment from a expect long term improvement or minutes of roller skiing, post exercise physical therapist at home. Upon resolution of symptoms following an readings elevated to 38 mmHg in the arrival back to school and start of the arthroscopic resection. Con- lateral compartment and 60 mmHg in spring season, no improvements were clusions: Persistent patellar femoral the anterior compartment. Once the noted and the athlete was referred to syndrome / anterior knee pain requires condition was diagnosed, the accepted the team physician for further appropriate imaging to ensure proper method of treatment is fasciotomy of examination. Differential Diag- diagnosis. Patellar impingement the involved compartments. A second nosis: Chronic bilateral patella syndromes like Hoffa’s syndrome can surgical treatment option that is less femoral syndrome; patellar cause debilitating pain because of the common combines both fasciotomy tendonosis; plica quadriceps muscle large amount of sensory innervations and fasciectomy, thereby not only atrophy. Treatment: Following a of the fat pad. Arthroscopic resection dividing the restricting envelope of physical exam, the physician appears to be a good long term solution fascia, but also excising some of the recommended blood work and an MRI permitting return to normal activity. problematic tissue. After surgery the with the suspicion of patella femoral athlete was partial (50%) weight- syndrome; he also discussed 11256OC bearing for 2 weeks. During the initial cortisone injections pending results of Bilateral Lower Extremity protection phase of rehabilitation (1- the diagnostics. The athlete elected to Exertional Compartment 4 weeks following surgery) therapy receive the injections immediately; Syndrome Management In A involved knee and ankle range of this was done and provided no relief. Professional Cross Country motion as well as stationary biking An MRI was then obtained which Ski Racer: A Case Study with no resistance. Phase 2 of therapy indicated Hoffa’s Disease, im- Lacy DL, Hackett TR: Steadman involved ski-specific exercises. The pingement of the infrapatellar fat pad. Clinic, Vail, CO following weeks included functional With this diagnosis the athlete was progression including strengthening advised to continue treatment of Background: A 29-year-old male (weeks 9-16) then return to sport at rehabilitation and the possibility of professional cross country skate ski 16 weeks status post surgery. surgical intervention via arthroscopic racer with a history of bilateral lower Uniqueness: CECS is an increasing resection was discussed with her. The extremity chronic exertional problem in the realm of cross-country athlete sought out a second opinion compartment syndrome (CECS) in the skiing over the last five years. One that confirmed the diagnosis but based anterior and lateral compartments. The possible reason for this could be the on this opinion opted against surgery athlete experienced 2-3 years of technique utilized by skate skiers. because of a concern of a re- anterior and lateral lower leg pain and These athletes forcefully dorsiflex the occurrence. The athlete was pre- tightness, mostly with cross-country great toe when they push their skis scribed treatment of phonophoresis. skiing and running. The tightness from side to side, thereby activating This method was utilized for a month resulted in difficulty closing races, muscles within the anterior at which time the athlete proclaimed thereby impeding the athlete’s ability compartment. Also, ski racers train it wasn’t helping and stopped receiving to perform. Differential Diagnosis: with roller skis which are heavier in treatment. The athlete no longer Medial tibial stress syndrome, stress weight than regular skis. The widely participates in field hockey and fracture, gastrocnemius strain, accepted and relatively successful continues to experience pain even in popliteal artery entrapment, and treatment option for CECS is surgical daily living. Uniqueness: There are chronic exertional compartment intervention through fasciotomy1. In reports of Hoffa’s Disease being syndrome. Treatment: After active individuals, such as cross present in less than 1% of patients conservative measures (contrast country ski racers, decreasing the undergoing knee arthroscopy. Hoffa’s therapy, electrical stimulation, and soft incidence of revision compartment Disease is characterized by tissue modalities) failed to relieve the release surgery is of importance so inflammation, swelling, hypertrophy, athlete’s symptoms he sought further that the individuals can return to fibrosis, and/or calcifications of the guidance from a physician. In order to training with minimal setback. infra-patellar fat pad. While typically accurately diagnose CECS, intra- Fasciotomy in combination with a thought of as a chronic injury, there are compartmental pressure was obtained. partial fasciectomy may be considered reports of acute onset fat pad Pressure readings between 25-30 in order to prolong and enhance irritation. The fat pad itself is highly mmHg or higher with activity are surgical success rate2. Conclusions: innervated with free nerve endings indicative of compartment syndrome. A professional skate ski racer leaving it a likely source of anterior Pre exercise pressure intra- presented to the clinic with lower leg patellar pain. A recent retrospective compartmental readings ascertained in pain and tightness with activity. The cohort study has indicated that patients the office read 18 mmHg in the lateral orthopedic surgeon combined these

S-150 Volume 46 • Number 3 (Supplement) May 2011 subjective symptoms with objective or specific tissue testing when year recovery period. This case is pressure measurements to diagnose compared bilaterally and he did not unusual because the patient returned to and treat the athlete. Eight months post report any radicular symptoms. a high functional level in just under one surgery, the athlete has returned to Differential Diagnosis: Long year. Conclusions: Long thoracic normal training and competition with thoracic neuropathy, brachial plexus neuropathy can often present without no complications or return of lesions, posterior shoulder instability a known mechanism, and the degree of symptoms. While the incidence of Treatment: Electromyography impairment varies. This presents a CECS is rare, it is important to (EMG) studies showed decreased unique challenge when working on understand and initiate proper nerve conduction velocity, and retraining of scapular kinematics, as management when the condition does abnormal spontaneous activity of the normal force couples are altered due present. It is important for health care serratus anterior. Following a rest to the denervation of the serratus providers to be aware of the signs and period of 36 weeks, the patient was anterior. Progression into strengthen- symptoms of this syndrome as well as cleared by an orthopedic surgeon to ing exercises should not begin until available diagnostic and treatment begin strengthening under the healthy kinematics have been methods. supervision of an athletic trainer. established in order to facilitate the Initially rehabilitation focused on scapula’s role as a stable base during 11267UC retraining of the muscles that support glenohumeral motion. Each case is Long Thoracic Neuropathy In A the scapula, as the patient demon- unique in the compensatory kinematics Division 1 Collegiate Wrestler strated winging upon initiation of any and altered firing patterns and need to Hardin SN, McClelland RI, Thoens shoulder movement. Rehabilitation be addressed individually. AL: Boston University, Boston, MA was later progressed to focus on restoration of normal scapular 11269FC Background: 20 year-old male kinematics once his scapular control Cervical Spine Fracture In A collegiate wrestler (weight= 90.9 kg, had increased and he was able to High School Football Player height=188 cm) reported to the statically stabilize his scapula. He still Storvsed JR, Broglio SP, Swartz athletic training staff in November demonstrated medial border and EE: Eastern Illinois University, 2009 presenting with “dull and inferior angle winging when Charleston, IL, and University of constant” right rib pain resulting from functionally stressed, so rehabilitation Illinois, Urbana-Champaign, IL a direct blow. He was restricted from exercises were progressed to focus on participation in wrestling, but was dynamic and sport-specific strength- Background: While attempting to allowed to ride an Airdyne bike. After ening. Simultaneously, he developed make tackle, an 18 year old high one week of bike riding, he reported spasm in his right upper and middle school football player (188cm tall and that his right shoulder felt weak and trapezius and rhomboid muscles, approximately 80kg) struck an painful. His pain increased with which was treated with combination opponent with the crown of his helmet wrestling-specific movements and therapy, mechanical release and and immediately fell to the ground. lying down for long periods of time, stretching. He continued to demon- The athlete was attended to by two which resulted in difficulty sleeping. strate slight inferior angle winging with certified athletic trainers. One of the Test of function revealed severe right functional fatigue, and it was agreed athletic trainers immediately applied scapular winging of the superior angle, upon by the athletic trainer and manual cervical stabilization while the inferior angle, and entire medial border orthopedic surgeon that this may not other athletic trainer began the primary of the scapula upon initiation of improve due to the level of damage to assessment. Although the athlete was elevation through abduction and the long thoracic nerve. At this point, conscious when first attended to, he flexion. He also could not perform a 47 weeks post initial injury, a repeat reported a brief loss of consciousness. pushup due to weakness. Evaluation EMG study was performed, which He reported that he had full feeling and of active range of motion revealed showed improvement in nerve movement of both upper and lower elevation through flexion 0°-140°, conduction velocity and no longer extremities. The major complaint was elevation through abduction 0°-80°, showed abnormal spontaneous activity pain directly over the cervical spine, and exacerbation of winging with of the serratus anterior. The patient specifically the C5 and C6 spinous extension. All other passive and active was cleared by the orthopedic surgeon processes. Differential Diagnosis: measurements were within normal to begin a progressive return to Cervical strain, cervical sprain, limits. With his scapula manually wrestling, and was later able to cervical fracture, spear tackler’s spine. stabilized, he was able to complete a compete in the opening match of the Treatment: Based on the primary full range of motion of elevation season. Uniqueness: There is limited evaluation, the emergency action plan through flexion and elevation through research on treatment for this for spinal injuries was initiated and the abduction. There were no notable pathology; however, the literature that athlete was subsequently transferred to differences in glenohumeral joint play does exist discusses a two or three a full-body immobilization device and

Journal of Athletic Training S-151 transported to a local level one trauma outcomes. By following a resonance angiographies (MRAs) center for further evaluation and predetermined emergency action plan revealed bilateral inferior and treatment. Upon arrival at the along with good communication and posterior labral tears and Hill-Sachs emergency department, the athlete teamwork with emergency medical lesions. Additionally, the right received a CT scan which revealed a personnel, the athlete was successfully shoulder MRA revealed tears of the left side cervical fracture involving the transferred to the local hospital. At the middle and inferior glenohumeral inferior articulating process of C6 and present time, the athlete has been ligaments and multiple adhesions in extending into the junction of the practicing with the high school the anterior joint compartment. The lamina. The athlete was also diagnosed basketball team and expects to patient was cleared by the orthopedic with a closed head injury. The athlete compete in both basketball and track surgeon to participate as tolerated and was placed into an Aspen cervical collar and field competitions. scapular retraining rehabilitation was and admitted to the hospital for initiated by the athletic trainer. The observation. The following morning 11287SC rehabilitation goal was to decrease pain the athlete received a MRI which Successful Management Of and increase function so the patient confirmed a left C6 inferior articular Bilateral Scapular Dyskinesis: could participate throughout the process and lamina fracture with a A Clinical Case Report season. The primary focus was on re- small amount of C6-C7 joint effusion McClelland RI, Vesci BJ, Webster establishing normal kinematics of the and left posterior paraspinal edema. KA: Boston University, Boston, MA scapula bilaterally via scapular There was no MRI evidence of assistance and biofeedback exercises. ligamentous disruption. The athlete Background: This case presents a 20 Once normal kinematics were was released from the hospital on Day year old sophomore club male lacrosse restored, rehabilitation focused on 3 post injury. He remained in the hard player who reported in January 2009 strengthening the scapular stabilizers cervical collar for 4 weeks following with bilateral shoulder pain. He is a and decreasing upper trapezius the injury. An X-ray performed at 6 right-arm dominant player who activation. Picture and video were weeks post injury revealed normal reported worse pain in the right taken prior to commencing program flexion and extension views, leading shoulder, frequent instances of and five weeks into the rehabilitation the athlete to inquire about returning instability, and pain with overhead program. Subjective observation to football activities during the current activities, including playing lacrosse. demonstrated a decrease in scapular season. The neurologist cleared the The patient reported that the pain had winging, decrease in upper trapezius athlete to return to non-contact been worsening over a period of 4-5 compensation, and an increase in football activities and scheduled a CT years. He had not sought help synchronous scapulothoracic motion scan for the following week. The CT previously because until the time of with dynamic glenohumeral motion scan at 7 weeks post injury revealed evaluation he had been able to continue bilaterally. The patient reported partial, but incomplete healing of the competing. The pain was reported as substantial decreases in pain with facet fracture. The athlete continued deep and diffuse throughout the overhead activities and instances of with non-contact football activities and superior and anterior aspects of the instability. He was also able to play then received a third CT scan at week glenohumeral joint. Upon evaluation, lacrosse for the entire season. 10 post injury. The CT scan revealed the patient demonstrated general Following the end of the season, the incomplete healing and the athlete was muscular weakness and marked patient had surgery to repair the torn ruled out from returning to contact scapular dyskinesis bilaterally. The labrum in his right shoulder. He football activities for the season but dyskinesis was more pronounced in the underwent a successful post-surgery was allowed to begin basketball right shoulder, and in accordance with rehabilitation protocol emphasizing activities. Uniqueness: Unilateral previously published data, it his scapular kinematics and made a full facet fractures with a diagnosed demonstrated a predominantly Type I return to lacrosse. He reported pain concussion and loss of consciousness pattern. The left shoulder demon- in his left shoulder when playing, but are very rare in sports. Published strated a Type I/Type II pattern. Upper was able to continue competing, and epidemiology reports indicate that trapezius compensation was also upon graduation was contemplating facet fractures and dislocations are evident bilaterally with glenohumeral surgery to repair the labral tears in his most common in motor vehicle abduction. Specific tissue testing left shoulder. Uniqueness: This case accidents. Caution must be utilized revealed no abnormal findings. illustrates the important role proper when releasing an athlete with a Differential Diagnosis: labral tear, scapular biomechanics play in partially healed fracture for any non- scapular dyskinesis, rotator cuff tear, maintaining, or restoring, overall contact sports activity. Conclusions: rotator cuff tendonopathy, sub- shoulder function. The exercises Proper on-field care of an athlete with acromial impingement syndrome, included in the pre-surgery protocol a suspected spine-injury is crucial in internal impingement, capsular primarily focused on restoration of minimizing potential catastrophic tightness Treatment: Magnetic kinematics, with scapular and

S-152 Volume 46 • Number 3 (Supplement) May 2011 glenohumeral strengthening and range ing reduction, the athlete was taken to often fracture blisters occur following of motion as a secondary focus. By the athletic training room where initial posterior elbow dislocations in the focusing on restoring normal scapular strength, neurological, and circulatory absence of fractures. Conclusions: kinematics, we were able to restore assessments revealed no abnor- Fracture blisters are thought to occur normal length and tension to the malities. However, significant edema, when there is damage at the junction scapulohumeral muscles, leading to a ecchymosis, and muscle guarding was of the dermis and epidermis secondary restoration of strength and function to observed. No fracture blisters were to strains created in the skin during the a pathologic shoulder. Conclusions: noted at this time. The athlete’s arm initial high traumatic injury. The high

The scapular dyskinesis in this patient was then immobilized with a SAM® traumatic injury typically causes was likely secondary to the chronic splint, ace wrap, and sling. Crushed ice edema and swelling which, in turn, labral tears, and was addressed as such. packs were applied on the anterior, causes an increase in interstitial and However, by addressing the posterior, medial, and lateral aspect of filtration pressures. Fluid then malposition and maltracking of the the elbow for 20 minutes after accumulates at the site of dermal and patient’s scapulae there was a decrease immobilization. At a follow-up visit epidermal separation. Athletic in his pain, increases in pain-free with the physician two days post- Trainers must be aware that fracture range of motion, strength of the injury, the splint and ace wrap were blisters may occur in the presence or shoulder girdle musculature, and removed. Post-reduction radiographs absence of a fracture, but do not pose functional activity. This case were taken and were negative for much of a health risk to athletes or a illustrates that for patients who choose fractures. Four fracture blisters were significant complication for to delay surgical repair for any reason, noted on the medial aspect of the right rehabilitation if handled con- appropriate rehabilitation can serve to elbow. At this time, the physician servatively. maintain a high level of function. recommended not aspirating the blisters to prevent infection and 11295UC 11292FC following a conservative treatment Psychosomatic Induced Pathology Fracture Blisters Following A approach. This treatment consisted of in a Division I Football Athlete Posterior Elbow Dislocation: A immobilizing the athlete’s elbow with Scott JL, Waite T, Norkus S: Case Report Quinnipiac University, Hamden, CT, a Bledsoe® elbow brace set at 90° Burrer JL, Hansen PJ, Miller KC, flexion, daily use of a compression and Villanova University, Villanova, Christensen B: North Dakota State sleeve covering mid-forearm and mid- PA University, Fargo, ND brachium, and icing for 20 minutes, three times a day. The sites of the Background: A 20yo, African- Background: A 21 year old, male fracture blisters were covered with American football athlete, collegiate football athlete (ht=187.9 antibacterial cream and sterile gauze experienced syncope a month prior to cm; mass=92.9 kg), with no prior which was changed three times a day pre-season. His physician ordered a history of elbow injury, extended his until the fracture blisters had finished brain/neck MRA and MRI which were right arm while being tackled. At the draining and the skin returned to negative. The athlete was held from same time, an opposing player fell on normal (14 days post-diagnosis). The conditioning and referred to the team his left shoulder causing more force athlete underwent rehabilitation physician. An MRI, EEG, and blood on the outstretched arm. The Athletic focusing on decreasing edema and pain screening were negative and the athlete Trainer initially observed gross and restoring full ROM while the was cleared. Approximately one week deformity of the elbow joint with the fracture blisters were still present. No later, the athlete experienced ulna projecting posteriorly to the complications or infection occurred gastrointestinal discomfort and was humerus. The physician on-site during or after rehabilitation as a result referred. The physician ordered a diagnosed the injury as a posterior of the fracture blisters. The physician polypectomy and the athlete recovered elbow dislocation and immediately cleared the athlete for full athletic without incident. Team physicals were reduced the joint. Thirty-six hours activity six weeks post-injury. seventeen days later; a history of head after reduction of the dislocation, the Uniqueness: Fracture blisters trauma and abdominal pain were athlete noted four clear-fluid blisters, occurring following athletic injuries reported. No abnormalities were noted each approximately 2.25 cm in and in the absence of a fracture are rare. and he was cleared. A week later, the diameter, over the medial aspect of the Most fracture blisters occur athlete reported after practice distal humerus. At a follow-up visit concurrently with acute fractures complaining of bilateral parathesia of 48 hours later, the physician diagnosed following highly traumatic incidences the upper extremities. Cervical the blisters as fracture blisters. such as car accidents. Some authors hypertrophy was noted and he was Differential Diagnosis: Compart- report that fracture blisters occur in treated for thoracic outlet ment syndrome, friction blister, 3% of all acute fractures requiring compression. Two days later, physician ganglion cysts. Treatment: Follow- hospitalization. It is less clear how examination revealed negative

Journal of Athletic Training S-153 Spurling compression test and was diagnosed with stress/ respondence from the patient reported radiographs. He was permitted to psychosomatic induced pathology. He she saw a podiatrist and was diagnosed continue playing, and rehabilitation followed up with counseling and was with sesmoiditis. The sesmoiditis was was initiated. After initial treatment, he prescribed anti-anxiety and ADHD treated with a donut pad in the skate complained of minor bilateral tingling. medication which he chose not to take. which allowed the patient to skate with Approximately thirty minutes later, he He ceased seeing the psychiatrist but minimal pain. The patient reported returned with facial swelling and chose on-campus counseling through back for the fall semester with no complaining of burning, tingling, and the university system. He was non- change. After on-ice practice started left vision loss. He denied drug use, compliant with this but felt most in late September the patient reported dietary changes, or insect bites. comfortable with the athletic training a dramatic increase in pain. The patient Numbness and tingling spread to the staff. In consultation with the entire was referred to the team physician for left trunk and his condition quickly medical team, a “zero tolerance further evaluation. Differential deteriorated. EMS was activated, he policy,” was instituted in which any Diagnosis: Sesmoiditis, Sesmoid became argumentative, was sweating symptom return would disqualify the stress reaction, flexor haluccis longus profusely; respiration was elevated, athlete from participation. He has tendinopathy, foreign body, fat shallow, and labored. He stated he felt been symptom free since spring 2010. necrosis, ganglion cyst, inclusion cyst. throat swelling. He also complained of Uniqueness: Somatic effects as a Treatment: Physician evaluation chest pain and sustained a petit mal result of stress are unpredictable and revealed pain in the area of the seizure. He was transported to the rarely reported. Neurologic symptoms sesmoids. The patient was referred for hospital and admitted. Differential can be an indication of psychosomatic radiographs which were negative for Diagnosis: Sickle cell disease, celiac induced pathology. Conclusions: fracture. After review of the disease, epilepsy, head trauma, Chrohns Athletes may experience anxiety from radiographs and a continued increase disease, brain tumor, anaphylactic their athletic participation or from in pain, the patient was then referred shock. Treatment: EEG, MRA head/ non-athletic related events. These for MRI. MRI was negative for stress neck without contrast, duplex scan, and influences, along with situations out of reaction in the sesmoids. The MRI blood labs were unremarkable. The the control of the athletic trainer, may revealed a small, 1.5cm subcutaneous athlete was prescribed anti-seizure create an unpredictable somatic cyst. Patient then underwent medication and discharged the response. Those who present with an musculoskeletal (MSK) ultrasound to following day. He was removed from array of signs and symptoms without determine the nature of the cyst. play, but experienced another seizure- the support of diagnostic tests may Although the cyst was clearly like episode five days status-post. need referral for psychiatric visualized with MSK ultrasound it Follow up EEG, MRA, CT scan, cardiac assessment. Once diagnosed, an could not definitively be determined evaluation, and chest x-ray, were appropriate support system and care as to the type or cause. Aspiration of negative. The anti-seizure medication must be provided. The athletic trainer the fluid around the cyst confirmed it was altered. Ten days after should be prepared for creative was not infected. The patient was hospitalization, the athlete solutions. referred to a podiatrist for further experienced another episode, was evaluation and to discuss treatment transported to the ED, and discharged. 11297SC options. Due to increasing pain the Cardiac involvement was ruled out, and Inclusion Cyst In A Division 1 patient chose to have the cyst in mid-September, epilepsy was ruled Women’s Ice Hockey Athlete surgically removed. Surgery was out. In October, he was admitted to the Chadburn JL, Berry R, Pecci M: performed November 19, 2009 to hospital with vertigo; diagnostic tests Boston University, Boston, MA remove the cyst. It was confirmed to were WNL. Later that month, he be an inclusion cyst. An inclusion cyst resumed full activity. Four months Background: A nineteen year old is a closed epithelium-lined sac or after initial hospitalization, vestibular female Division I ice hockey player capsule containing a liquid or semi- testing revealed an inner ear viral presented with pain in the plantar solid substance. Post surgical infection. However, the athlete aspect of left foot/1st MTP joint during treatment was non-weight bearing for continued to experience bilateral late spring 2009. Initial findings of the three weeks to allow the incision to parathesia along the ulnar nerve athletic trainer were point tenderness heal. The patient then began a distribution as well as gastrointestinal over the sesmoids, patient also has progression to return to play as pain symptoms, which were treated bilateral pes cavus and plantarflexed and healing permitted and fully symptomatically. In March, he was first ray. No swelling, ecchymosis, or returned to hockey participation 5 admitted to the ED for blurred vision, erythema present. The patient is an weeks after surgical intervention with abnormal ocular response, vomiting, otherwise healthy college aged athlete. no complications. Uniqueness: The and left side facial pain. After The patient spent the summer of 2009 etiology of an inclusion cyst is psychiatric consultation, the athlete playing hockey in Canada. Cor- typically hard to determine. This case

S-154 Volume 46 • Number 3 (Supplement) May 2011 is unique since inclusion cysts are rare warranting recommendation for an from TCS and myelo-meningocele. in this age population, occur two times MRI. Preliminary MRI results showed The LBP and neurological defects in more often in men, do not usually a myelomeningocele cyst. The athlete the lower extremities associated with occur in the extremities and typically was referred to a myelomeningocele this condition resulted from abnormal cause a visible “bump”. Conclusions: clinic for further consult where stretching of the spinal cord. In an Sesmoiditis is a common pathology surgical removal of the cyst was adult, the signs of TCS may mimic diagnosed in athletes particularly recommended. The athlete sought a conditions such as disc herniation or those with pes cavus. A differential second opinion where a full spinal, nerve injury. Therefore, the athletic diagnosis must be included since pain pelvic, and brain MRI was performed. trainer should consider TCS when in the area of the sesmoids does not Following the second MRI, physicians evaluating a patient that complains of always correlate to sesmoiditis. In this diagnosed myelomeningocele, a idiopathic LBP, weakness and case it was a rare inclusion cyst that dermoid tumor, and Tethered Cord paresthesia in the legs. A detailed was ultimately determined to be the Syndrome (TCS). Surgery was history including information about source of pain. warranted for tethered cord release current or past history of bladder and dermoid tumor removal. Pre- incontinence must be obtained. The 11300FC operatively, a Cystometrogram physical evaluation should observe for Tethered Cord Syndrome And (CMG) demonstrated that the bladder skin abnormalities directly overlying Myelomeningocele In A never fully empties following the spinal cord (i.e. dimples or Competitive Tumbler - Collegiate urination. Manual muscle testing birthmarks). Scoliosis and leg length Cheerleader: A Case Report (MMT) of the lower extremities discrepancy should be assessed so that Plos JM, Saladino HA: Western resulted in diminished strength (4/5). early detection, immediate referral, Illinois University, Macomb, IL Post-op included an 8-day hospital and proper treatment can be provided. stay with the following restrictions: no Background: This case presents low sitting (days 1-4); no food/beverages 11309UC back pain (LBP) from an undiagnosed (days 1-6); 10 minute sitting Collegiate Volleyball Player With congenital condition in an 18-year-old increments (days 4-5); sitting as Primary Immune Deficiency: A female competitive tumbler and tolerated (days 5-6); standing/walking Case Report collegiate cheerleader. The athlete with ambulatory assistance (days 6-8); Tice M: Texas Wesleyan University, complained of intermittent pain in her standing/walking as tolerated (day 8). Fort Worth, TX lumbosacral region along with lower Discharge on day 9 included home extremity paresthesia. Pain instructions of bed rest with walking Background: Presented is a unique aggravation and increased paresthesia (10 minutes x 5 times per day) and case of an 18 year old female were reported during postural changes Tylenol for pain. One year post- collegiate volleyball player who that resulted in flexion and extension surgery, an MRI, CMG, and MMT were continues to participate in competitive of the spine, including tumbling performed. The CMG showed little to athletics after being diagnosed with moves, jarring activities, and no difference and the MMT showed a primary immune deficiency disease. prolonged seated positions. The decrease in strength of the lower The patient was diagnosed six years athlete’s medical history included extremities (3/5). At 5 months post- previously, and has no parent diagnoses of mild scoliosis, op, the athlete returned to diagnosed with primary immune incontinence since childhood, and a cheerleading with restrictions of deficiency. She has two siblings, and previous history of idiopathic LBP limited tumbling and no lifting her younger sister has also been during competition. The athlete denied activities. Return to full activity was diagnosed with the disease. Before past history of low back injury. permitted at two years post-op. being diagnosed, the patient had a Physical findings revealed a birthmark Uniqueness: Tethered Cord history of bronchitis and ear and dimple approximately 1-inch to the Syndrome is usually diagnosed at birth infections. After the diagnosis, the she right of the S1-S2 vertebrae, leg length or early infancy. The signs of TCS may has only had one episode of discrepancy (R leg = 89.4 cm, L leg = include lesions, hairy patches, hospitalization due to bronchial 91 cm) and positive tests (i.e. Kernig/ dimples, or fatty tumors on the lower spasms and pulse oximetry Brudzinski, Slump, Quadrant, Sitting back; foot and spinal deformities; monitoring. Differential Diagnosis: Root). Differential Diagnosis: Disc weakness in the legs; LBP; scoliosis; Possible diagnosis includes anemia, herniation, nerve root entrapment, and incontinence. In this case, the allergic reactions, and cystic fibrosis. sciatic nerve impingement, spon- athlete exhibited many of these signs Treatment: After diagnosis of dylosis. Treatment: The athlete as a child and throughout adolescence, primary immune deficiency disease, obtained her initial treatment from a yet she was not diagnosed with the the patient began taking natural Chiropractor where x-rays indicated an condition until adulthood. Con- supplements and natural sugars in abnormality in the lumbosacral region, clusions: In this case, LBP resulted addition to implementing dietary

Journal of Athletic Training S-155 changes to help aid in the proper common conditions. Because an activity. Differential Diagnosis: function of the immune system. When inefficient immune system is prevalent MBTI, cerebral contusion, vestibular these attempts were not successful, the in patients diagnosed with primary dysfunction, Benign Paroxysmal patient was put on a vivaglobullen immune deficiency and there are Positional Vertigo (BPPV). Treat- transdermal form of treatment. This associated side effects from the ment: An MRI revealed an ill-defined treatment consists of three needle transdermal treatment, it is important area of mildly increased flair and T2 injections that are placed in the adipose to understand this condition to signal present in the lateral right tissue, typically on the patient’s properly refer and treat patients frontaparietal area. The athlete was hypogastric region, proximal anterior accordingly. referred to a chiropractor to evaluate leg, and in the lumbar spine region. the rotated C2-C3 region for the This treatment uses a pump and tubing 11336OC possibility that cervical spine to help get the medication through the Persistent Concussion Symptoms pathology was causing the concussion- body, with the entire treatment taking In A Div. I Men’s Ice Hockey like symptoms including dizziness and roughly three to four hours. This Player vertigo. At ten weeks S/P a neurologist treatment must be repeated every two McNeil M, Fairbrother B, Straub SJ: specializing in long term concussive weeks. As a result of the treatment, the Quinnipiac University, Hamden, CT symptoms examined the athlete, patient has a variety of symptoms. reviewed the MRI and ImPACT scores, After treatments the infusion sites are Background: A 23 year old male ice and referred athlete to a vestibular often point tender and swollen as the hockey player came into the athletic specialist. While wearing frenzel medicine is dispersing throughout the training room stating he was struck on goggles, the athlete showed no body. The patient also often develops the left side of the head by an elbow spontaneous nystagmus while sitting migraines and nausea as a result of this during a game in October, 2009. He still; however, with the head rotated treatment. It is also common for the declared his hearing was “foggy,” he left, he showed right beating nystagmus patient to develop contact dermatitis was dizzy, lightheaded and felt “slow”. with headshaking and hyperventilation at the infusion sites. Uniqueness: The athlete had a history of two which lead to the diagnosis of left Primary immune deficiency causes a incidences of mild traumatic brain BPPV. BPPV can be caused by an lowered capability of fighting injury (MTBI) in December 2008 and abnormal collection of calcium infections and pathologies present February 2009. He was able to crystals within the semicircular canals; throughout the body. The lowered communicate, aware of his these crystals may be released from immune system and transdermal surroundings, and was able to recall the the saccule secondary to a concussive treatment leads the patient to feel event with full memory. Pupils were trauma. The athlete was referred for lethargic. This is a unique case because equal and reactive to light. Cranial therapy to perform the Eply maneuver despite having primary immune nerve testing was within normal limits to reposition the calcium build up and deficiency disease, this patient is able but he displayed a positive Rhomberg’s appropriate night positioning to to continue volleyball participation in sign, and also nystagmus during lateral maintain the correction. Within a week, the competitive collegiate atmosphere, eye movement. Cognitive tests were the athlete presented asymptomatic even when having to miss competition performed with little delay, and there with the Epley maneuver, but remained as a result of treatment or due to its were no signs of trouble with delayed slightly symptomatic with vertical side effects. In addition, the patient recall. He was evaluated by the team movements. He was given vestibular often misses academic commitments physician the following day and home exercises to continue for 3-4 due to the disease. Conclusion: diagnosed with a grade 1 MTBI and weeks, and permitted to start low level, Primary immune deficiency disease in restricted from activity. The athlete symptom free physical activity with this case causes nausea, migraines, and continued post-concussion testing and gradual progression to functional contact dermatitis after the was treated with pulsed ultrasound and activity. S/P twenty-two weeks, he was transdermal treatments every two anterior-posterior glides for a rotated cleared to return to non-contact weeks. Despite the disease causing an C2 vertebrate suffered during the same skating; at forty-eight weeks, he was inefficient immune system and incident. At four weeks S/P, the athlete cleared to return to play for the lethargy, the patient continues to cope presented asymptomatically. The team upcoming season. Uniqueness: BPPV with the side effects and symptoms of physician permitted a gradual return to is reported as the cause of up to 20% treatment in order to compete in physical activity. During the next 2 of all dizziness, and incidence intercollegiate athletics. As healthcare weeks, the athlete complained of mild increases with age. The maneuvers to professionals, it is important to headaches and dizziness following treat BPPV are reported to be understand the signs and symptoms longer workouts. At six weeks S/P a approximately 80% effective; however associated with primary immune neurologist diagnosed the athlete with only a reported 8% of sufferers deficiency because this condition can post concussive syndrome, and receive this effective treatment. The present with similar attributes as other instructed him to refrain from physical most common cause of BPPV in

S-156 Volume 46 • Number 3 (Supplement) May 2011 people under 50 is head injury, gondi. She was found to have an old case underscores the importance of including MTBI. Conclusions: toxoplasmosis scar with an adjacent ruling out all the possible differential Following MTBI, some athletes area of reactivation in her right eye. diagnoses when evaluating conditions. experience symptoms longer than Fortunately, the lesions in the left eye This remains a sight threatening others, and its important to monitor were located on the nasal side of the condition as the subject could have 2 these athletes on a daily basis. If optic nerve and were not infringing on or 3 recurrences by the time she symptoms persist and athlete is no the macula or temporal arcades. If the reaches her 40’s. However, with the longer responsive to treatments or lesions were nearer the macula or the proper education on the signs and progressions, BPPV should be optic nerve, a course of oral symptoms of recurrence, this should considered as a cause of vertigo or medications, pyrimethamine and be avoided. Presently, the subject does nystagmus. The athlete should be sulfadiazine or clindamycin (if allergy experience the black floaters on an referred to a vestibular specialist for to sulfa) in addition to steroids to occasional basis and only on a limited appropriate assessment and inter- suppress the inflammatory response, basis. The symptoms of toxoplas- vention. would have been started. In our mosis did not affect her play this past subject’s case, she was treated without soccer season. 11341OC oral medication and was only Ocular Problems In A Female prescribed ocular steroid (pred- High School Soccer Athlete nisolone acetate) eye drops to reduce Freed SD, Alvarez JL, McGinness the eye inflammation. In July 2010, CJ, Michael CL, Blair DF, Abbott she returned to her eye doctor and was MJ: Wenatchee High School, found to have minimal floaters and Wenatchee, WA improved vision. Uniqueness: The cause of her case is still unknown, but Background: Our subject is a is most likely from congenital origin. seventeen-year-old female soccer It is possible that the parasite was player. She was first seen by the ATC passed on congenitally during an at her high school with a complaint of acquired maternal infection where the black floaters and vision problems in organism simply crossed the placenta, her left eye in June 2010. She had and infected the fetus. The parasite constant floaters, which caused the persists in an encysted state for many blurring of vision in her left eye. The years following infection. Cats are the ATC referred her to an optometrist for primary hosts, while humans and other possible retinal pathology. After an mammals serve as intermediate hosts. ocular examination, she was also She did not have a cat, however, a referred to her family physician for family member had a cat for a few additional diagnostic laboratory tests. months when she was 8. Other possible Differential Diagnosis: Detached modes of transmitting include: eating retina, tuberculosis, toxoplasmosis, poorly washed vegetables that retinitis, infectious or autoimmune contained contaminated soil or eating retinopathy, Behcet’s disease, syphilis, undercooked meat. Most individuals histoplasmosis, toxocariasis Treat- do not show any symptoms with ment: The tests indicated positive toxoplasmosis or only show symptoms toxoplasma IgG (immunoglobulin G) later in life (ages 20-40). Conclusion 4.31 mg/dl; however, the IgM There are numerous medical (immunoglobulin M) was negative. conditions that can mimic a more The IgM is only positive with an active “routine” problem. On the surface, this infection and gradually becomes appeared to be a common condition negative while the IgG will remain associated with the retina, such as a positive when the infection is no retinal detachment. However, the longer active. Ocular physical problem was a more obscure diagnosis examination and laboratory tests of ocular toxoplasmosis. This confirmed the diagnosis of ocular condition is so rare, showing up in toxoplasmosis in the left eye. only .01% of live births. Nearly 80% Toxoplasmosis is a zoonotic infection of congenital toxoplasmosis will in humans caused by the protozoal cause retinitis, compared to less than intracellular parasite Toxoplasma 1% of acquired toxoplasmosis. This

Journal of Athletic Training S-157 Free Communications, Poster Presentations: Knee & Hip Mechanics Tuesday, June 21, 2011, 8:00AM - 11:30AM, Outside Hall A, authors present 10:30AM - 11:30AM 11008FOBI Anterior Tibiofemoral via electromagnetic position sensors investigate the combined contribution Intersegmental Forces During during 40% body weight acceptance of passive and active restraints to high- Landing Are Predicted By trials at 20 knee flexion while surface risk mechanics. Passive Restraint Mechanics EMG was collected from the medial Schmitz RJ, Sauret JJ, Shultz SJ: and lateral quadriceps and hamstrings. 11053FOMU Applied Neuromechanics Research Peak knee shear force (%Body The Effect Of Knee And Ankle Laboratory, Dept of Kinesiology, Weight) during the initial landing phase Angles On The Plantarflexion University of North Carolina at of the drop jump was calculated via Torque Of The Gastrocnemius Greensboro, Greensboro, NC inverse dynamics. To ensure that peak Landin D, Thompson MD: Louisiana tibial acceleration measures occurred State University, Baton Rouge, LA Context: Mechanical behavior of prior to muscular force generation, passive restraints may contribute to time to peak acceleration was Context: Muscle action descriptions sagittal knee plane joint stability during compared to time to muscle onset in have remained unchanged since the functional activity. Axial loading the 40%BW trials. Sex specific linear early 1900s. New technology now increases anterior displacement of the stepwise regressions determined if makes it possible to identify joint tibia relative to the femur. Resultant passive restraint characteristics positions that allow a muscle to exert acceleration at the proximal tibia can (anterior knee laxity, 0-20N anterior the greatest force, and add to the body generate anterior intersegmental of knowledge regarding musculo- stiffness, 100-130N anterior stiffness, forces that load passive knee & peak anterior tibial acceleration) skeletal dynamics. Understanding the structures. It is unclear how sagittal predicted peak anterior shear knee joint positions that are most favorable passive restraint characteristics may joint forces during landings. Results: to a muscles action would also aid contribute to high-risk landing Peak acceleration (91.0±26.2 ms) and clinicians in injury recognition and mechanics. Objective: Determine if quadriceps muscle onset (95.2±21.1 rehabilitation. Objective: To knee sagittal plane passive restraint ms) times were not significantly determine how different combinations characteristics are predictive of the different (P>0.05) while both were of knee and ankle joint positions high-risk landing mechanic of peak significantly less (P<0.05) than influence the plantarflexion moment anterior knee shear force. Design: hamstring muscle onset time of the gastrocnemius. Design: Descriptive cohort. Setting: (120.5.2±22.1 ms) with no sex main Descriptive cohort study design. Controlled laboratory. Parti- effect or interaction. In females, Setting: Clinical anatomy laboratory. cipants: Recreationally active, increasing peak tibial acceleration Participants: Twenty-six under- college-aged students (74 females, (5.1±1.8 m/s2) (R2∆=7.6%, P∆= graduate female students (age = 42males; 21.8±2.9 yr, 1.69±0.1 m, 0.017), increasing 0-20N anterior 19.3+0.9 years, mass = 54.2 +4.2 kg, 68.9±14.1 kg). Interventions: All stiffness (31.0±13.9 N/mm) (R2∆= height 165.5+5.7 cm) with no history measures were performed on the 5.5%, P”=0.038), and 100-130N of surgery or current injury to the right dominant leg (stance leg when kicking anterior stiffness (43.2±17.3 N/mm) lower extremity. Interventions: a ball). Knee passive restraint behavior (R2∆=5.3%, P∆=0.036) collectively Participants were positioned in a was assessed via joint arthrometry and greater peak knee shear forces Biodex System 3 with the right ankle during 40% body weight simulated (70.0±12.3%BW) (Multiple R2 = joint parallel to the rotational axis of weight acceptance. Electromagnetic 18.4%). No male regressions were the dynamometer. Eight knee flexion motion sensors and an instrumented significant (P>0.05). Conclusions: angles (0°, 15°, 30°, 45°, 60°, 75°, force platform assessed lower In females, sagittal plane passive 90°, 105°) were combined with three extremity landing mechanics during restraint characteristics appear to be ankle angles (dorsiflexion = -15°, 0°, the initial landing phase of double leg predictive of movement mechanics plantarflexion = +15°) creating 24 drop jumps (0.45m). Main Outcome thought to be high-risk. Specifically joint combinations in which the Measures: Anterior knee laxity (mm) greater magnitudes of tibial participants were tested in a was assessed at 133N while initial (0- acceleration during early axial load counterbalanced fashion. Knee angles 20N) and terminal (100-130 N) along with greater initial and lesser were maintained with removable casts, anterior stiffnesses (N/mm) were terminal anterior stiffnesses predicted while ankle angles were controlled by calculated from arthrometer data. increasing anterior knee shear forces. the dynamometer. At each position the Peak anterior tibial acceleration (m/ To optimize injury prevention right gastrocnemius was electrically s2) relative to the femur was assessed programs, future work should stimulated three times, at a

S-158 Volume 46 • Number 3 (Supplement) May 2011 standardized level, via surface task to specific impairments; however, performing on an unstable surface electrodes. Main Outcome current use of the SEBT involves no produced the lowest reliability in all Measure: The maximum plantar- sensory modifications. If the addition directions; however, values were still flexion moment was defined as the of sensory input modifications does acceptable for clinical application. greatest torque achieved during each not alter reliability of the SEBT, The clinical utility of the MS-SEBT is stimulation. Torque was recorded by inclusion of these conditions may in need of further investigation; the Biodex, averaged into a single improve the utility of the test in however, this investigation establishes score for each knee and ankle joint evaluating various pathologies. that the measure is reliable and stable combination, and then used in the Objective: To establish the test-retest over time in a healthy population. analysis. Data were analyzed with a 2 reliability of the Modified-Sensory factor (Knee x Ankle) within subject Star Excursion Balance Test (MS- 11075DOCE ANOVA with repeated measures. SEBT). Design: Repeated measures Serum Cartilage Oligomeric Results: Significant main effects design. Setting: Research laboratory. Matrix Protein And Patient were found for the knee (P=.001) and Participants: Nineteen healthy, young Reported Outcomes In Division I ankle (P=.001). As knee flexion adults (24.63±4.40yrs, 77.61 Soccer Athletes Over The Course increased and the ankle was ±18.90kg, 169.38± 12.77cm) parti- Of A Soccer Season plantarflexed the maximum moment cipated in this study. Participants Hoch JM, Mattacola CG, Silkman decreased. The greatest torque (25.16 reported no changes in activity level CL, Stephenson DR, Bush HM, + 7.9 Nm) was obtained with the knee or musculoskeletal injury status Lattermann C: University of at 0° and the ankle dorsiflexed -15°. throughout the duration of the Kentucky, Lexington, KY The lowest torque (12.37 + 4.7 Nm) investigation. Interventions: The MS- was obtained with the knee flexed to SEBT was administered to each Context: Serum cartilage oligomeric 105° and the ankle plantarflexed +15°. participant on two separate occasions matrix protein(sCOMP) is a Conclusions: A straight knee and with an average of 55.26 days between biomarker elicited during cartilage dorsiflexed ankle create a position in sessions. Following four practice trials degradation. Patient reported which the gastrocnemius generates the in each direction, MS-SEBT measures outcomes(PRO) are used to document greatest plantarflexion moment. in the anterior, medial, and posterior progress following injury and are not Manual muscle testing of the directions were recorded with the non- often employed prospectively to gastrocnemius should be performed in dominant limb (based on kicking identify changes in the course of a this position. Clinicians should be preference) as the stance limb. Testing season. It is unknown what affect aware that flexing the knee beyond 600 was completed under four conditions: intense, continuous physical activity significantly decreases torque stable surface-eyes open (SO), stable has on sCOMP levels and PRO values production. Furthermore, the ankle surface-eyes closed (SC), unstable in un-injured elite athletes. Objective: should be dorsiflexed during surface-eyes open (UO), and unstable To document the course of sCOMP gastrocnemius testing for the surface-eyes closed (UC). Main levels, and to determine if changes in plantarflexion torque drops Outcome Measures: Intra-class PROs occur in elite, soccer athletes significantly at 0° and +15°. correlation coefficients [ICC(2,1)] at three distinct time points during a were calculated using mean season. Design: Prospective, 11056DONE performance for reach direction by longitudinal cohort study. Setting: Reliability Of The Modified- condition to evaluate test-retest Athletic training facility. Patients or Sensory Star Excursion Balance reliability. Results: High reliabilities Other Participants: Thirty-one Test were noted for the anterior reach Division-I soccer athletes (19 males, Sabin MJ, Leal EW, Gordon JR, direction: SO=0.97, SC=0.97, 12 females, age:19.53+1.16years, Sosnoff JJ, Broglio SP: University UO=0.95, UC=0.94; medial reach height:176.91+7.24cm, of Illinois at Urbana-Champaign, direction: SO=0.96, SC=0.95, weight:73.22+9.73kg) participated in Neurotrauma Research Laboratory, UO=0.93, UC=0.90; and posterior three (pre-season(T1), mid-season(T2), Urbana-Champaign, IL reach direction: SO=0.93, SC=0.88, and post-season(T3)) data collection UO=0.95, UC=0.78. Conclusions: sessions. Subjects were included if Context: The Star Excursion Balance Mean reach distance during the MS- they participated in the 2010 spring Test (SEBT) is a measure of postural SEBT was reliable during test-retest soccer season and were free of severe control utilized in the assessment of measures separated by approximately knee injury at time of data collection. balance in multiple pathologies. eight weeks. All conditions and Interventions: At each session, Modification of afferent sensory input directions boasted good to excellent patients remained seated for 30 is often implemented to increase the values, ranging between 0.78 to 0.97 minutes and completed two PROs difficulty of postural control tasks as with an average value of 0.93 (±0.05). (Lysholm, IKDC) prior to serum well as increase the sensitivity of the Eliminating visual input while collection. Following the rest period,

Journal of Athletic Training S-159 10cc of serum was collected from the microtraumatic injury was not Scoring System (BESS) single-limb antecubital vein, placed on ice and identifiable in PRO scores on the stance on a firm surface for each limb. transported to the laboratory. Sera was Lysholm and IKDC. The number of errors incurred during separated, and placed in a -80ˆC each trial were tallied and totaled for freezer prior to analysis. Once all 11086DOIN a comprehensive BESS score. Main samples were collected, ELISA tests The Role Of Sex In Physical Self- Outcome Measures: The dependent were run (Euro-Diagnostica, ALPCO, Efficacy And Balance Among High variables were scores on the PSE and Salem,NH) for human sCOMP. Serum School Basketball Players BESS. Data were not normally COMP values are expressed as ng/mL. Silkman CS, Medina McKeon JM: distributed; therefore, sex differences Independent variables included time University of Kentucky, Lexington, for the PSE and the BESS were and gender. Main Outcome KY analyzed using the Mann-Whitney U Measures: Serum COMP values and test. Bivariate Spearman’s rho PRO scores for each time point were Context: Self-efficacy is the concept correlations were performed to the dependent variables, investigated that an individual’s measure of self- examine the relationship between the over time by using separate linear confidence, during a given situation PSE and the BESS error scores. mixed models. Paired-sample t-tests influences the effort and de- Results: The following results are were used to explain significant termination put forth in order to presented as a median [range]. Males interactions or main effects. The alpha successfully accomplish a given task. had a significantly higher PSE score was set at p<0.05. Values are presented Physical self-efficacy is the measure than females (males: 103[80 to 127]; as mean±SE. Results: There was no of an individual’s perceived physical females: 97[78 to 108]; p=0.01). gender by time interaction for capabilities. A direct relationship There was no difference between the sCOMP(p=0.43), Lysholm(p=0.76), between self-efficacy and ex- sexes for BESS and error scores and IKDC(p=0.22). For sCOMP there pectations of performance outcomes (males median score = 15.5[0 to 52], was a significant effect for gender has been established in the literature. females median score = 11[0 to 40], (Males:1682.86±45.86, Limited evidence exists in regards to p=0.20). There was a weak, Females:1502.82±56.30, p=0.02) and the examination of sex differences in nonsignificant relationship (r=-0.17, time (p=0.001). The significant physical self-efficacy in high school p=0.21) between BESS error scores differences occurred between time athletes. In addition, to our knowledge, and PSE scores. Conclusions: there is no data as to how physical self- points T1(1462.81±35.51) - T2 (1698.94 Previous research has demonstrated efficacy relates to the performance of ±50.68, p=0.001) and T1 (1462.81 that physical self-efficacy is directly functional postural control. Ob- ±35.51) - T3(1616.78 ±49.54, p= related to physical performance in jective: To examine sex differences in 0.0018), but not for T2(1698.94 ±50.68) accuracy, endurance, and performance physical self-efficacy expectations - T3(1616.78 ±49.54, p=0.07). For to physical tasks. In contrast, the each of the PROs there was no and to determine the relationship results of this study indicate that significant effect for gender (Lysholm between physical self-efficacy and a physical self-efficacy expectations as p=0.11, IKDC p=0.71), however there clinical measure of functional postural measured by the PSE do not relate to was a significant effect of time control. Design: Prospective cohort postural control as measured by the (Lysholm p=0.01, IKDC p=0.04). Post- study. Setting: Field testing. Patients BESS. The PSE may represent a more hoc tests for the Lysholm indicated there or Other Participants: Fifty-seven global perspective of physical self- were significant differences between high school basketball players (30 efficacy, and correspond to a general males, age=15 ±1.4, height=178.9 T1(92.26±1.49) – T3(95.90±1.43, level of perceived physical abilities. ±9.9 cm, mass=75.6 ±14.6 kg; 27 p=0.02) and T2(92.47±2.03)– T3(95.90 The postural control system may be ±1.43, p=0.04). For the IKDC, there females, age=15 ±1.2, height=168.1 too complex to predict through were significant differences between ±7.0 cm, mass=63.8 ±9.3) partici- physical self-efficacy expectations pating in interscholastic basketball. T2(91.29±1.72) - T3(94.47 ±1.32, alone. p=0.03). Conclusions: These data Interventions: Each participant indicate sCOMP values increase over completed the Physical Self-Efficacy the duration of an athletic season and scale (PSE). The PSE is a 22-item the PROs indicate an increased level Likert scale questionnaire with of function over time. Therefore, the possible scores ranging from 22 to effects of continuous, intense physical 132, with higher scores indicating activity resulted in cartilage higher level of self-efficacy. Each degradation identified as increased participant then completed 3 20- levels of sCOMP, however this second trials of the Balance Error

S-160 Volume 46 • Number 3 (Supplement) May 2011 11096FOBI Eight-Weeks Of Abdominal to analyze mean and peak VGRF over could be used to monitor rehabilitation Training Reduces Vertical time. Post-hoc testing with a progress. Thus, the Wii Fit could be Ground Reaction Forces During Bonferonni correction determined an effective and cost effective tool to A Landing Task differences between and within groups. assess and monitor changes in balance Gage MJ, Hopkins JT, Draper DD, The p-value was set at 0.05 a priori. ability. However, the validity and Hunter I, Feland JB, Myrer JW, Results: Peak and mean VGRF (N) reliability of Wii Fit balance scores Sudweeks RR, Seeley MK: Indiana were measured pre- (Peak: Control – remains unknown. Objective: To test State University, Terre Haute, IN, 2216.0 ± 418.6: CAI -2459.6 ± 430.8: the criterion and construct validity as and Brigham Young University, Healthy -2085.9 ± 534.1; Mean: well as the intrasession and Provo, UT Control –1171.8 ± 252.6: CAI - intersession reliability of Wii Fit 1275.9 ± 257.7: Healthy - 1122.0 ± balance scores. Design: Test-retest Context: Peak vertical ground 309.3) and post-training (Peak: study design. Setting: Controlled, reaction forces (VGRF) are greater in Control – 2217.5 ± 436.0: CAI - laboratory setting. Participants: chronic ankle instability (CAI) 2286.1 ± 583.3: Healthy -2039.7 ± Forty-five subjects, 22 controls subjects than able-bodied subjects 473.5; Mean: Control – 1149.6 ± (26.2±9.2yrs, 154.9±21.4cm, 66.5± during landing. CAI may alter trunk 265.6: CAI -1197.8 ± 321.5: Healthy 3.3kg) and 23 with a history of lower control, thus forcing the body to -1124.2 ± 294.1). A difference in peak extremity injury (27.8±10.4yrs, compensate for the increased vertical VGRF was observed between the CAI 163.5± 29.7cm, 68.0±3.8kg) partici- loads placed on the lower extremity. and healthy groups prior to training pated. Interventions: Each subject Improved postural control has been (CAIe•Healthy; p=0.03). The CAI completed three traditional balance observed following core training in group’s mean (p = 0.006) and peak tests (single-leg stance on a force healthy subjects, therefore abdominal (p=0.002) VGRF decreased after eight plate, Star Excursion Balance Test training may have a positive outcome weeks of abdominal training. No [SEBT], and the Balance Error Scoring on the CAI patient population. change in VGRF (mean: p=0.40,peak: System [BESS]) and twelve Wii Fit Objective: To determine if abdominal p=0.94) was observed in the Healthy balance activities (Basic Balance, training reduces VGRF in CAI and group following training. Con- Agility, Walking, Steadiness, Single healthy subjects during a landing task. clusions: CAI subjects had greater Leg Stance, Deep Breathing, Tree, Design: A 3 x 2 (group x time) cohort peak VGRF during a single leg drop Standing Knee, Palm Tree, Single-leg design. Setting: Biomechanics landing task than healthy subjects prior Extension, Single-Leg Twist, and laboratory. Patients or Other to training. Eight weeks of abdominal Sideways Leg Lift). Traditional balance Participants: Nineteen Control (age training can decrease the VGRF that tests and Wii Fit activities were = 22±3 yrs, mass = 74.1±13.8 kg, act on the foot and ankle. Abdominal completed during the first test session. height = 172.6±11.3 cm, BMI = training reduces vertical loading Wii Fit activities were repeated during 24.8±3.1%), 21 CAI (age = 22±2yrs, forces, which may decrease the a second test session one-week later. mass = 77.6±14.0 kg, height = likelihood of recurrent ankle sprains. Main Outcome Measures: Tradi- 175.4±12.3 cm, BMI = 25.1±2.6%), Clinicians may consider abdominal tional balance outcomes included the and 20 healthy (age = 23±3yrs, mass training as part of their patient’s ankle resultant center-of-pressure excursion = 70.9 ±15.6 kg, height = 172.2±8.9 rehabilitation program. and velocity (single-leg stance), cm, BMI = 23.7±3.3%) subjects normalized reach distance in the participated. CAI subjects self- 11129FOMU anterior, posteriomedial, and Validity And Reliability Of Wii reported ankle instability using the posteriolateral direction (SEBT), and Fit Balance Scores Ankle Instability Index and Functional number of errors during all six BESS Wikstrom EA, Wikstrom AM: Ankle Ability Measure. Inter- conditions. Wii Fit outcomes included University of North Carolina at ventions: The CAI and healthy groups the game generated scores for each of Charlotte, Charlotte, NC, and participated in an eight week the twelve tested activities. OrthoCarolina, Charlotte, NC abdominal training program while the Independent t-tests compared Wii Fit control group maintained their normal balance scores between control and activities of daily living and current Context: A growing number of health injured subjects to quantify construct fitness level. A force plate (AMTI, care professionals are using a variety validity. Correlations between Wii Fit Newton, MA) was used to measure of interactive video games to help and traditional balance outcomes VGRF during a single leg drop landing rehabilitate musculoskeletal path- quantified criterion validity. Intraclass pre- and post-training. Main Outcome ologies. The Wii Fit is purported to correlation coefficients determined Measures: The dependent variable was improve balance and rehabilitation the intra- and intersession reliability VGRF. A general linear model compliance and provides objective of Wii Fit balance scores. Results: repeated measures ANOVA was used measures of balance ability which Construct validity was not identified

Journal of Athletic Training S-161 as no Wii Fit activity identified 21.3±3.0yrs, 169.5±7.4cm, 64.8 greater anterior translation of the differences between the control and ±11.6kg). Interventions: All lateral versus medial tibia plateau injured groups (p>0.05). The Palm measures were obtained on the relative to the femur, resulting in Tree activity demonstrated the greatest dominant stance leg. Tibial slope internal rotation of the tibia; coupled sensitivity (p=0.12) to group characteristics were measured from motions known to strain the ACL. differences (Control: 69.1±12.4%, MRI images (1.5 T; voxel size 0.55 × Conversely, reduced CTS (reported to Injured: 61.5±16.0%). Overall, Wii Fit 0.55 × 1.0 mm) using MIPAV software be more common in females vs. balance scores had poor criterion (http://mipav.cit.nih.gov/). MTS and males) may couple with ATT to validity. Four significant relationships LTS (o) represented the angles between increase ACL strain during landing via were identified: Single-leg Stance (r= the perpendicular mid-diaphysis of the greater initial knee valgus alignment. -0.43, p<0.01) and Single-Leg tibia and posterior inferior inclination Acknowledgement: Funded by NIH- Extension (r=-0.32, p=0.03) to Bess of the medial and lateral tibial NIAMS #RO1-AR053172. tandem stance on foam, Sideways Leg plateaus, respectively, and the ratio Lift to BESS double-limb stance on (MTS/LTS) was calculated. CTS 11133DOMU foam (r=-0.47, p<0.01), and Single- represented the angle between a line A Reliability Study Of The Patella Leg Twist to SEBT anterior reach joining the peak points of the medial Quadrant Test And Clinical Visual (r=0.21, p=0.48). Intrasession and lateral tibial plateaus, and a line Measures Of Medial And Lateral reliability of Wii Fit balance scores perpendicular to the longitudinal axis Patella Glides ranged from 0.39 to 0.80 while of the tibia (lateral superior to medial Walter JM, McDevitt SM, Van Lunen intersession reliability ranged from tibial plateau contact = positive slope). BL: Old Dominion University, Norfolk, VA 0.29 to 0.61. Conclusions: The Test-retest reliability [ICC2,3 (SEM)] overall findings indicate that Wii Fit for MTS [0.98 (0.53o)], LTS [0.97 balance scores should not be used as a (0.41o)], and CTS [0.99 (0.18o)] was Context: Patella hypermobility has diagnostic tool monitor balance confirmed on 10 subjects. Main been linked to patellofemoral pain improvements over time. However, Outcome Measures: Subjects were syndrome. Since there are currently no Wii Fit activities can still be used as a instrumented for biomechanical inexpensive, easy to use clinical tools fun and innovative tool in the analysis during a double leg drop jump to assess patella mobility, clinicians rehabilitation process. landing (0.45m). Knee valgus and often rely on visual inspection to internal rotation angles at initial assess patella movement. Objective: 11132FOBI Establish intra-rater, inter-rater, and contact (KVALINI, KIRINI) and Tibial Plateau Slope Geometry inter-session reliability of the patella excursions (KVALEXC, KIREXC) during Predicts High-Risk Knee Joint the initial landing phase (initial contact quadrant test utilizing a newly develop Biomechanics During Landing to peak center of mass displacement) patella quadrant tool (PQT) and to Shultz SJ, Schmitz RJ: University were averaged across 5 trials. determine reliability of a clinical of North Carolina at Greensboro, Backward, stepwise multiple linear visual measure. Design: Descriptive Greensboro, NC regressions determined the extent to cohort study. Setting: Controlled which LTS, MTS/LTS ratio, and CTS laboratory setting. Participants: Context: Females have greater medial Eighty-eight healthy collegiate predicted KVALINI, KIRINI, KVALEXC, (MTS) and lateral (LTS) posterior subjects participated (36 males, 52 and KIREXC. Results: Greater CTS inferior tibial plateau slopes and (3.9±2.8o) and lower MTS/LTS (1.1 ± females, 21.83 ± 3.13 years, 171.60 reduced coronal tibial plateau slopes ± 10.62 cm, 72.60 ± 13.79 kg). 0.8) predicted greater KIREXC (-8.3 ± (CTS) compared to males, and greater 6.1o) (Multiple R2 = .33, P=.03; Subjects had no past medical history LTS has been associated with greater of knee or back surgery, direct knee KIREXC = -7.51 – 1.02CTS + 2.99 risk of ACL trauma. The impact of MTS/LTS). Conversely, reduced CTS trauma within the previous three these tibial plateau slope was the sole predictor of greater months, chronic subluxing, dislocating characteristics on high-risk knee joint o 2 patellae, or the presence of Ehlers- KVALINI (2.1 ± 4.0 ) (R =.20, P=.031; biomechanics has received little Danlos syndrome. Intervention: Two KVALINI = 4.54 -.634CTS). Tibial attention. Objective: To determine the slope characteristics were not novice athletic trainers performed extent to which tibial plateau slope patella mobility measurements significant predictors of KIRINI or geometry predicts frontal and bilaterally on all subjects during two KVALEXC. Conclusions: The posterior transverse plane knee joint kinematics inferior slope of the tibial plateau testing sessions separated five days during a drop jump landing. Design: results in anterior translation of the apart. Each examiner visually divided Descriptive cohort study. Setting: tibia relative to the femur (ATT) during the patella in four horizontal quadrants Controlled, laboratory. Patients or weight acceptance. These findings and took a subjective visual assessment Other Participants: Healthy, suggest that greater relative height and of medial and lateral glides and labeled physically active females (N=24; slope of the LTS vs. MTS may promote them according to quadrants of

S-162 Volume 46 • Number 3 (Supplement) May 2011 11137UOBI movement. The examiner then Validation Of 2D Measures Of Motion Inc., USA) and Peak Motus categorized each subject into a Hip And Knee Frontal Plane (Vicon, Oxford, UK) software hypomobile or normal category based Biomechanics During Running calculated 3D and 2D measures, on the number of quadrants moved. Cormack S, Kendall KD, Ferber R: respectively, for the first 60% of the The patella width was measured and Faculty of Medicine, Faculty of stance phase. Main Outcome divided into four quadrants using the Kinesiology, University of Calgary, Measures: 2D and 3D measures of PQT. Medial and lateral displacement Calgary, AB, Canada peak knee abduction, peak hip was measured by quadrant and in adduction, and frontal plane knee and centimeters, through three trials using Context: Clinicians commonly assess hip time-series curves, were the PQT. Main Outcome Measures: gait patterns using single-camera, two- calculated. Paired t-tests were used Intraclass correlation coefficients dimensional (2D) systems whereas to determine differences, if any, in 2D

(ICC2,1) were used to determine intra- researchers commonly use three- and 3D peak angles (Pd”0.05) and rater, inter-rater, and intersession dimensional (3D) systems, which are coefficient of multiple correlation reliability using the PQT for all glides considered the gold standard. (CMC) were used to compare 2D and (4). Cohen’s kappa statistics were used However, few studies have investigated 3D knee and hip time-normalized to determine the intersession and whether 2D and 3D systems are waveform patterns. Results: For the inter-rater reliability of the subjective comparative, and thus whether 2D knee, 2D measures of peak abduction visual assessment. Percent agreement measures are valid for assessing angle were consistently greater by (PA) was obtained to determine running kinematics. Objective: To 5.52±1.50 degrees (P=0.03) whether raters agreed on the category determine whether 2D measures of compared to 3D values and showed a for the subjective visual measure. hip and knee frontal plane kinematics strong correlation (r = 0.82, P=0.05)

Results: ICC2,1 results for intra-rater are comparable to 3D measures during in waveform pattern. For the hip, 2D reliability for session one ranged from the stance phase of running. We measures of peak adduction angle were .865 to .917 for rater one and .913 to hypothesized that 2D measures of consistently greater by 2.85±1.73 .947 for rater two. Inter-rater peak frontal plane knee and hip angles degrees (P=0.05) compared to 3D reliability during session one ranged would be comparable and moderately values and also showed a strong from .675 to .762. Intersession correlated (r-value=0.50-0.69) in correlation (r = 0.83, P=0.05) in reliability ranged from .690 to .777 for waveform pattern to 3D measures. waveform pattern. Conclusions: In rater one and .528 to .732 for rater two. Design: Descriptive laboratory study. contrast to the hypotheses, peak knee Inter-rater Kappa results for session Setting: Clinical research laboratory. abduction and hip adduction angles one ranged from .161 (PA=48%) to Patients or Other Participants: Ten measured using a single camera were .333 (PA=66%). Intersession kappa participants (3 male, 7 female; consistently greater compared to the values ranged from .482 (PA=74%) to age=24.4±4.2 years, mass= 77.2± 3D measures. In support of the .505 (PA=80%) for rater one and .367 9.1kg, height= 164.4±9.8cm) partici- hypotheses, the 2D time series curves (PA=72%) to .574 (PA=85%) for rater pated. The number of subjects exhibited a strong correlation in two. Conclusions: Clinician’s sub- temporal pattern compared to the 3D (pL=0.29; p*=0.80) needed for 80% jective clinical visual assessment reliability was determined based on an curves. Caution should be taken not reliability ranged from fair to agreement analysis from Fleiss to compare peak 2D angles to the 3D moderate. These findings may allow (1999). Subjects were recreationally values but waveform patterns are clinicians to utilize the subjective active, accustomed to running on a similar. visual assessment when no PQT is treadmill, and free from any injury. available. For a more objective Interventions: Retroreflective 11143UOTE measure, the PQT can be used by markers were placed to represent Ninetendo Wii Utilized As A clinicians for quantitatively measuring foot, shank, thigh, and pelvis segments Balance Rehabilitation Tool patella mobility. and anatomical markers placed to Candelaria KA, Padilla RA, Forsyth determine ankle, knee, and hip joint JL, Tsang KKW: California State centers for the right limb. A Sony (60 University Fullerton, Fullerton, CA Hz) camera was placed directly posterior to the treadmill and Context: The use of video gaming perpendicular to the lab frontal plane systems in the rehabilitation setting is to record 2D frontal plane kinematics. becoming more popular and widely 3D measures were recorded using an accepted by patients and clinicians. 8-camera motion capture system Intuitively, playing video games (Vicon, Oxford, UK: 120Hz) placed requires the patient to utilize the same around the treadmill. Visual 3D (C- neuromuscular strategies as traditional

Journal of Athletic Training S-163 rehabilitation exercise. Objective: respectively, P = .436); COPY right leg 12.3kg) volunteered for this The purpose of this study is to compare (41.567±14.03 and 38.286 ±20.75, investigation. Interventions: Five the effectiveness of a video game respectively, P = .678); left leg consecutive isokinetic trials of CON based protocol to traditional balance (44.548 ±17.68 and 34.885±18.31, and ECC torque of the hip abductors training exercises. Design: Ran- respectively, P = .161). A significant (ABD), external rotators (ER), and domized controlled trial. Setting: main effect for time [COPX right leg extensors (EXT) were collected at research laboratory. Patients or (P =.024), left leg (P = .045) and 60°% s-1. Frontal and transverse plane Other Participants: 15 (males = 6, COPY right leg ( P = .048), left leg (P kinematics and external joint moments females = 9) healthy participants (age = .033)] indicated all subjects of the hip and knee were collected = 22.3 ±3.0 years, mass = 65.3 ±12.5 improved in balance. Conclusions: during a jump-cut task using a three- kg, height = 167.1 ±9.7 cm) with no VG was shown to be an effective dimensional motion analysis system. history of current or recent injury training tool for use in rehabilitation. All measures were assessed on the involving their lower extremities. While all participants demonstrated dominant lower extremity. Main Interventions: Independent variable improvements in balance, VG Outcome Measures: The average was balance training protocol: participants appeared to be more CON and ECC hip muscle peak traditional exercises (TE), video game enthusiastic during training sessions torques of the middle three isokinetic (VG). Participants completed 9 possibly leading to improved trials were calculated and normalized training sessions over a 3 week period. compliance with rehabilitation. to body mass. Frontal and transverse Each session consisted of performing plane hip and knee joint excursions 3 sets of 4 different exercises. The 11151FOBI (peak joint angle minus initial contact order of exercises was randomized for The Influence Of Hip Muscle angle) and external joint moments each session. TE protocol: Single Leg Strength On Lower Extremity (normalized to body mass and height) Balance, Balance Board Training, Kinematics And Kinetics During were averaged across 5 jump-cut trials Single Leg Weight Shifts, Lateral A Cutting Task during the deceleration phase (initial Jumps. VG protocol: participants were Rozzi SL, Nguyen A, Parisi GL, contact to peak knee flexion). Separate instructed to perform the same Slye CA, Boling MC: College of stepwise linear regressions were exercises as the TE group while Charleston, Charleston, SC, and performed to determine the influence simultaneously playing various video University of North Florida, of hip muscle torque on hip and knee ® Jacksonville, FL frontal and transverse plane joint games on the Nintendo Wii™ system: Tennis (Single Leg Balance); Archery excursions and external joint moments. Results: Greater ER ECC (Balance Board Training); Wii™ Fit Context: Strength of the hip (Single Leg Weight Shift); Boxing musculature has been suggested to torque predicted less hip internal (Lateral Jumps). Static balance was contribute to altered hip and knee rotation excursion, explaining 21.8% measured prior to starting and after biomechanics, increasing the risk of of the variance (P=0.002). Greater ER completion of all training sessions. anterior cruciate ligament (ACL) CON torque predicted less hip Main Outcome Measures: Depend- injury. However, the relationship adduction excursion, explaining 11.3% ent variable: total range (mm) of Center between hip strength and lower of the variance (P=0.034). Greater of Pressure in the frontal (COPX) and extremity biomechanics remains EXT ECC torque predicted greater sagittal (COPY) planes (for both legs) unclear. A limitation with previous knee valgus excursion, explaining was collected at a sample rate of 1500 investigations is that hip strength has 11.1% of the variance (P=0.036). Hz on a force platform (AMTI, Inc., been assessed isometrically. There were no significant predictors Watertown, MA). Participants were Examining isokinetic hip strength and for knee external rotation excursion. instructed to stand on one leg on the relating this to dynamic motion during Greater ABD CON torque predicted force platform for 30 seconds while a cutting task may be more reflective less hip adduction moment, explaining remaining as still as possible. of the dynamic hip muscle function 11.4% of the variance (P=0.033). Measurements for each leg were during a common task associated with Greater EXT CON torque predicted averaged over 3 trials. A two-way mixed ACL injury. Objective: To examine the less knee valgus moment, explaining factor [2 (protocol) x 2 (time)] influence of concentric (CON) and 14.3% of the variance (P=0.016). ANOVA was used to assess eccentric (ECC) hip muscle torque on There were no other significant differences between training hip and knee joint kinematics and predictors of hip and knee moments. protocols. Results: No differences kinetics during a jump-cut task. Conclusions: Based on these between VG and TE groups (mean ± Design: Descriptive cohort. Setting: findings, strength of the posterior- SD) were found for: COPX right leg Laboratory. Patients or Other lateral hip muscles plays a role in (30.589 ±6.26 and 30.172 ±10.53, Participants: Forty healthy dynamic motion of the lower respectively, P = .659), left leg individuals (20 females, 20 males: extremity during a jump-cut task. (29.768 ±7.75 and 28.790 ±10.93, 21.6+1.9yrs, 173.3+9.0cm, 69.0+ However, due to the small amount of

S-164 Volume 46 • Number 3 (Supplement) May 2011 11159UOMU variance explained by hip muscle determined warm -up, subjects Hip Flexor Tightness And Its strength (R2<0.218), future research performed five tests in the following Influence On Muscle Power And is warranted to determine the order: Modified Star Excursion Endurance additional variables (i.e. muscle Balance Test (SEBT), vertical jump Hashiwaki J, Long BC, Warren AJ, activity) that are influencing lower (VJ), broad jump and hold (BJH), triple Akehi K: Department of Health and extremity biomechanics during hop (TH) and T-test. Multiple Pearson Human Performance, Oklahoma dynamic tasks. (Funded by the product moment correlations (r) were State University, Stillwater, OK College of Charleston Summer used to determine relationships Undergraduate Research with between the variables. The alpha level Context: It is suggested that Faculty Grant) was set a prior at p=0.05. Main clinicians should consider muscular Outcome Measures: The Modified imbalance when initiating rehabili- 11155MONE SEBT scores (max anterior, tation for patients with tight hip The Relationship Between normalized (%LL) anterior, max flexors. Objective: Determine if hip Dynamic Postural Control And posteromedial, %LL posteromedial, flexor tightness influences muscle Physical Performance max posterolateral, %LL postero- power or endurance in dominant and Mutchler J, Van Lunen B, Kollock R, lateral, composite) were used as the non-dominant lower extremities. Oñate JA: Old Dominion University, m easure for dynamic balance. Design: A 2x2x2 factorial with Norfolk, VA, and The Ohio State Normalization was calculated by repeated measures guided data University, Columbus, OH distance reached (cm) / leg length of collection. Setting: Controlled stance leg (cm) x 100 for a % leg laboratory setting. Patients or Other Context: Improving dynamic balance length. Physical performance was Participants: Thirty-two subjects to enhance physical performance is measured by vertical jump height (cm) (male: n=11, age=21.64±1.80 yrs, one technique used by clinicians as part and work (mass (N) x distance (m)) ht=174.80±13.38 cm, mass= 74.54 of return-to-play rehabilitation performed in joules (J), standing broad ±12.86 kg; female: n=21, age= programs. To date however, there is jump distance (cm) and work 20.86±3.47 yrs, ht=161.59 ±11.00 limited information into the performed (J), triple hop distance (cm) cm, mass=60.88±8.89 kg) with no relationship between dynamic balance and work performed (J), and timed T- injuries to the spine or lower extremity and level of physical performance of test in seconds (s). Results: were recruited to participate. high school athletes. Objective: To Posteriomedial reach correlation Intervention: The Biodex System 4 determine the relationship between coefficients ranged from r = -.420 to (Biodex Medical System, Inc., Shirley, dynamic postural control and physical -.539 (p<.05) between the measures NY) was used to assess muscular performance. Design: Between- of work for VJ, BJH and TH. output differences between tight and subjects correlational study. Setting: Composite score correlation non-tight extremity groups, at 60 deg/ This study was performed in a high coefficients ranged from r= -.382 to sec (power) or 180 deg/sec school gymnasium. Patients or -.422 (p<.05) between measures of (endurance). Muscle tightness was Other Participants: Twenty-eight Work for BJH and TH. No significant assessed using a bubble inclinometer high school athletes (14 male, 14 correlations were found for the other in the modified Thomas test position female; age= 16±1.3yrs; ht= measures of the SEBT. As a secondary as described by Starkey, Brown, and 174.75±10.84cm; mass=71.3 ± finding, correlation coefficients Ryan (2010). Extremities were 17.3kg). Inclusionary criteria included between VJ, BJH, TH and T-test ranged grouped according to hip flexor healthy individuals with no lower from r = -.645 to .897 (p<.0001). tightness with measurements less than extremity injury within the past four Conclusions: Normalized postero- 0° considered normal (control group), months, participation in competitive medial reach may indicate the level of and those ≥ 0° considered tight. sports for at least one season prior to work produced by an athlete to Isokinetic testing occurred on two the start of the study, and a valid pre- perform a VJ, BJH and TH. Secondary subsequent days, with test speeds and participation physical exam. r esults of this study indicate that the order of the extremities tested Exclusionary criteria included accurate measures of physical randomized. Prior to testing subjects participation in an in-season sport performance may be achieved by warmed up on a stationary cycle for 5 during the time of testing, a testing vertical jump alone. Future minutes. Subjects also received a contraindication to performing any of research needs to be conducted on familiarization session of 5 the included tests, a Cumberland Ankle dynam ic postural control of subjects submaximal repetitions at the test Instability Tool score of <24, or with a history of lower extremity speed prior to each test. Day one surgery to the lower extremity within pathology. consisted of either 1 set of 5 the last two years. Intervention: repetitions at 60 deg/sec or 1 set of Following an eight minute pre- 25 repetitions at 180 deg/sec on both

Journal of Athletic Training S-165 11194DONE extremities. Day two consisted of the Spinal Reflex Excitability In bar with their feet 58cm above the same test protocol at the opposite test Males And Females During Drop ground. As the participant released speed. To prevent accessory Landing their grip on the bar, stimulation was movement, the pelvis, trunk, and Doeringer JR, Perrier ET, Hoffman triggered and delivered prior to the opposite thigh were secured. Main MA: Department of Nutrition and participant’s feet touching the ground. Outcome Measures: Hip flexion and Exercise Science, Sports Medicine Peak-to-peak H reflex amplitude was extension peak torque and total work. Laboratory, Oregon State University, normalized to Hmax. Main Outcome Results: Extremities with hip flexor Corvallis, OR Measures: The independent variables tightness resulted in greater peak were sex (male vs. female), testing flexion torque (F1,120=5.85; P=.02) but Context: Measuring spinal control position (prone vs. landing), and H- no significant increases in extension mechanisms during drop landings reflex conditioning (unconditioned vs. torque (F1,120=3.76; P=.055). Flexion allows assessment of neuromuscular conditioned). The dependent variable and extension toque was greater at 60 control in a simulated sport-specific was the slope of the ascending portion deg/sec than 180 deg/sec (flexion: movement. Objective: To determine of the H-reflex recruitment curve,

F1,120=14.42; P=.001; extension: if a difference exists in how males and measured from motor threshold to

F1,120=4.26; P=.04). There was no females modulate spinal reflex activity Hmax. Results: A 2 [sex] x 2 [testing difference in leg dominance (flexion: during a landing task. Design: Cohort position] x 2 [H-reflex conditioning]

F1,120=0.24; P=.62; extension: study design. Setting: Sports mixed design ANOVA with repeated

F1,120=0.02; P=.89). When correcting Medicine Research Laboratory. factors (testing position and H-reflex for body weight, hip flexor tightness Patients or Other Participants: conditioning) revealed a significant resulted in greater flexion torque Thirty healthy college-aged individuals main effect of position (prone =

(F1,120=7.09; P=.009) but not volunteered to participate. Fifteen 5.2±1.6, landing = 3.8±1.6; P =.001). extension torque (F1,120=2.60; P=.11). males (24.4±3.2yrs, 176.9±10.5cm, There was no main effect of sex There was also no difference in leg 78.6±11.9kg) and 15 females (24.3 (males = 4.9±1.7, females = 4.1±1.7, dominance when correcting for body ±3.2yrs, 166.7±5.8cm, 62.6±6.4kg) P >.05) or conditioning (uncondition- weight (flexion: F1,120=0.61; P=.44; enrolled in the study. Two females ed = 4.6±1.7, conditioned = 4.4±1.5, extension: F1,120=0.01; P=.95). Peak were excluded from the analysis P > .05). Additionally, there were no torque was greater at 60 deg/sec than because their values exceeded 2 significant interaction effects.

180 deg/sec (flexion: F1,120=29.34; standard deviations from the group Conclusions: Our results are

P=.001; extension: F1,120=6.72; average. Interventions: To elicit consistent with other findings in the P=.01). Hip flexor tightness and leg soleus H-reflexes, a stimulating literature that show reflex modulation dominance did not affect total work electrode was placed over the tibial (inhibition) related to changes in body (P>.05). Conclusions: Hip flexor nerve in the popliteal space on the right orientation. Additionally and possibly tightness increased torque in hip leg. A second stimulating electrode more important is the lack of a sex flexion but not extension. This was placed over the ipsilateral difference, indicating that men and observation also supports recent common peroneal nerve at the head of women modulate spinal reflexes in findings in the literature that muscle the fibula, to condition the soleus H- similar ways during a simulated tightness is associated with greater reflex. Surface EMG (Ag/AgCl) landing task. muscular peak torque generation. electrodes recorded the soleus H- Clinicians should be aware that reflex (2000 Hz; MP100, Biopac, Inc). 11204FONE ACL Prevention Program tightness in the hip flexor can While lying prone, multiple Produces Sustainable Effects contribute to a potential muscular stimulations were delivered at In Jump-Landing Technique In imbalance on the ipsilateral extremity. increasing intensities for the Division I Women’s Basketball development of both an unconditioned Players and conditioned recruitment curve. Pfile KR, Pietrosimone BG, Gribble Stimulations were administered in 15s PA, Buskirk GE, McGriff SL: intervals (S88 stimulator, Grass University of Toledo, Toledo, OH Instruments, Inc). During the conditioned trials, an 80ms delay was used between the conditioning and test Context: Neuromuscular control and reflexes. Next, similar recruitment plyometric training programs are curves (unconditioned and commonly implemented to improve conditioned) were elicited during a jump-landing patterns associated with series of drop landings. For the anterior cruciate ligament (ACL) landings, the participant hung from a injury risk. However, it is unknown if

S-166 Volume 46 • Number 3 (Supplement) May 2011 changes in landing biomechanics can than POST1 (4.90+1.20; t1,9= 2.71, P= laboratory. Patients or Other be sustained following an intervention 0.024) and POST2 scores (4.78+1.93; Participants: A sample of 40 period in elite athletes. The Landing t1,9= 3.41, P=0.008) indicating participants from university Error Scoring System (LESS) is a valid improvements from baseline in the populations in Toledo (USA) and and reliable clinical tool used to assess LESS score at both posttests. No Sydney (Australia) volunteered for the jump-landing technique. Objective: significant differences were found study (27F, 13M; 30.9±11yrs;

To determine whether improvements between POST1 and POST2 (t1,9= .25, 170.9±9.2cm; 67.0± 14.1kg). Inter- in jump-landing patterns following a 6- P=0.81). Categorical grouping ventions: At each of the two testing week intervention program can be indicated that at baseline 20% were locations, a sub-set of the 40 attained, and then maintained over an considered excellent, 30% moderate participants were tested by three additional 7-week period. Design: and 50% poor; POST1 40% were raters. One of the raters was present Controlled Laboratory Study. Setting: excellent, 50% moderate and 10% at both sites and trained the other Laboratory. Patients or Other poor; while at POST2 50% were raters at each site prior to testing, for Participants: Ten Division I female excellent, 40% moderate and 10% a total of 6 raters involved in the study. basketball players (19.40+1.35 yrs; poor. Conclusions: Jump-landing Participants reported to the 178.05+7.52 cm, 72.86+10.70 kg) technique can be improved following laboratories for a single testing participated in this study. Inter- a 6-week intervention focused on session. For normalizing, length of the vention(s): Participants were tested at neuromuscular control and plyometric stance leg was measured in supine from three separate sessions: baseline; training. Interestingly, these the ASIS to the most distal point on following the 6- week training session participants were able to maintain the ipsilateral medial malleolus. A (POST1) and following a 7-week improvements in landing errors over verbal and visual demonstration of the period of no training, which was 13 an additional 7 weeks after the training SEBT was given to participants for total weeks after baseline (POST2). ended. Further research is needed to three directions; anterior, postero- During each session, participants were determine how long initial medial and posterolateral. Participants video-taped simultaneously from two improvements last and if other, non- performed four practice trials in each angles while performing 3 jump- elite populations can sustain direction, followed by three test trials landings from a 30cm high box. The improvements following a 6-week in each direction for three separate neuromuscular control and plyometric intervention. raters. The participants’ test (stance) training program consisted of 18 leg, the order of test directions and the sessions over a 6-week period, 11212UOMU order of raters were randomized. Main supervised and progressed by 2 Inter-Rater Reliability Of The Outcome Measures: Normalized Certified Athletic Trainers (ATC). Star Excursion Balance Test reaching distances (maximum reach/ The exercises focused on improving Kelly SE, Hiller CE, Refshauge KM, leg length) were used. Intraclass neuromuscular control and emphasiz- Gribble PA: University of Sydney, Correlation Coefficients [ICC (1,1)] ing proper landing techniques. Main Sydney, Australia, and University of with 95% Confidence Intervals were Outcome Measures: All videos were Toledo, Todedo, OH calculated for normalized measure- scored by an ATC using the established ments from each SEBT direction. This LESS scoring criteria. The worst Context: The Star Excursion Balance was done using the average and (highest) score of both legs was used Test (SEBT) is widely used by maximum scores of the three trials for analysis of each testing session clinicians in many settings to assess from each direction. The reliability (baseline, POST1 and POST2). dynamic postural control. While inter- model [ICC(1,1)] was employed Additionally, participants were rater reliability of the test has been because there were always three raters categorically grouped as excellent examined, the sample sizes from measuring each participant, although (LESS score <4), moderate (LESS previous studies were small, resulting the individual raters varied. Results: score 5-6) and poor (LESS score >6) in wide confidence intervals. The inter-rater reliability was based on their worst score from each Furthermore, measurements were not excellent for all directions and type of session. A 1x3 repeated measures normalized for leg length, which is measure. For the average reach of the analysis of variance and post-hoc now standard practice. Objective: three trials normalised for leg length, dependent t-tests were performed to The main objective was to determine ICC(1,1) was 0.87 (95%CI:0.79-0.93) identify mean differences over the 3 inter-rater reliability of the SEBT for for anterior, 0.91 (95%CI:0.85-0.95) testing sessions. A priori significance normalized measurements. Addition- for posteromedial and 0.87 (95% level was set at P<0.05. Results: The ally, reliability was determined for CI:0.79-0.92) for posterolateral. For mean LESS score was significantly measurements using the average and the normalized maximum reach of the the maximum score from three test different over time (F2,9= 7.75, P= three trials, reliability also was 0.004). Baseline LESS scores trials. Design: Descriptive labora- excellent, with an ICC (1,1) of 0.86 (7.30+3.4) were significantly higher tory study Setting: Research (95%CI:0.77-0.92) for the anterior

Journal of Athletic Training S-167 direction, 0.88 (95%CI:0.81-0.93) for comfort and stability under two sock between the sock conditions. posteromedial and 0.81 (95%CI:0.71- conditions: FRB and regular socks. Continued research is needed to 0.89) for posterolateral. Con- The order of the sock condition was determine if the FRB could positively clusions: Raters from two different randomized and athletic shoes were influence patient populations with sites, trained by the same experienced worn for all testing. The jump-landing balance deficits. individual, produced strong inter-rater task consisted of a single-leg landing reliability when using the SEBT on from 50% of the participant’s healthy participants. This strengthens maximum jump height. Participants 11214MONE the existing evidence that the SEBT can jumped off both feet, reached up and Inter-Limb Deficits Between be used by clinicians as a reliable touched the indicated marker, and Measures Of Quadriceps Strength outcome tool for assessing dynamic landed on a force plate on the dominant And Voluntary Activation Do Not postural control. limb. Three trials were performed with Correlate each sock condition. Ground reaction Park CM, Gribble PA, Pfile KR, 11213DOXX forces were used to calculate Time to Pietrosimone BG: University of Effects Of Five-Toed Socks With Stabilization (TTS) in the medial/ Toledo, Toledo, OH Multiple Rubber Bits On The lateral (MLTTS) and anterior/posterior Foot Sole On Dynamic Postural (APTTS) directions. After the jump- Context: Lower extremity neuro- Control And Subjective landing procedure was completed in muscular assessment is important for Parameters During Jump And each sock condition, three separate detecting possible injury risk and Landing Among Healthy Young 10-point visual analogue scale determining return to play criteria Adults measures were completed asking about following injury. Evaluation of Shinohara J, Armstrong CW, subjective parameters concerning: 1) isokinetic strength and voluntary Pietrosimone BG, Pfile KR, Tevald perceived comfort (PC), 2) feeling of activation testing are both commonly MA, Gribble PA: The University of stability (FS), and 3) confidence in performed to detect inter-limb Toledo, Toledo, OH protecting the ankle from a potential neuromuscular quadriceps deficits, yet injurious situation (CON). Main it is unknown if inter-limb deficits in Context: Previous studies have Outcome Measure(s): The dependent these two measures provide similar demonstrated that wearing five-toed variables were the dynamic postural information regarding quadriceps socks with multiple rubber bits on the control (APTTS and MLTTS) and the function. Objective: Determine if foot sole (FRB) improves static subjective parameters (PC, FS, and inter-limb deficits differ between postural control in individuals with and CON). The independent variable was measures of isokinetic quadriceps without chronic ankle instability, the sock condition (FRB, regular strength and voluntary activation at possibly through enhanced plantar socks). A separate paired t-test was 30°, 70° and 90° of knee flexion in tactile feedback and foot gripping. performed for each of the dependent healthy participants. Secondarily, we However, it is unclear if FRB have variables. Significance was set a priori sought to determine the relationship similar effects on dynamic postural at p <0.05. Results: A significant between inter-limb deficits in control during activities such as a statistical difference was observed in quadriceps strength and voluntary jump-landing task. Additionally, self- CON (FRB=5.36± 2.02, RS= activation. Design: Crossover. reported feelings of comfort and Setting: Research laboratory. 4.79±1.53, t1,13=2.51, p=0.03). No stability when wearing the FRB during significant difference was observed in Participants: Twenty-five partici- activity have not been considered. either PC (FRB=6.93±1.86, RS= pants (11 Males, 14 Females, Objective: To assess the effect of age=25.08 ±4.67 years, height= 7.07±1.64, t1,13=-0.32, p=0.75) or FS FRB on dynamic postural control and (FRB=6.93±1.86, RS=7.07±1.64, 172.88± 7.74cm, weight= 67.04 self-reported comfort and stability ±10.67kg) with no history of knee t1,13=1.86, p=0.09). No significant during a jump-landing task among difference was observed for APTTS injury volunteered for the study. healthy young adults. Design: (FRB=1.15±0.04, RS=1.15±0.04, Interventions: Independent variables Crossover design. Setting: Research included testing measure (isokinetic t1,13=-1.49, p=0.16) or MLTTS (FRB= laboratory. Patients or Other strength and voluntary activation) and 1.15±0.10, RS=1.16±0.08, t1,13=-0.33, Participants: Fourteen healthy young p=0.75) directions. Conclusions: joint angle (30°, 70° and 90° of knee adults (8 males, 6 females: These results indicate that wearing the flexion). The order in which testing 25.79±3.95 yrs, 169.09±5.69 cm, FRB is associated with improved measure, joint angle and leg (dominant 66.18±10.30 kg) volunteered to confidence in protecting the ankle vs. non-dominant) were performed participate. Interventions: Partici- from a potential injurious situation, was randomly assigned. Isokinetic pants completed a one-time testing compared to wearing the regular socks. strength was performed at 60°/second session to quantify dynamic postural However, the dynamic postural control through the full range of motion. control and subjective feelings of measured by the TTS did not change Voluntary activation was assessed by

S-168 Volume 46 • Number 3 (Supplement) May 2011 administering a supramaximal assessment of quadriceps neuro- At the first testing session, prior to electrical stimulus during a maximal muscular function. viewing the video tape segments, the voluntary isometric contraction at primary investigator, an ATC with each target angle. Main Outcome 11215MOMU experience using the FMS, provided Measures: Isometric quadriceps Intra-Rater Reliability Of The verbal and visual explanation of how strength was determined by extracting Functional Movement Screen the FMS is performed and scored. torque measurements at each joint Among Certified Athletic Then evaluators from all groups angle, while voluntary activation was Trainers And Athletic Training individually scored the video-taped measured via the central activation Students subjects’ performance, which is ratio. Inter-limb difference scores for Brigle J, Pfile KR, Pietrosimone reported as the number of points out each measure were expressed as an BG, Webster KA, Gribble PA: of 21, with a higher number indicating absolute value percentage of the University of Toledo, Toledo, OH; better function. The evaluators dominant leg ((non-dominant - Ball State University, Muncie, IN; returned a week later and watched the dominant leg)/ dominant leg). A 2x3 Boston University, Boston, MA same video-taped subjects again. The repeated measures analysis of variance order of the presentation of the three was used to determine differences in Context: Injury prevention often video-taped subjects in each session inter-limb deficits between measures focuses on recognizing muscular was randomized. Main Outcome at each joint angle. A Pearson product strength and flexibility imbalances. Measures: The intra-rater reliability One proposed method of detecting moment correlation was used to (ICC2,k) of the average FMS scores for assess the relationship between muscular strength and flexibility the 3 observed video-taped subjects for deficits at each joint angle. An a priori imbalances is the Functional all evaluators and for each group. level of significance was set at Movement ScreenTM (FMS). Using the Means and standard deviations for each P<0.05.Results: Inter-limb iso- FMS as a clinical outcome tool may evaluator’s rating of all three video- kinetic strength deficits were greater be useful for Athletic Trainers. taped subjects were used for analysis. than voluntary activation deficits at all However, intra-rater reliability of the Interclass coefficients were performed joint angles (30°, 15.26±14.46 vs FMS among different levels of clinical for all 37 evaluators as well for each 10.47±7.24%; 70°,13.3±14.47 vs and FMS experience has not been group of evaluators between the scores 8.86±7.4% and 90°; 12.82±17.76 vs. adequately established. Objective: from session 1 and 2. Results: For The purpose of this study was to 4.97±4.87%, F1,24=11.26, P=0.003). all 37 evaluators, the intra-rater establish the intra-rater reliability of No significant correlations were reliability was moderate (ICC2,37 = the FMS among athletic trainers and found for inter-limb differences 0.723). The ATCExp (ICC2,7 = 0.946) between quadriceps isokinetic strength athletic training students (ATS). had strong intra-rater reliability, while and voluntary activation at any of the Design: Cohort study. Setting: A the ATC group had moderate reliability controlled research laboratory. joint angles 30° (r=-0.17, P=.43), 70° (ICC2,14=0.758) the ATS group had Patients or Other Participants: A (r=0.19, P=.38) and 90° (r=-0.06, poor reliability (ICC2,16 = 0.372) P=.79). Conclusion: Inter-limb convenience sample of 37 evaluators Conclusions: Intra-rater reliability of deficits were higher for quadriceps was divided into three groups, based the FMS appears to improve with isokinetic strength compared to on level of clinical and FMS clinical experience. With previous voluntary activation at all joint angles. experience: senior ATS (n=16; 7M, 9F; training, the reliability among athletic Interestingly, inter-limb deficits 20.94±0.44 yrs; 172.72±9.45 cm; trainers slightly improves. These between measures were not strongly 70.25±9.35 kg; 0.00±0.00 years of results indicate that the FMSTM has correlated, suggesting that these certification), certified athletic high reliability when employed by measurements may be evaluating trainers with no FMS experience (ATC) athletic trainers with experience using completely different phenomena (n=14; 7M, 7F; 24.50± 2.31 yrs; the FMS. within the neuromuscular system. 175.08±8.48 cm; 69.66± 10.46 kg; While future data is still needed to 2.50±2.56 yrs of certification); or determine how deficits in each certified athletic trainers with FMS measure relate to physical function experience (ATCExp) (n=7; 2M, 5F; and long-term outcomes in injured 27.71±5.28 yrs; 177.99±8.51 cm; populations, this may be evidence to 72.58±8.78 kg; 6.28±4.96 yrs of suggest that athletic trainers should certification). Interventions: Evalu- utilize information from both ators watched video-taped recordings isokinetic strength and voluntary of three subjects performing three activation tests to compile a complete trials of all seven tasks of the FMS on two occasions separated by one week.

Journal of Athletic Training S-169 11243FOBI 11252DOEX Sex Comparison Of The Effects Of Significant interaction effects were Strength Differences Between Contractile Effort On Hamstring evaluated post hoc using Bonferroni’s Male And Female Soldiers Of Stiffness And Anterior Tibial correction. The extent to which The 101st Airborne Division Translation increasing stiffness influenced the (Air Assault) Blackburn JT, Norcross MF: decrease in ATT was evaluated via the Keenan KA, Abt JP, Sell TC, Nagai Neuromuscular Research correlation between change scores T, House AJ, Deluzio JB, Smalley Laboratory, University of North (45%MVC–30%MVC). Results: BW, Lephart SM: Neuromuscular

Carolina at Chapel Hill, Chapel ATT (ICC2,1=0.98, SEM=1.7mm) and Research Laboratory, Department

Hill, NC hamstring stiffness (ICC2,1=0.75, of Sports Medicine and Nutrition, SEM=3.1N/m*kg-1) demonstrated School of Health and Rehabilitation Context: Anterior tibial translation moderate-to-excellent intra-session Sciences, University of Pittsburgh, (ATT) is greater in females than in reliability and precision. The Sex x Pittsburgh, PA, and 101st Airborne males, and excessive ATT increases %MVC interaction effect (F1,34= Division (Air Assault), Fort anterior cruciate ligament (ACL) 5.594, p=0.024) and %MVC main Campbell, KY injury risk. Individuals with greater effect (F1,34=6.320, p=0.017) for ATT hamstring stiffness demonstrate less were significant. ATT was less at Context: In the US Army, male and ATT, thus increasing hamstring 45%MVC compared to 30%MVC in female Soldiers participate in gender- stiffness may reduce ATT and ACL females (10.3±10.9mm vs. 13.0± neutral physical training and may have injury risk. Muscle stiffness increases 12.4mm), but not in males (10.1 similar physical demands during with contractile effort, but it is unclear ±9.3mm vs. 10.2±9.0mm). The occupational and operational tasks. how increasing hamstring stiffness %MVC (F1,34=53.122, p<0.001) main Musculoskeletal injuries, many of influences ATT. Objective: To effect was significant for hamstring which may be preventable, are the compare the effects of contractile stiffness, with stiffness being greater primary reason for seeking medical effort on hamstring stiffness and ATT at 45%MVC compared to 30%MVC care among military personnel and may across sex. Design: Cohort design (19.8±5.5 N/m*kg-1 vs. 15.5±3.6 N/ be related to suboptimal musculo- with repeated measures. Setting: m*kg-1). The correlation between the skeletal characteristics, which may Research laboratory. Patients or increase in hamstring stiffness and the result in higher injury rates in female Other Participants: Thirty-six decrease in ATT was non-significant (r Soldiers. Objective: To determine if healthy volunteers (18 males: = -0.005, p = 0.978). Conclusions: strength differences exist between age=23±4yr, mass=82±17kg, height Hamstring stiffness increased and ATT genders in US Army Soldiers of the =1.8±0.1m; 18 females: age=23±3yr, decreased with increasing contractile 101st Airborne Division (Air Assault) mass=65±11kg, height=1.7±0.1m). effort. Contrary to our hypotheses, matched on age and years of service Interventions: Hamstring stiffness however, the decrease in ATT was not (YOS). Design: Cross-sectional and ATT were assessed at 30 and 45 % correlated with the increase in study. Setting: Research laboratory. maximal voluntary contraction stiffness. The decrease in ATT was Participants: Data were collected on (%MVC) with subjects positioned likely attributable to the increase in 65 female Soldiers (age=26.9±5.7 prone in 30° of knee and hip flexion. tibiofemoral compressive force years, height =1.65 ±0.06 m, mass During stiffness assessments, a caused by increasing contractile =65.7±9.8 kg) and 65 male Soldiers perturbation was applied to the shank effort. These data suggest that the (age=26.9±5.8 years, height =1.76± to produce oscillatory knee flexion/ magnitude of hamstring stiffness 0.07 m, mass= 82.3± 12.7 kg) matched extension. An accelerometer captured increase between 30 and 45%MVC on age (±2 years) and YOS (± 1.0 the damped oscillatory frequency (mean increase=28%) may be years). All subjects were free of from which stiffness was derived. ATT insufficient to influence ATT. current medical or musculoskeletal was assessed via a custom-built However, though not statistically conditions that prevented full active perturbation device that applied 20% significant (t34=0.989, p=0.330), duty. Inter-ventions: Isokinetic knee body weight to the proximal posterior females demonstrated a larger flexion/extension (FLEX/EXT), shank. Electromagnetic motion increase in hamstring stiffness shoulder internal/external rotation (IR/ capture sensors were used to calculate compared to males (31% vs. 25%), ER), and torso rotation (ROT) strength ATT as the peak difference in anterior potentially explaining the significant was assessed using an isokinetic displacement of the shank relative to decrease in ATT in females but not in dynamometer (5 repetitions each, 60°/ the thigh. Main Outcome Measures: males. sec). Isometric hip abduction/ Hamstring stiffness (N/m*kg-1) and adduction (ABD/ADD) strength was ATT (mm) were compared across sex assessed with three, 5 sec alternating and %MVC via 2(Sex) x 2(%MVC) contractions using an isokinetic repeated measures ANOVAs (d”0.05). dynamometer. Isometric ankle

S-170 Volume 46 • Number 3 (Supplement) May 2011 11253DOMU inversion/eversion (IN/EV) and The Relationship Between seconds[ms]). Results: AB PT and %T plantarflexion/dorsiflexion (PF/DF) Isometric Maximum Strength demonstrated trivial to moderate strength was assessed using a handheld And Rate Of Torque Development correlations (r=0.03-0.45) to AB dynamometer (3 repetitions). All tests Assessed At The Hip And Thigh RTD, with AB RTD at 200 ms were performed on the right side. Kollock RO, Cortes N, Greska E, displaying significant correlations to Paired t-tests were used to compare Van Lunen, B, Onate JA: Old PT (r=0.45, p≤.01) and %T (r=0.41, normally distributed variables and Dominion University, Norfolk, VA; p≤.01). AD PT showed trivial Wilcoxon signed rank tests were use George Mason University, Fairfax correlations (r=0.00-0.05) to AD to compare non-normally distributed VA; The Ohio State University, RTD, while AD %T displayed trivial to variables. Statistical significance was Columbus, OH small negative correlations (r= -0.07 set at p<0.05 a priori. Main to -0.12) to RTD. KF PT and %T Outcome Measures: Peak torque Context: Isometric maximum strength demonstrated trivial to moderate was averaged normalized to body (Smax) may not provide an adequate correlations (r=0.15-0.49) to RTD, weight (%BW) for: shoulder IR/ER, representation of other aspects of with KF RTD at 100 (r=0.41, p≤.01) knee FLEX/EXT, torso ROT, and hip muscular strength (e.g., rapid force and 200 ms (r=0.49, p≤.01) displaying ABD/ADD. Average peak force (kg) production). To date there is limited significant correlations to PT. was calculated for ankle IN/EV and PF/ research comparing measures of rate Additionally, KF %T showed a DF. Results: Female Soldiers of torque development (e.g., rapid significant moderate correlation demonstrated significantly less force production) to Smax (i.e. peak (r=0.36, p≤.05) to KF RTD at 200 ms. strength in shoulder IR (F: 35.8±8.9 torque) in the collegiate athlete KE PT and %T displayed moderate to %BW; M: 61.3±15.1 %BW), shoulder setting. Objective: To determine the strong significant correlations ER (F: 29.5±5.2 %BW; M: 43.7±9.7 relationship between isometric peak (r=0.36-0.58, p≤.05) to KE RTD. KE %BW), knee FLEX (F: 92.9±20.9 %BW; torque (PT) and rate of torque PT demonstrated strong significant M: 116.8±30.1 %BW), knee EXT (F: development (RTD) Design: Correla- correlations (r=0.52-0.58, p≤.01) to 189.5±36.9 %BW; M: 241.6±55.4 %BW), tional Design Setting: Research all KE RTD time intervals, with the torso ROT (F: 105.8±25.3 %BW; M: Laboratory Patients and Other strength of the association increasing 150.9±29.2 %BW), ankle IN (F: 25.2±6.8 Participants: 36 NCAA Division I as the time interval increased. The kg; M: 34.3±7.5 kg), and ankle EV (F: female soccer athletes (19.4±1 years, shared variance between Smax 22.3±6.0 kg; M: 30.7±6.3 kg), (all, 166.4±5.1 cm, and 62.1± 5.3 kg) were variables and RTD at separate time p<0.001). Conclusions: Strength recruited. Interventions: Participants intervals ranged from 0-34%. differences do exist between male and per-formed 3 maximum isometric Conclusions: Except for AD PT, the female Soldiers, with female Soldiers contractions, 5 seconds in duration, results suggest that Smax displays its demonstrating less shoulder, knee, separated by 60 seconds of rest at the lowest association with RTD at 0-30 ankle, and torso strength. No gender hip abductors (AB), hip adductors ms. The results demonstrate that the differences were noted in hip strength (AD), knee flexors (KF), and knee strength of the associations increases or ankle PF/DF; however it is unclear extensors (KE). Isometric data were as the interval of time increases. The if this is due to adequate strength in collected with a portable fixed percentage of common variance female Soldiers or inadequate strength dynamometer sampled at 1000Hz and between Smax and RTD suggest each in male Soldiers and should be filtered using a low pass 4th order parameter is measuring a different explored further. Future research Butterworth filter with a 50Hz cut-off aspect of strength and may not be should explore if these differences frequency. Separate Pearson’s Product indicative of the other, thus contribute to unintentional musculo- -Moment Correlations were per- highlighting the need to evaluate both skeletal injury and decreased physical formed and the coefficients of parameters. readiness as well as if these determination calculated. Hopkins differences can be mitigated through (2002) scale was used to interpret the gender-specific physical training. correlation coefficients: trivial (0.0), small (0.1), moderate (0.3), strong (0.5), very strong (0.7), nearly perfect (0.9), and perfect (1.0). Alpha level was set at p≤0.05. Main Outcome Measures: Isometric AB, AD, KF, and KE PT[Nm], normalized PT (%T =PT[Nm]/(weight[N] x height[m]), and RTD[Nm/s] at 4 time intervals (0- 30,0-50,0-100,and 0-200 milli-

Journal of Athletic Training S-171 11255FONE Validity Of The Single Leg Triple starting line to initial heel contact on musculature leads to a dynamic knee Hop As A Clinical Predictor Of the final hop. Main Outcome valgus position during functional tasks; Neuromuscular Function At The Measures: The average CON and ECC however, few studies have investigated Hip peak torque of the middle three trials the influence of concentric and Nguyen A, Callans TE, Lopes ME, was calculated for each strength eccentric hip muscle strength on lower DeAngelis AI, Boling MC: College measure and normalized to body mass. extremity motion during single and of Charleston, Charleston, SC, and The average of 3 SEBT reaches for double leg landing tasks. Objective: University of North Florida, each direction, normalized to leg To determine the influence of Jacksonville, FL length (%LL), and the max distance concentric and eccentric hip muscle during 3 SLTH trials were used for strength on hip and knee joint Context: Decreased neuromuscular analysis. A step-wise linear regression excursions during single and double function of the hip has been suggested determined the extent to which hip leg landings. Design: Descriptive to increase the risk of acute and strength and distance during the SEBT cohort. Setting: Research laboratory. chronic knee injuries. While neuro- predicted SLTH distance. Results: Patients or Other Participants: muscular evaluation of hip muscles Greater ER CON (R2=0.488, Forty participants (20 females, 20 2 have been included in prospective risk P<0.001) and EXT CON (R change males: 21.6±1.9yrs, 173.3±9.0cm, factor studies, methods of assessment =0.085, P=0.010) were positive 79.0±12.3kg) with no previous history can be time consuming and have been predictors of greater SLTH distance of lower extremity surgery, hip or knee limited to isometric strength explaining 57.4% of variance joint injury within the last 6 months, measures. Functional hop tests have (P=0.007). All other hip torque and no current injury to the lower been suggested to assess neuro- measures were significantly correlated extremity volunteered to participate in muscular function of the lower (R=0.300-0.680) with SLTH distance, this study. Interventions: An iso- extremity and may be an efficient but did not contribute significantly to kinetic dynamometer was used to alternative to evaluate neuromuscular the model once ER CON and EXT assess concentric and eccentric torque function of the hip in large, CON were accounted for. SEBT reach of the hip abductors, external rotators, prospective risk factor studies. distances were not significantly and extensors across five trials at Objective: To determine if concentric correlated (R=0.070-0.237) with 60°×s-1. A three-dimensional motion (CON) and eccentric (ECC) hip SLTH distance. Conclusions: Hip analysis system was used to collect hip strength and reach distance during the muscle strength, particularly the and knee kinematics of the dominant Star Excursion Balance Test (SEBT) gluteus maximus serving as the stance leg during five trials of a single are associated with distance during a primary hip external rotator and leg land (SLL) and double leg land Single Leg Triple Hop (SLTH). extensor, is a strong predictor of SLTH (DLL). Main Outcome Measures: Design: Descriptive cohort. Setting: distance. These findings suggest the Peak concentric torque and peak Research laboratory. Patients or SLTH may be an efficient functional eccentric torque were separately Other Participants: Forty individuals tool to assess gross muscular strength averaged across the middle three trials (20 males, 20 females: 21.3±1.6yrs, of the gluteus maximus, during for each hip muscle group and were 173.7±9.1cm, 73.6±13.4kg) partici- prospective risk factor screening normalized to body mass. Frontal and pated in the study. Interventions: All studies. transverse plane hip and knee joint measures were performed on the excursions were calculated by dominant stance leg. Five continuous 11279UOBI subtracting the initial contact angle Influence Of Hip Strength On isokinetic trials of CON and ECC from the peak joint angle during the Lower Extremity Joint torque of the hip abductors (ABD), deceleration phase (initial contact to Excursions During Single And external rotators (ER), and extensors peak knee flexion) of the SLL and DLL. Double Leg Landings (EXT) were measured at 60°·s-1. To Separate stepwise linear regressions Parisi GL, Slye CA, Nguyen A, assess neuromuscular control at the were performed to determine the Rozzi SL, Boling MC: College of hip, SEBT trials were performed influence of hip muscle torque on Charleston, Charleston, SC, and standing on the stance leg and frontal and transverse plane joint University of North Florida, maximally reaching with the excursions at the hip and knee. Jacksonville, FL contralateral leg in the anteromedial Results: During a SLL, greater hip (AM), medial (MD), and postero- extension eccentric torque predicted medial (PM) directions. SLTH Context: The hip musculature plays an greater knee valgus excursion, distance was assessed beginning in a important role in controlling lower explaining 12.1% of the variance (P= single leg stance followed by 3 extremity frontal and transverse plane 0.028). During a DLL, greater hip consecutive hops for maximal distance motion. It has been suggested that external rotation concentric torque and recorded in centimeters from the decreased strength of the hip predicted less hip adduction excursion,

S-172 Volume 46 • Number 3 (Supplement) May 2011 explaining 11.9% of the variance each day was retained for analysis. A to measures of sport performance, (P=0.030). No other hip torque 5x2 repeated measures ANOVA was which may be important for injury measures contributed significantly to used to determine the effects of day prevention program design and hip and knee joint excursions during a and leg on TCOH time, α=0.05. Non- compliance. It is also unknown if these SLL or DLL(P>0.05). Conclusions: linear regression was used to predict measures are reliable in youth athletes. Hip extension torque and external asymptote of learning. Main Objective: To evaluate the within-day rotation torques were associated with Outcome Measures: Learning effect reliability of landing technique and frontal plane hip and knee excursions and between leg differences for single performance measures and to evaluate during a SLL and DLL. However, the leg TCOH (s) test between days. the relationship between these relationships were weak where Results: There were no leg (p = .267) measures. We hypothesized that all approximately 88% of the variance was or leg x day interactions (p = .425) for measures would be reliable and that left unexplained. These findings, along single leg TCOH performance. The landing technique would be related to with a lack of identified relationships single leg TCOH performance performance measures. Design: between other hip torque measures and significantly improved over time (p = Correlational research design. joint kinematics, suggest that hip .000) with a significant quadratic trend Setting: Soccer field. Patients or strength alone may not control lower (p = .01): Day1 17.11 ± 5.69 s, 95% Other Participants: Fourteen extremity motion during landing tasks. CI 14.81−19.40 s; Day2 14.92 ± 4.12 healthy youth female soccer athletes Future research should examine the s, 95% CI 13.26 −16.58 s; Day3 14.22 (Age:13±2 years, Height:154.9±10.4 role of muscle activation along with ± 3.66 s, 95% CI 12.74 −15.70 s; Day4 cm, Mass:50.6±13.2 kg) volunteered other neuromuscular and anatomical 13.00 ± 3.39 s, 95% CI 11.63 −14.37 to participate. Interventions: factors that may influence kinematics s; Day5 12.48 ± 3.15 s, 95% CI 11.21− Participants performed three trials of of the hip during functional tasks. 13.76 s. The absolute value of the a jump landing task, an agility test (T- differences between legs by days was: test), a double-leg countermovement 11290FOMU LegDiffDay1 = 2.43 ± 3.07 s, 95% CI vertical jump and a double-leg broad Learning Effect For The Timed 1.20−3.68 s; LegDiffDay2 = 1.36 ± jump in a random order during a single Cross Over Hop Test 1.52 s, 95% CI 0.75-1.98 s; test session. The jump-landing task Han KM, Ricard MD: Department LegDiffDay3 = 1.37 ± 1.12 s, 95% CI required participants to jump forward of Kinesiology, Athletic Training 0.92−1.82 s; LegDiffDay4 = 0.90 ± from a 30cm high box a distance of Research Laboratory, San José State 0.78 s, 95% CI 0.59−1.22 s; LegDiff- half their body height and jump University, San José, CA, and Day5 = 0.72 ± 0.49 s, 95% CI 0.52− vertically for maximal height Department of Kinesiology, The 0.91 s. The non-linear re-gression immediately upon landing. The jump- University of Texas at Arlington, indicated that improvement and landing trials were videotaped from the Arlington, TX between leg differences reached a sagittal and frontal planes and graded plateau at day 5, R2 = .984, SEE = .32 using the Landing Error Scoring Context: Athletic trainers have used a s, R2 = .92, SEE = .27 s, respectively. System (LESS). The agility test variety of functional tests to access an Conclusions: The 95% CI threshold required participants to sprint forward, athlete’s rehabilitation progress to for between leg differences in healthy side shuffle left and right, and sprint determine physical readiness to return subjects is 3.68 s which represents the backwards. Participants jumped as high to sport. Without knowledge of the minimum detectable difference as possible for the vertical jump test learning effect of a functional test it between healthy and injured limbs for and jumped as far as possible for the is difficult to differentiate the effects the TCOH test. The learning effect for broad jump. Intraclass coefficients of learning from rehabilitation. the test is extinguished after 5 days. were calculated between the three Objective: To determine the learning trials of each dependent variable. effect between days and legs on the 11320UOBI Pearson correlation coefficients Timed Cross Over Hop (TCOH) test. The Relationship Between evaluated the relationship between Design: A 5x2 (day, leg) counter- Performance Measures And LESS score and performance on the balanced repeated measures. Setting: Landing Technique In Female agility, vertical jump, and broad jump Research laboratory. Patients or Youth Soccer Athletes tests (α≤0.05). Main Outcome Other Participants: Twenty six (11 Sanger RH, Hall EA, DiStefano LJ: Measures: The LESS uses a binary males, 15 females) healthy subjects University of Connecticut, Storrs, system to evaluate several landing (age = 23.0 ± 3.5 yrs, height = 169.6 CT characteristics. A low LESS score ± 7.1 cm, mass = 70.3 ± 11.4 kg) with indicates few landing errors and proper no history of lower extremity injury. Context: Poor landing technique is landing technique. Performance on the Interventions: All subjects performed associated with anterior cruciate agility test was measured using a 2 trials of TCOH test (s) each leg for ligament (ACL) injury risk. It is digital timing system. Maximal 5 different days, and the best trial for unknown how injury risk factors relate vertical jump height was measured via

Journal of Athletic Training S-173 a Vertec Jump Training System. Broad LESS scores. Design: Cross appears to increase average LESS jump distance was manually recorded. Sectional. Setting: Field laboratory. scores when compared with the Intra-class coefficients and standard Patients or Other Participants: traditional, or sagittal plane task. error of measurements were Thirty healthy individuals (n=25 Individual item analysis showed the calculated for all variables. Average Males, 5 Females; age=18±1 years) transverse jump to be as effective as scores were calculated and used for volunteered to participate. Inter- the sagittal jump at eliciting most analyses. Results: All four tests ventions: Participants performed two individual LESS item errors. The demonstrated good to excellent jump-landing tasks: sagittal plane task proportion of errors scored with the within-day reliability (ICC(2,k),, SEM and transverse plane task. The sagittal transverse jump was significantly values= LESS: 0.76, 0.91 points; plane task required participants to higher for Trunk Lateral Flexion at IC, Agility: 0.96, 0.31s; Vertical jump: jump forward off a 30cm high box to a while the sagittal jump was more 1.00, 1.37cm; Broad jump: 0.96, distance of half their body height and effective at eliciting asymmetrical 4.39cm). Agility test time (r=0.69, jump for maximum vertical height landing. A composite average for both P=0.007) and broad jump distance (r immediately upon landing. Participants types of jumps may best address the =-0.74, P=0.002) were significantly performed the transverse plane task LESS ceiling effect. related to LESS score. Vertical jump similarly but started with their body height was not significantly related to facing 90 degrees to the front camera. 11344DOBI LESS score (P>0.05). Conclusions: Participants were instructed to jump Predictors Of Internal Knee All measures demonstrated good off the box, rotate 90 degrees in the Abduction Moment During within-day reliability. Female youth air to land with their body facing Running In Healthy Participants soccer athletes who demonstrate forward and immediately rebound for Bazett-Jones DM, Joshi M, Sanders proper landing technique also score maximum vertical height. Each type of JJ, Weinhandl JT, Cashin SE, Cobb well on sport performance measures. jump was performed 2 times. Both SC, Earl JE: University of Future research should evaluate if tasks were videotaped in the frontal and Wisconsin-Milwaukee, Milwaukee, there is a causal relationship between sagittal plane and graded using the WI landing technique and sport LESS. LESS scores on the two tasks performance. were compared using a paired t-test. Context: Research has identified the McNemar’s test for marginal knee abduction moment (KAM) during 11325FOMU homogeneity evaluated the paired running as an important factor in the A Comparison Of Transverse And proportions of individual LESS items identification and prediction of those Sagittal Plane Jump-Landing scored between the two tasks. Alpha with patellofemoral pain syndrome Tasks Using The Landing Error was set a priori at 0.05. Main (PFPS). The KAM has also been show Scoring System Outcome Measures: The LESS uses to decrease with hip strengthening in de la Motte SJ, DiStefano LJ, a binary system to identify the those with and without PFPS. Beutler AI, Marshall SW, Cameron presence or absence of several landing However, no research has been K, Padua DA: United States Military characteristics including knee flexion, performed to investigate clinical Academy, West Point, NY; knee valgus, and foot position. A higher measures that would be predictive of Uniformed Services University of LESS score indicates a greater number KAM. Objective: To determine if the Health Sciences, Bethesda, MD; of errors committed and, thus, poorer static or dynamic measures of hip and University of Connecticut, Storrs, jump-landing technique. Average LESS trunk strength and endurance are better CT; University of North Carolina, scores for sagittal and transverse plane predictors of KAM during running, and Chapel Hill, NC jump-landing tasks were computed. which of these measure(s) are most Results: There was a significant predictive of KAM during running. Context: The Landing Error Scoring difference between the sagittal plane Design: Multi-session, cross- System (LESS) is a valid and reliable and transverse plane LESS scores sectional. Setting: Neuromechanics clinical movement analysis tool. (Transverse LESS: 5.97±1.51, Sagittal Laboratory. Patients or Other Participants: 54 healthy, physically Traditional uses of the LESS during a LESS: 5.10±1.69, t(29)=3.45, P= jump-landing task in the sagittal plane 0.002). McNemar’s test showed non- active participants (24 men, 30 women; may have a ceiling effect that makes it homogeneity between tasks for Trunk age=23.2±4.7yrs, mass=75.6±18.6kg, difficult to see improvements in Lateral Flexion at Initial Contact (IC) height=1.74±0.09m) volunteered to Χ2 participate. Interventions: Partici- individuals with decent landing ( (1)=13.00; P<0.001), and Sym- Χ2 pants attended five testing sessions technique. It is possible that a more metrical Foot Contact ( (1)=7.14; challenging jump-landing task may P=0.013). No other proportional during which static and dynamic address this problem and expand the differences for LESS items were measures of hip and trunk strength and range of scores. Objective: To observed. Conclusions: The endurance were taken. The tests for compare transverse and sagittal plane transverse plane jump-landing task muscle strength was a static maximal

S-174 Volume 46 • Number 3 (Supplement) May 2011 voluntary isometric contraction knee injury and osteoarthritis participant lowered one foot down to (MVIC) and dynamic one-repetition prevention. touch the ground while standing on a maximum (1RM), whereas the tests 21.5cm block. Video was recorded for muscle endurance was a static 11345FOBI using a standard video camera at a timed hold test (THT; body part held Relationships Among Hip And distance of 2.4m in front of the in position for maximal time) and Trunk Strength And Endurance participant and an image was extracted dynamic repetitions to failure (RTF). And The Frontal Plane Projection when the participant’s knee flexion Tests were performed on the dominant Angle During Single-Leg, Lateral angle was 45°. The FPPA was measured (DLTF) and non-dominant lateral trunk Step-Downs from the picture using ImageJ flexors (NLTF), hip lateral rotators Earl JE, Bazett-Jones DM, Joshi M, freeware. Main Outcome Measures: (LR), abductors (ABD), and hip Sanders JJ, Weinhandl J, Cashin SE, Independent variables included THT extensors with a bent knee (BKE). Five Cobb SC: University of Wisconsin- (seconds) and 3-trial average running trials were recorded with a 3D Milwaukee, Milwaukee, WI normalized MVIC for each of the 11 motion capture system and force plate, tests and the dependent variable was the and peak KAM during stance was Context: Hip strength and trunk FPPA (more negative=greater valgus). extracted and averaged over the five endurance are thought to be factors in Pearson correlations were used for the trials. Main Outcome Measures: The dynamic valgus and lower extremity statistical analysis to investigate the dependent variable was KAM and injury. Other evidence suggests that relationship between strength and independent variables included THT hip endurance and trunk strength may endurance measures, and FPPA. (seconds), RTF (reps), and normalized also be factors. All of these factors Significant variables (p<0.10) and MVIC and 1RM values for each of the 6 have not been investigated together gender were used in a regression tests. Pearson correlations were used to using clinically available measures. model to determine the most investigate the relationship between Objective: To determine the predictive factor(s). A significance strength and endurance measures, and relationships among hip and trunk level of p<0.05 was used for the KAM. Those variables that were muscular strength and endurance regression analysis. Results: DLTF significant (p<0.001), as well as gender, measures and frontal plane projection MVIC (r=0.245, p=0.075), NLTF were put into a single regression to angle (FPPA) during a single-leg, MVIC (r=0.393, p=0.032), and TF determine the most predictive factors. lateral step-down. Design: Multi- THT (r=-0.453, p=0.001) were Two separate regressions for static and session, cross-sectional. Setting: significantly correlated with FPPA. dynamic measures were also performed Neuromechanics Laboratory. Patients The regression model was significant with all measures to determine the most or Other Participants: 54 healthy, (R=0.629,R2=0.395,p<0.001), and TF variance explained (adjusted R2). physically active participants (24 men, THT (p=0.010) and gender (p=0.006) Significance was determined with an 30 women; age=23.2±4.7yrs, mass= were the only significant variable. The alpha level of p<0.05 for the regression 75.6±18.6kg, height= 1.74±0.09m) average FPPA (-3.3±4.0°) was similar analyses. Results: ABD MVIC (r= volunteered to participate. Inter- to previously reported healthy -0.235, p=0.088), NLTF THT ventions: Participants attended five controls. Conclusions: Trunk strength (r=0.247, p=0.074) and HER 1RM testing sessions during which static and endurance are important factors (r=0.255, p=0.066) were significantly measures of hip and trunk strength and related to a clinical assessment of correlated with KAM. ABD MVIC endurance were taken. The test for dynamic valgus, though gender seems (p=0.015) was predictive of KAM in muscle strength was a maximal to also play a significant role in these the regression analysis (R=0.497, voluntary isometric contraction relationships. Decreased lateral trunk R2=0.247, p=0.009). All static (MVIC), whereas the test for muscle flexor strength was related to greater measures accounted for 24.1% of the endurance was a timed hold test (THT; FPPA and dynamic valgus, and higher variance while dynamic measures body part held in position for maximal trunk flexor endurance was predictive explained 5.8%. Conclusions: Static time). Tests were performed on the of greater FPPA. These factors should measures of hip and trunk strength and trunk flexors (TF), trunk extensors be evaluated when an individual endurance are sufficient measures to (TE), dominant (DLTF) and non- displays dynamic valgus, and may be a evaluate muscle function. Less hip dominant lateral trunk flexor (NLTF), focus of a rehabilitation program. abductor strength was the only hip lateral (LR) and medial rotators predictor of greater KAM; therefore, (MR), adductors (ADD), abductors those with less ABD strength may be (ABD), hip flexors lying supine (SHF), more prone to overuse knee injury. and hip with a bent knee (BKE). A Predicting KAM using a clinical single leg, lateral step-down was strength measure may be important in performed to assess FPPA, where the

Journal of Athletic Training S-175 11F05MONE 11F14DOBI A Gender Comparison Of timed knee flexion perturbation of 40°. Landing Biomechanics Differ Reactive Knee Stiffening Reactive knee stiffness was measured Between High And Low Energy Strategies Under Cognitive Loads during the move and data was Absorption Groups Kim AS, Swanik CB, Higginson C, processed using customized LabVIEW Norcross MF, Blackburn JT, Lewek Thomas SJ: Department of software (National Instruments, Austin, MD, Padua DA, Shultz SJ, Weinhold Kinesiology and Applied Physiology, Tx). Surface electromyography PS: University of North Carolina at University of Delaware, Newark, DE; (EMG) assessed muscle activation in Chapel Hill, Chapel Hill, NC, and Department of Psychology, Loyola the quadriceps and hamstrings. An University of North Carolina at University, Baltimore, MD; analysis of variance with repeated Greensboro, Greensboro, NC Department of Bioengineering, measures was used to analyze the University of Pennsylvania, differences in gender and reactive knee Context: While greater lower Philadelphia, PA stiffening strategies between the extremity energy absorption (EA) cognitive tasks. Main Outcome during the first 100ms of a double-leg Context: There is a higher incidence Measure(s): Reaction time (ms) to jump landing (DLJL) is associated of non-contact anterior cruciate peak torque (TTP) was assessed and with biomechanical factors related to ligament (NC-ACL) injuries in knee stiffness was calculated as torque non-contact ACL injury, it is currently females, and irregular neuromuscular (Nm) / position (degrees), normalized unknown if individuals displaying high control strategies have been blamed for to body mass (kg). Results: Equal vs. low EA during landing exhibit disrupting the dynamic restraint performance was observed on the differences in these same bio- mechanism during unanticipated joint JOLO (Female=24.7±3.7, Male= mechanical factors. Objective: To loading. Gender differences in mental 26.400±2.761) and SDMT (Female compare landing biomechanics faculties have also been identified, =65.6±8.0, Male=65.3±7.9) cognitive between high and low EA groups. which suggests that altered tasks. Males were significantly faster Design: Cross-sectional, quasi- neuromuscular control may originate attaining TTP (Males=338.1±57.1 ms, experimental. Setting: Research from differences in processing Females= 363.5±48.2 ms; p=0.039). laboratory. Patients or Other cognitive loads and potentially lead to All participants were 9% slower and Participants: 22 Female (Age: the disproportionate number of NC- had decreased muscle activity under 21.5±3.3 years, Height: 1.66± 0.07 m, ACL injuries. Objective: To assess cognitive loading; however, females Mass:63.6±9.9 kg) and 17 Male whether preparatory and reactive knee had greater stiffness (Females= (Age:21.4±2.4 years, Height: 1.80± stiffening strategies are affected 0.043±0.010 Nm/Deg/kg, Males= 0.07 m, Mass:80.0±14.3 kg) volun- differently in males and females 0.035±0.014 Nm/Deg/kg). Few EMG teers. Interventions: Dominant leg exposed to gender-biased cognitive differences were observed but kinematics and kinetics were assessed loads. Design: A two group repeated interaction effects between gender and using an electro-magnetic motion measures post test only study. Setting: cognitive loading (p>0.05). Con- capture system and a force plate as This study was performed in a clusion: Cognitive loading decreased participants performed five DLJLs controlled laboratory setting. reaction times and muscle recruitment from a 30-cm box placed 50% of their Patients or Other Participants: critical for joint stability, regardless height behind the plate. Hip, knee, and Forty (20 males, 20 females) healthy of gender. The propensity for females ankle joint angular velocities were college aged participants (20.3 ± 1.4 to generate greater knee stiffness, with multiplied by net internal joint yrs; 71.6 ± 10.0 cm; 73.5 ± 20.0 kg) different muscle activation timing has moments calculated using inverse with no current injury or previous also been observed during functional dynamics to produce net joint power surgery to their dominant lower tasks. However, the strong effect by curves. Eccentric muscle activity extremity. Interventions: The both cognitive load conditions results in negative work at a joint, thus independent variables were the type of appeared to exceed the influence of EA for each joint was calculated by cognitive tasks administered, which specific gender biased cognitive integrating the negative portions of the included the Benton Judgment of Line loading tasks. More research is needed joint power curves during the 100 ms Orientation (JOLO), Symbol Digit investigating how cognitive faculties following initial ground contact (IGC). Modalities Test (SDMT), and a control may alter neuromuscular control and Total lower extremity EA, calculated condition. Participants were seated in stiffness regulation strategies in as the sum of hip, knee, and ankle EA, the custom-made Stiffness and regards to injury prevention and was normalized to the product of Proprioception Assessment Device rehabilitation. subject height (Ht) and body weight (SPAD) with the testing leg in 30° of (BW) [%BW*Ht] and used to group knee flexion. They were then instructed subjects into tertiles. Main Outcome to perform one of the three cognitive Measures: Peak vertical (vGRF) and conditions and also react to a randomly posterior (pGRF) ground reaction

S-176 Volume 46 • Number 3 (Supplement) May 2011 forces; internal knee extension (KEM) and knee varus (KVM) moments; and anterior tibial shear force (ATSF) were identified between IGC and the minimum vertical position of the whole body center of mass. Independent samples t-tests (α=0.05) were used to compare these dependent variables between the highest (H) and lowest (L) EA tertiles. Results: Total EA was 15.45±1.57 [%(BW*Ht)] and 9.79±1.45 [%(BW*Ht)] for H (3M,10F) and L (9M,4F), respectively. No significant differences were identified between groups for vGRF (H:3.07±0.61 [xBW-1] vs. L:2.81±0.66 [xBW-1], p=0.296) or KVM (H:0.099±0.058 [x(BW*Ht)-1] vs. L:0.084±0.053 [x(BW*Ht)-1], p= 0.479). However, H exhibited significantly greater pGRF (H:0.94 ±0.29 [xBW-1] vs. L:0.72±0.16 [xBW- 1], p=0.023), KEM (H:0.204 ±0.053 [x(BW*Ht)-1] vs. L:0.158 ±0.032 [x(BW*Ht)-1], p=0.015), and ATSF (H:1.04±0.13 [xBW-1] vs. L:0.84 ±0.16 [xBW-1], p=0.002) than L. Conclusions: Individuals absorbing greater energy during the 100 ms following IGC display significantly greater peak pGRF, KEM, and ATSF. As these biomechanical factors purportedly result in greater ACL loading, we suggest that greater EA during the 100 ms following ground contact may manifest in a higher-risk movement strategy and serve as a surrogate for the multiple, discrete variables currently used to evaluate landing biomechanics. Future research should further explore these notions. Moreover, modifiable biomechanical factors that are predictive of EA should be identified in hopes that they might be targeted in intervention programs to alter landing biomechanics and minimize ACL injury risk.

Journal of Athletic Training S-177 Free Communications, Poster Presentations: The Ankle Wednesday, June 22, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11027DOGA 11038DONE Ankle Kinematics During Shod calculated at each increment. Means Decreased Hoffmann Reflex Gait In Subjects With And and associated 95% confidence Modulation Of The Soleus And Without Chronic Ankle Instability intervals (CIs) were calculated in each Peroneals With Chronic Ankle Chinn L, Dicharry J, Watt J, Hertel plane across the entire gait cycle. To Instability J: University of Virginia, identify significant differences, Kim KM, Ingersoll CD, Hertel J: Charlottesville, VA increments where the CI bands for the University of Virginia, two groups did not cross each other Charlottesville, VA, and Central Context: Previous research has were identified. Main Outcome Michigan University, Mount reported that while barefoot, Measures: Sagittal plane and frontal Pleasant, MI individuals with chronic ankle plane angles were recorded instability (CAI) demonstrate altered throughout the entire gait cycle for Context: Hoffmann (H) reflex gait kinematics compared to healthy each speed. Results: While walking, modulation between different body controls. Specifically, during the late the CAI group was significantly less postures has been linked to postural swing phase CAI subjects tend to be dorsiflexed compared to the healthy stability. Decreased modulation less dorsiflexed and more inverted group from 44% to 48% of the gait between increasingly complex compared to healthy controls. cycle (mean difference=5.0±0.2°). postures may be a potential However, no studies have previously While the CAI group was slightly more mechanism of postural instability evaluated the effect of CAI on gait everted than the healthy group related to chronic ankle instability kinematics while shod. Objective: To throughout the entire walking gait (CAI). Objective: To assess H-reflex determine if there are sagittal and cycle (mean difference=0.5±2.8°), modulation of the soleus and peroneals frontal plane ankle kinematic there were no increments where the in three body positions (prone, bipedal differences during shod walking and CIs between the two groups did not and unipedal stances) in subjects with jogging between groups of individuals overlap. While jogging, the CAI group and without CAI. Design: Case- with and without CAI. Design: was less dorsiflexed (mean control. Setting: Laboratory. Descriptive laboratory study. Setting: difference=3.9±3.1°) and more Patients or Other Participants: Motion analysis laboratory. Patients inverted (mean difference=2.0±2.5°) Sixteen subjects with unilateral CAI or Other Participants: Nine subjects than the control group across the entire (10 males, 6 females; age=21±6.9 with self-reported CAI (males=6, gait cycle but there were no increments years; height=173.9±7.4cm; mass= female=3; age=28.4±7.8 yr; height= where the CI between the two groups 72.6±11.9kg) and 15 controls without 172.2±6.8 cm; mass=73.3±13.5 kg; did not overlap. Conclusions: During any history of ankle sprains (9 males, Foot and Ankle Ability Measure shod walking, the CAI group was 6 females; age=19±4.3years; (FAAM)=92.7±4.2%, Foot and Ankle significantly less dorsiflexed height=175.8±9.7cm; mass =71.3 Ability Measure-Sports Scale (FAAM- compared to the healthy group near the ±17.8kg) participated. Inter- S)=76.0±14.4%; number of previous time of peak dorsiflexion. This ventions: Independent variables were sprains=5.9±3.2) and 8 healthy kinematic difference is similar to what group (CAI, control) and limb subjects with no history of lower has previously been reported during (involved, uninvolved). Limbs of extremity injury (males=3, females barefoot gait. Significant differences controls were side-matched to the =5; age=24±5.1 yr; height= 167.0± between groups were not found in involved and uninvolved limbs of CAI 10.9 cm; mass= 65.1±18.0 kg) frontal plane motion during walking or subjects. Maximum H-reflexes and volunteered. Interventions: Subjects in either the frontal or sagittal planes motor (M) waves were recorded walked (speed=1.34 m/s) and jogged during jogging. There do not appear to bilaterally from the soleus and (speed=2.68 m/s) on a treadmill with be identical ankle kinematic peroneals while subjects lied prone embedded force plates while a 12- differences between CAI and healthy and then stood in quiet bipedal and camera motion analysis system groups during shod gait, as has been unipedal stances with eyes closed. captured 3-D lower extremity previously reported during barefoot Two-way ANOVAs with repeated kinematics. One 15-second period of gait. measures on limb compared H-reflex gait (average walking strides=10; modulation between groups and limbs average jogging strides=20) was for both muscles. Tukey’s HSD tests captured at each speed for analysis. were conducted for post-hoc Each stride of the gait cycle was comparisons. The alpha level was normalized to 100 increments. Sagittal P<.05. Main Outcome Measures: and frontal plane angles were H-reflexes were normalized to M

S-178 Volume 46 • Number 3 (Supplement) May 2011 waves to obtain Hmax:Mmax ratios for H-reflex in more demanding postures dominant limb. Baseline testing was the three positions. Dependent may represent a potential mechanism performed with no insoles. Immediate variables, for each muscle, were the of postural control deficits associated and 2-week testing was performed with percent change scores in Hmax:Mmax with CAI. subjects wearing their assigned ratios between each pair of positions: insoles. Subjects performed three 15- prone to bipedal (P-Bi), bipedal to 11049MONE secon trials of eyes-closed single limb unipedal (Bi-Uni), and prone to Effect Of Posture Control Insoles® quiet standing on a force plate. Center unipedal (P-Uni). Results: For the On Static And Dynamic Balance In of pressure velocity (COPV) was the soleus, significant group by limb Healthy Young Adults dependent variable for static balance. interactions were found for all three Wheeler R, Chinn, L, Hertel J, Sauer Dynamic balance was evaluated using modulations (P-Bi, P=.002; Bi-Uni, L: University of Virginia, the star excursion balance test in the P=.05; P-Uni, P=.001). In the CAI Charlottesville, VA anterior, posteromedial, and group, soleus modulations in involved posterolateral directions. Subjects limbs (P-Bi=14.06±9.11%, Bi-Uni=- Context: Postural Control Insoles® performed three trials in each 19.3±15.9%, P-Uni=-2.3±16.2%) (PCI) are over the counter orthotics direction. Reach distances were were significantly lower than in purported to improve function and normalized to subject limb length. uninvolved limbs (P-Bi=26.4±11.8%, posture and decrease pain in healthy Separate 3x3 analyses of variance with Bi-Uni=-9.6±13.0%, P-Uni=19.2 and pathological populations by repeated measures examined the ±17.3%) and both limbs in the providing posting to the first ray. To influence of group and time for each controls. There were no significant date, no peer-reviewed research has outcome variable. Interaction and side-to-side differences in controls been published on this intervention. group main effects were evaluated to (control “involved”: P-Bi=26.4 Objective: To determine if PCI determine the effects of insole ±14.2%, Bi-Uni=10.4±11.1%, P- insoles affect static and dynamic intervention. Results: No significant Uni=18.5±18.2%, control “unin- balance compared to sham and control results were found for COPV (PCI: volved”: P-Bi=27.6±16.6%, Bi-Uni=- interventions immediately and after a baseline=4.3±2.6 cm/s, immediate 10.0±10.9%, P-Uni= 20.2± 19.9%). 2-week accommodation period in =4.3±2.1 cm/s, 2-week= 7.7±11.9 cm/ For the peroneals, significant group by healthy subjects. Design: Single blind s; Sham: baseline=3.6±1.6 cm/s, limb interactions were found for the randomized controlled trial. Setting: immediate=3.5±1.2 cm/s, 2-week Bi-Uni (P=.01) and P-Uni (P=.02) Laboratory. Participants: Forty-four =5.1±3.0 cm/s; Control: baseline modulations. In the CAI group, healthy subjects with no history of =4.3±1.8 cm/s, immediate=6.6±6.6 peroneal modulation in involved limbs shoe insert use volunteered. Subjects cm/s, 2-week=4.5±2.0 cm/s; inter- (Bi-Uni=-27.1±23.4%, P-Uni= were randomly assigned into one of action: p=0.30, group main effect: -9.0±25.1%) were significantly lower three groups: PCI (females=10, p=0.53). There were also no than the uninvolved limbs (Bi-Uni= males=5; age=21.6±2.7 yrs; height significant results for dynamic balance -10.4±21.7%, P-Uni= 8.8±15.6%) =168.9±8.2 cm; mass= 69.8±10.8 kg), in the anterior (PCI: baseline and both limbs in controls. There were sham (females=10, males=5; age= =64.4±5.4%, immediate=64.5±6.6%, no significant side-to-side differences 23.8±5.3 yrs; height =167.4±7.3 cm; 2-week=64.2±5.4%; Sham: baseline= in controls for the peroneals (control mass=70.1±12.0 kg) and control 65.1±5.7%, immediate=66.7±5.0%, “involved”: Bi-Uni=-15.6±13.7%, P- (females=10, males=4; age=22.0±3.1 2-week=66.4±6.4%; Control: base- Uni=5.5±14.2%, control “unin- yrs; height=169.5±7.4 cm; mass= line= 63.9±7.2%, immediate =63.6 volved”: Bi-Uni=-16.4±13.7%, P- 67.7±6.1 kg). Interventions: The ±8.1%, 2-week=63.1±6.5%; inter- Uni=5.7±17.1%). The group by limb independent variables were group action: p=0.61, group main effect: interaction (P=0.18) and group main (PCI, sham, control) and time p=0.49), posteromedial (PCI: baseline effect (P=0.66) were not statistically (baseline, immediate, 2-week). =88.2±7.0%, immediate =86.9±8.4%, significant for the P-Bi peroneal reflex Subjects in the experimental group 2-week= 86.3±7.0%; Sham: baseline= modulation (CAI involved =14.3 were fitted for PCI insoles according 88.5±8.5%, immediate=87.2±9.0%, ±11.2%, CAI uninvolved =20.6 to manufacturer recommendations. 2-week= 91.5±10.3%; Control: ±12.8%, control “involved”= 18.5± The sham group was given insoles that baseline =85.7±11.1%, immediate 7.8%, control “uninvolved” =19.2 identical PCI insoles but without any =84.5± 10.1%, 2-week= 84.4 ±10.0%; ±9.7%). Conclusions: Decreased H- posting. The control group was not interaction: p=0.14, group main reflex modulations in the CAI involved provided any insoles. All subjects were effect: p=0.40), and posterolateral limbs were present in the soleus during instructed to wear their assigned (PCI: baseline= 82.9±8.8%, all of three postural transitions and in assigned intervention a minimum of six immediate=83.6±11.8%, 2-week= the peroneals for two of the three hours a day for two weeks. Main 83.9 ±10.9%; Sham: baseline = transitions. Constrained ability of the Outcome Measures: Measures were 83.2±12.6%, immediate =84.3 sensorimotor system to down regulate performed on subjects’ self-reported ±14.0%, 2-week=87.5 ±14.7%;

Journal of Athletic Training S-179 11067DOGA Control: baseline= 77.8±12.3%, plate were used to collect time Elevations In Ankle-Knee immediate =75.7±11.6%, 2-week synchronized gait data as participants Coupling Variability Correspond =77.9±10.7%; interaction: p=0.41, ran at 4.0m·s-1±10% down an 18m With Phase Transitions During group main effect: p=0.15) reach runway. Lower extremity joint Walking Gait In Healthy Adults directions. Conclusions: In healthy kinematics and kinetics were assessed Hoch MC, Mullineaux DR, subjects, PCI insoles had no effect on prior to the start of the physical Kyoungyu J, McKeon PO: static or dynamic balance immediately training program. Cadets were then University of Kentucky, Lexington, after introduction or following two- tracked for the development of KY; University of Lincoln, Lincoln, weeks of accommodation. ERLLP by a certified athletic trainer England; University of Incheon, for one academic year. Main South Korea Outcome Measures: At the end of the 11062MOBI academic year, cadets were divided Context: It has been proposed that Prospective Risk Factors For into two groups for analysis: those who coupling variability between two joints Exercise Related Lower Leg Pain developed ERLLP and those who did increases during phase transitions in Among ROTC Cadets not. Multiple one-way ANOVAs were gait, however little is known about this Perlsweig KA, Stickley CD, Kimura used to compare the biomechanical phenomenon in relation to clinically- IF, Hetzler RK: University of Hawaii gait characteristics between the two relevant gait cycle (GC) transitions. at Manoa, Honolulu, HI groups. Results: Ten cadets (nine men Examining the contextual relationship and one woman) developed ERLLP between joint coupling variability and Context: Injuries affect military that required a reduction in training GC transitions may provide insight readiness more than any other medical volume and intensity. Cadets who into sensorimotor organization. Prior condition, both in the number of developed ERLLP demonstrated larger to assessing if such information has individuals affected and the annual cost maximum vertical ground reaction clinical relevance, confirmation of the to the service branches. Exercise force (vGRF, 26.87N·kg-1 vs. existence of joint coupling variability related lower leg pain (ERLLP) is a 24.36N·kg-1, p=0.0082) and delayed at the gait transitions is required. category of lower extremity overuse timing of peak braking force (tPBF, Objective: Identify areas in the injury defined as any shin, calf, ankle, 31.60% vs. 30.12% of stance, walking GC with elevated levels of or foot pain exacerbated by exercise p=0.0223) before injury development. coupling variability and determine if and relieved with rest, including medial Conclusion: Incidence of ERLLP in these areas are associated with tibial stress syndrome, tibial stress this cohort (13.7%) is similar to that specific gait transitions. Design: fracture, and chronic exertional reported by previous researchers. The Cross-sectional. Setting: Laboratory. compartment syndrome. High delay in tPBF among those who Participants: Ten healthy adults (6 incidences of ERLLP during basic developed ERLLP indicates a delay in males, 4 females; age:25.3±3.8years; training cycles have been reported, and the shear force on the tibia as the height:173.2 ±4.8cm; weight: 71.7± it is cited as a major cause of failing forward momentum of the foot contact 10.2kg) volunteered to participate. to complete the run portion of on the ground is reversed into Interventions: Subjects walked on a physical fitness tests. Previous propulsive force during stance. treadmill instrumented with force research has primarily identified risk Because there were no significant plates at a speed of 1.5m/s. Three- factors retrospectively by comparing differences in the kinematics of the dimensional kinematics of the lower the gait characteristics of those with knee or ankle, the change in tPBF and extremity joints were captured for 30s and without a history of ERLLP. increase in maximum vGRF indicate a using a 15-camera motion analysis Objective: To prospectively identify change in the shear and vertical forces system. Data were time normalized to risk factors for developing ERLLP absorbed by the static structures of the 101 points from initial-contact (0%) based on biomechanical gait lower leg. Therefore, delayed tPBF to the subsequent initial-contact of the characteristics. Design: Cohort and increased vGRF during running are same limb (100%). Main Outcome study. Setting: University gait significant risk factors for the Measures: Left knee flexion- laboratory and Reserve Officer development of ERLLP in ROTC extension and ankle dorsiflexion- Training Corps (ROTC) Battalion cadets. plantar flexion angles were calculated facilities. Participants: Forty-eight for 5 nonconsecutive GCs. Based on male (age 26.5±7.1 years) and 25 ankle and foot position, the stance female (age 24.2±3.6 years) cadets phase was divided into 3 rockers: heel- from the same Army ROTC Battalion rocker (initial heel contact to initial participating in the same physical forefoot-contact, e.g. load response), training program. Interventions: A ankle-rocker (forefoot-contact to 3D motion capture system and force maximum tibial progression over the

S-180 Volume 46 • Number 3 (Supplement) May 2011 11113MOBI ankle, e.g. absorption phase), and Differences In Static Hindfoot motion capture, reflective markers forefoot-rocker (propulsion phase Alignment Among Individuals were placed on the subjects’ foot and noted by heel lift and toe off). The With Functional Ankle Instability, shank consistent with the Oxford Foot swing phase was separated into initial- Copers And Healthy Controls Model. Main Outcome Measures: swing, mid-swing, and terminal-swing Letchford EC, Goldberg JS, Wright Hindfoot position in the frontal and (preparation for initial-contact). To CJ, Arnold BL, Ross SE: Virginia saggital planes were used for analysis. assess ankle-knee coupling variability Commonwealth University, We performed separate one-way (AKCV), vector-coding coefficients Richmond, VA (group: healthy, coper and FAI) (VCC) ranging from 0 (no variability) ANOVAs for frontal and saggital to 1 (maximum variability) with Context: Several researchers have planes. Tukey’s post hoc tests were corresponding 95% confidence investigated dynamic ankle motion used to compare each possible pair. intervals (CI) were calculated for each during functional activity in individuals Results: Group differences were of the 101 GC points. A grand mean with and without functional ankle found in hindfoot sagittal plane and CI were calculated to represent the instability (FAI). However, few position (F2,65= 4.70, p= 0.01). overall AKCV across the entire GC researchers have examined Specifically, post hoc testing found (overall VCC-CI). Points in the GC differences in static ankle hindfoot that individuals without a history of where the lower boundary of the CI alignment. Additionally, to our ankle sprains stood with greater exceeded upper boundary of the overall knowledge, there is no research on dorsiflexion than individuals with a VCC-CI were considered meaningful static hindfoot alignment in individuals history of ankle sprains, i.e. FAI and (p<0.05). The mean (±standard who have had a single ankle sprain but copers (Healthy: 5.08±2.81º, Coper: deviation), and maximum were no subsequent re-injury or instability 3.00±2.60º, FAI: 2.89±6.07°). There calculated in areas with elevated VCCs. (copers). Objective: To determine if was no significant sagittal plane Results: Two areas with VCCs there are static hindfoot position difference between FAI and coper elevated above the overall VCC-CI differences in the sagittal (plantar- groups. In the frontal plane, no upper boundary (0.20) were identified flexion and dorsiflexion) and frontal significant group differences were at the transition from terminal-swing planes (inversion and eversion) among found (F2,65= 0.25 p= 0.78; Healthy: to the heel-rocker (98-2% of GC; FAI individuals, copers, and healthy -2.28±5.62º, Coper: -0.98±7.08º, VCC=0.37±0.08, maximum=0.49) individuals. Design: A three-group FAI: -1.75±6.07°). Conclusions: and the ankle-rocker to forefoot- cross-sectional study. Setting: A Individuals with a history of ankle rocker (38-48% of GC; VCC= controlled sports medicine research sprain (both copers and individuals 0.36±0.07, maximum=0.47). Con- laboratory. Participants: Sixty-five with FAI) show decreased clusions: Areas throughout the individuals volunteered to participate. dorsiflexion, regardless of whether or walking GC with the greatest AKCV The Cumberland Ankle Instability Tool not they have symptoms of instability. occurred concurrently with specific (CAIT) was used to measure functional This indicates that decreased rocker transitions, namely the limitations. Participants included 23 dorsiflexion is associated with ankle transition from an unloaded to a loaded healthy individuals without history of sprains but not a causal mechanism for state and from an absorption to a ankle sprain (age=23.17±4years, instability. Thus, it appears to be a propulsion state. The AKCV increases height= 1.72±.08.m, mass =68.78 relatively benign change post-injury. may represent areas of sensorimotor ±13.26kg, CAIT=28.78±1.78), 21 system re-organization of the ankle- copers with history of a single ankle knee relationship to manage sprain without re-injury or giving-way perturbations encountered during (age=23.48 ±3.80years, height= these gait transitions. Further 1.71±.07m, mass=69.62 ±14.62kg, investigation within those who suffer CAIT=27.86±1.71), and 23 FAI ankle and knee injuries may provide individuals with history of ≥ 1 ankle insight into the functional role of sprain and ≥ 2 episodes of giving-way AKCV and lower extremity injuries (GW) in the past year (age= involving the ankle and knee. 23.30±3.84years, height =1.70±.11m, mass=68.66±14.60kg, GW per month= 5.81±8.41, CAIT= 20.52 ±2.94). Interventions: During a single visit, each participant’s standing hindfoot alignment was captured with a 12-camera motion analysis system at 100Hz (Vicon, Oxford, UK). For

Journal of Athletic Training S-181 11118FOBI 11221FONE The Relationship Between Ankle was group (CAI, healthy) and dependent Effects Of Chronic Ankle Range Of Motion And Dynamic variables included maximal Instability On Excitability Of Postural Control In Healthy DFROM(cm) and maximal reach The Motor Cortex Individuals And Those Reporting distance normalized to leg length on Pietrosimone BG, McLeod MM, Chronic Ankle Instability the SEBT(%). Pearson Product- Ko JP, Schaffner L, Gribble PA: McKeon PO, Staton GS, Hoch MC, Moment correlation coefficients were University of Toledo, Toledo, OH McKeon JM, Mattacola CG: calculated to examine the relationship University of Kentucky, Lexington, between the WBLT and each direction Context: Lower extremity neuro- KY of the SEBT for each group. muscular dysfunction is common Independent t-tests were used to following ankle sprains and may be a Context: Structural and functional examine differences between groups contributing factor to chronic ankle impairments have been identified as on the WBLT and each SEBT direction. instability (CAI). There is mounding contributing factors associated with Alpha was set a priori at pd”0.05. evidence to suggest the central nervous chronic ankle instability (CAI). Results: In the healthy group, the system plays an important role in Examining the relationship between WBLT was significantly correlated to neuromuscular alterations following weight-bearing ankle dorsiflexion the SEBTANT (r=0.70, r2=0.49, joint injury. While spinal level range of motion (DFROM) and p<0.001) and SEBTPL (r=0.47, excitability is altered following acute performance on the Star Excursion r2=0.22, p=0.02), but not to the and chronic ankle sprains, little is Balance Test (SEBT) may provide SEBTPM (r=0.38, r2=0.14, p=0.07). In known about how excitability of the insight to sensorimotor system the CAI group, the WBLT was motor cortex is affected in those with alterations in individuals with CAI. significantly correlated to the CAI. Objective: Determine if Objective: To examine the SEBTANT (r=0.42, r2=0.18, p=0.04), cortical excitability of the fibularis relationship between ankle DFROM but not to the SEBTPL (r= longus (FL) differs in those with and performance on the SEBT in those 0.34,r2=0.14,p=0.10) or the SEBTPM unilateral CAI and healthy controls. with and without CAI. Additionally, we (r=0.31, r2=0.09, p=0.14). No Design: Blinded, Case-control. explored group differences in these significant differences were detected Setting: Research laboratory. measures. Design: Case-control between groups on the WBLT or any Patients or Other Participants: Ten design. Setting: Laboratory. of the SEBT directions; (Healthy: participants with CAI (7F/3M, Participants: Twenty-four subjects WBLT=11.9±3.1cm, SEBTANT 20.5±1.4years, 175.9±36.7cm, 70.5 with self-reported CAI (11 males, 13 =78.4 ±5.6%, SEBTPM =92.3 ±13.3kg) and seven healthy females, age:23.6+5.8 years, ±9.8%,SEBTPL= 84.8±15.2%; CAI: participants free from ankle injury height:174.6+7.6cm; weight: 77.9+ WBLT =11.8 ±3.0cm, SEBTANT (7F/0M, 19.9±0.7years, 168.9 15.1kg) were gender and side matched =79.1 ±5.1%, SEBTPM =90.9 ±8.9cm, 66.4±45.1kg) were involved to twenty-four healthy subjects (11 ±8.9%, SEBTPL =84.5 ±11.5%; all in this study. Healthy subjects were males, 13 females, age:24.3+4.4 p’s>0.34). Conclusions: Although assigned a matched “injured leg” prior years, height: 172.4 +10.4 cm; both groups exhibited similar to data analysis. Interventions: weight:71.5+13.9kg). Interven- DFROM and SEBT reach distances, up Cortical excitability was measured tions: All subjects performed 3 trials to 30% less variance in SEBT bilaterally in both groups while seated of maximum reach in the anterior performance could be explained by in 10° of knee flexion, ankles in 10° (ANT), posteromedial (PM) and DFROM in those with CAI compared of plantar flexion and feet secured in posterolateral (PL) directions of the to healthy subjects. These findings a molded heel cup. Transcranial SEBT to assess dynamic balance. All suggest that CAI subjects may have magnetic stimulation (TMS) was used reach distances were normalized to leg utilized a different movement strategy to excite areas on the motor cortex length. The weight-bearing lunge test compared to healthy subjects when corresponding to the contralateral FL. (WBLT) was used to measure DFROM. performing the SEBT. Examining the Electromyography positioned on the Subjects performed 3 trials of the relationship between structural and FL was used to collect motor evoked WBLT in which they kept their test heel functional contributing factors may potentials (MEP) elicited in the firmly planted on the floor while they provide more insight into the muscle from the TMS. Active motor flexed their knee to the wall. sensorimotor alterations in those with thresholds (AMT) were collected as Maximum dorsiflexion was defined as CAI beyond examining these measures participants plantar flexed at 5% of a the distance from the great toe to the in isolation. maximal isometric contraction. AMT wall based on the furthest distance the were determined as the lowest amount foot was able to be placed without the of TMS able to elicit a measurable heel lifting. Main Outcome MEP (> 100mV) in 5 out 10 Measures: The independent variable consecutive trials at the same TMS

S-182 Volume 46 • Number 3 (Supplement) May 2011 11271FOBI intensity. All MEPs were normalized Effects Of Injury And Tape On sprain group was matched with a to maximal FL Muscle Responses Dynamic Ankle Inversion Speed healthy participant of a similar height (MEP:M) elicited with an electrical Using Fulcrum Methodology and mass. Participants reported for stimulus over the common fibular Knight AC, Weimar WH: testing on three days; ankle taping was nerve. Main Outcome Measures: Department of Kinesiology, randomly assigned one of the first two Peak-to-peak MEP:M amplitudes Mississippi State University, testing days, and the third testing day were evaluated at individual AMT Mississippi State, MS, and (no ankle taping) was to determine the intensity bilaterally in both groups. A Department of Kinesiology, reliability of the TMI variable with the 2x2 (Leg, Group) ANOVA was used to Auburn University, Auburn, AL first or second testing day without evaluate differences in MEP:M ankle taping. Ten trials were performed between legs in the CAI and healthy Context: The lateral ankle sprain is the on the previously injured leg (LAS participants, while independent and most common injury in athletics. The group) or matched control leg (NI dependant t-tests were utilized post rate at which the ankle is unexpectedly group) each testing day. Main hoc to evaluate between and within forced into inversion will influence the Outcome Measures: The dependent groups, respectively. A priori levels of likelihood of a lateral ankle sprain as variable was TMI, measured in significance were set at P£0.05. well as the severity of injury. milliseconds, defined as the time from Results: A significant Group x Leg Objective: To determine if a previous contact of the fulcrum with the landing interaction was found (F1,15=5.21, lateral ankle sprain or ankle taping surface to the time when the lateral P=0.04). Injured leg MEPs effects the time to maximum border of the outer sole made contact (0.012±0.008) in the CAI group were inversion (TMI) during a simulated with the landing surface. This is a significantly lower than the injured leg lateral ankle sprain, and to determine measure of the time it took the in the control group (0.032±0.023; the reliability of this measurement. participants to complete the 25° of t16=-2.58, P=0.02), while no Design: Repeated measures design. inversion. Results: Presented as significant differences were found in Setting: Controlled laboratory Mean + SD and level of significance. the uninjured legs between the CAI setting. Participants: Twenty six No significant interaction (p=.973), or (0.013±0.007) and control groups volunteers (age=21.46+1.17 years; main effects for injury history (0.023±0.029; t16=-.975, P=0.34). mass=73.92+14.55 kg; height= (NI=53.49+18.89 ms; LAS=48.79 Additionally, no differences were 1.75+0.087 m), which included 13 +19.54 ms; p=.493) or ankle support found between legs within the CAI with no previous ankle sprain (NI) and (no support =48.83 +18.49 ms; ankle (t16=-0.58, P=0.56) or healthy groups 13 with a previous lateral ankle sprain taping=53.44+19.46 ms; p=.179) was Conclusions: (t16=2.0, P=0.09). (LAS). Interventions: The inde- found for either variable, but good Lower FL MEPs in the injured legs of pendent variables were injury history, reliability was found for TMI individuals with CAI suggests a with two levels (no ankle injury, (ICC=.81). Conclusions: Neither a potential motor cortex alteration that previous lateral ankle sprain), and previous lateral ankle sprain or ankle presents with diminished excitability ankle support, with two levels (ankle taping affects TMI, but the TMI to the FL. Decreased cortical taping, no ankle taping). Statistical variable demonstrated good reliability. excitability of stabilizing muscles analysis included a 2 x 2 ANOVA with around the ankle may have critical repeated measures on ankle support 11F23DONE Resting Muscle Spindle Activity implications for rehabilitation condition to analyze the difference in Correlates With Ankle Stiffness strategies for those with ankle TMI between the injury groups and Needle AR, Swanik CB, Farquhar pathology. ankle support conditions. Reliability WB, Kaminski TW, Rose W: coefficients, using intra-class University of Delaware, Newark, DE correlation coefficients, were calculated between the two testing days without ankle taping. An outer Context: Investigations on the sole with fulcrum was placed on the neuromechanical contributors to joint bottom of the participants’ shoe that stability and functional performance forced them into 25° of inversion upon emphasize the importance of optimal landing from a 27 cm single leg drop joint stiffness regulation. The landing. The landing surface was maintenance of muscle tone, mediated synchronized with a multichannel by muscle spindle function, is often electromyography amplifier/pro- cited for its critical role in cessor unit to signal the initiation and coordinated motion and musculo- completion of the 25° of inversion. skeletal protection via stiffness Each participant in the lateral ankle regulation, however, no studies have

Journal of Athletic Training S-183 simultaneously investigated resting properties of a joint. This synergistic muscle spindle afferent (MSA) activity relationship may permit ankles with and joint stiffness values. Objective: greater inherent stiffness to passively The purpose of this study was to resist loads and thus maintain lower determine if resting MSA activity muscle spindle activity at rest. correlates with joint stiffness during However, relatively compliant joints passive ankle joint loading. Design: may exhibit greater resting muscle Single-group post-test only. Setting: spindle afferent activity for earlier Human Performance Laboratory. detection of relatively small changes Patients or Other Participants: 29 in joint biomechanics. These subjects (20.9±2.2yrs, 173.1±8.9cm, complementary neuromechanical 74.5± 12.7kg) were recruited for this properties may exist to maximize study. Interventions: MSA recordings individual structure/ function were obtained at the common peroneal relationships and preserve joint nerve using microneurography, equilibrium. The inverse nature of this involving direct nerve recordings. relationship could contribute to the MSA activity was identified as divergent research outcomes response to muscle stretch, with attempting to link joint laxity, silence during muscle shortening and sensation and functional stability. skin stimulation. A modified ankle arthrometer was coupled with a nerve traffic analyzer and affixed to the subjects’ ankles. Three anterior translation movements to a force of 125 N of force were performed, allowing for simultaneous measure- ment of joint load, laxity, and MSA traffic. Main Outcome Measures: The MSA signal was normalized to peak values, and stiffness values (N/ mm) were calculated from 0-30N, 30- 60N, 60-90N, 90-125N, and 0-125N of anterior force. Pearson product- moment correlation coefficients were used to determine the relationship between resting MSA traffic (at 0N of force) and stiffness values. Alpha level was set a priori at 0.01. Results: Resting muscle spindle activity was 7.9±2.3% of peak activity. Significant negative correlations (p<.01) were observed between resting afferent traffic and joint stiffness at 0-30N (25.5±15.2N/mm; r=-0.61), 30-60N (18.1±7.7N/mm; r=-0.87), 60-90N (17.8±8.0N/mm; r=-0.77), and 90- 125N (15.2±3.8N/mm; r=-0.47), and total stiffness (17.9±5.3N/mm; r= -0.945). Conclusions: We hypoth- esize that the inverse relationship between MSA activity and ankle stiffness may reflect a neuro-logic optimization strategy whereby fundamental adaptations exist within the adult sensorimotor system that are contingent upon passive mechanical

S-184 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Poster Presentations: Injury Prevention & Treatment Wednesday, June 22, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11069SODI 11203DOEM Bioeletrical Impedance Analysis used to evaluate relationships between Log Roll Push Or Log Roll Pull: ∆ Versus Clinical Hydration Usg, Ucol, and TBW, as well as BM, Which Is The Favored Spine ∆ ∆ ∆ Measures In Minor Professional TBW, Usg, and Ucol. Results: BIA Boarding Technique For A Ice Hockey Players measured no significant changes in Prone Patient With A Suspected Emerson CC, Torres-McGehee TM, TBW and a significant increase in Thoracolumbar Injury? Minton DM: University of South %HY (1.03±1.26%, P<0.001). We Horodyski MB, Conrad BP,

Carolina, Columbia, SC, and North found increased Usg (0.002±0.005 µG, Marchese DL, Horodyski N, Terilli

Carolina State University, Raleigh, P=0.014), Ucol (0.87±1.23 shades, P, Smith M, Rechtine GR: University NC P<0.001), and decreased BM of Rochester, Rochester NY; (-1.31±1.02 kg, P<0.001) post- Department of Orthopaedics and Context: When choosing clinical practice. Body mass loss was Rehabilitation, University of Florida, assessment tools, clinicians must significantly greater than TBW loss Gainesville, FL; College of often balance accuracy and (P<0.001). There were no relation- Medicine, Florida State University, practicality. The National Athletic ships pre- or post-practice between Tallahassee, FL; Department of

Trainers’ Association recommends %HY and Usg, or %HY and Ucol. We Athletic Training, SUNY Brockport, monitoring hydration status and fluid found significant relationships Brockport, NY balance by assessing urine specific between Usg and Ucol both pre-practice ρ gravity (U ), urine color (U ), and ( =0.786, P<0.001) and post-practice Context: Previous research has found sg col ρ change in body mass (∆BM). The ( =0.744, P<0.001). Correlations that the log roll (LR) technique ∆ tetrapolar bioelectrical impedance were also found between BM and produces excess motion in the spinal ∆ ρ analysis (BIA) technique has been TBW ( =0.629, P<0.001), as well as column during patient transfer onto the ∆ ∆ ρ established as a valid, non-invasive Usg and Ucol ( =0.528, P<0.001). long spine board. Although alternatives Conclusions: ∆ measure of hydration status via total Usg, Ucol, and BM to the LR have been reported for body water (TBW) in euhydrated indicated hypohydration, while TBW patients in the supine position with humans. However, in the clinical and %HY indicated maintenance and either cervical or thoracolumbar setting the more cost efficient bipolar increase in hydration, respectively. injuries, the safest method of transfer technique is often applied to both Previous research has indicated that for a prone patient with a euhydrated and hypohydrated athletes. resistance is decreased after exercise, thoracolumbar injury has not been Objective: To compare the bipolar which may lead to positively skewed studied. Objective: To measure the BIA technique to common clinical TBW measurements and %HY amount of spinal motion occurring measures of hydration. Design: We calculations. Usg and Ucol provided when a prone patient with a employed cross-sectional analysis of assessments of hydration status which thoracolumbar injury is moved to a data from a larger randomized, control were comparable to each other. Bipolar long spine board using LR pull or LR trial. Participants: We recruited 10 BIA did not provide accurate measures push techniques. Design: A repeated male minor professional ice hockey of hydration status pre- or post- measures study design was used. players (age = 24.33+2.35 y, height = practice or changes in fluid balance in Setting: Cadaver laboratory. 182+5.26 cm, weight = 90.51+7.47 minor professional hockey players. Patients or Other Participants: kg). Interventions: Hydration Clinicians should rely on the Five lightly-embalmed cadavers (3 measures were taken before and after conventional practice of monitoring males, 2 females; mass: 135 kg ± 10 practices of a minor professional hydration status and fluid balance 31.2). None had any history of spinal ∆ ice hockey team. Main Outcome through urinalysis and BM. injury or thoracolumbar abnormality. Measures: As part a larger study, Interventions: A global instability researchers obtained pre- and post was surgically created at the L1 level measures of Usg, Ucol, BM and TBW by performing a corpectomy and (Tanita TBF-300A, Tanita Corpo- transection of the posterior ration, Tokyo, Japan). Concurrent ligamentous complex. An electro- TBW and BM measures were used to magnetic tracking device registered calculate percent hydration (%HY). motion between the T12 and L2 Dependent t-tests were used to vertebral segments as the two spine evaluate differences between pre- and boarding protocols were tested: LR post-practice BM and TBW, as well as pull and LR push. Both techniques ∆BM and TBW. Spearman’s rho was entailed performing a 180º LR rotation

Journal of Athletic Training S-185 11224UOEX of the prone patient from the ground Athlete Assessment Of Urine continuous variables and avoids the to the supine position on the spine Color Effectively Influences shortcomings of other correlation board while pulling (towards rescuers) Planned Hydration Behaviors statistics. We used a regression or pushing (away from rescuers) the Kelly JL, Eberman LE, Yeargin SW, analysis to determine the predictive cadaver onto the spine board. Main Vaal TL, Falconer SK: Indiana State value of UCa on planned hydration Outcome Measures: Dependent University, Terre Haute, IN behavior. We also analyzed the variables were flexion-extension, axial dependent measures with univariate and rotation, lateral bending, antero- Context: Athletic trainers educate bivariate statistics. Results: We posterior displacement, axial athletes on hydration practices and identified a strong relationship ρ translation, and medial-lateral self-assessment of hydration status via ( c=0.772, lower CL95=0.736) translation. Techniques were repeated urine color (UC) to help prevent heat between UCp (4±2) and UCa (4±1); three times per cadaver. Repeated illness and limit decrements to however we also identified 39.7% measures ANOVAs were completed to performance. However, athletes’ (n=125/315) of athletes somewhat assess differences for each of the ability to determine UC and their underestimated their UCa (mean dependent variables. Results: Under planned behaviors subsequent to this difference=-0.33±0.97). We found all conditions motion was greater with self-assessment are unknown. that even when UCa is moderate or high LR pull than with LR push. Objective: To determine the (UC≥4; 53.0%, n=167/315), athletes Differences were statistically relationship between practitioner are likely to report being only “a little” significant for three of the parameters. (50.9%, n=85/167) or “somewhat” (UCp) and athlete (UCa) assessments LR pull produced significantly greater of UC. To identify athletes’ planned (26.9%, n=45/167) dehydrated. Only motion for: flexion-extension [10.6º hydration behaviors after UC self- when UCa=7 (4.4%, n=14/315), did ± 2.8º for LR pull and 7.7º ± 2.8º for assessment. Design: Cross-sectional these athletes state they were “very LR push (p=0.021)]; axial dis- research design. Setting: Separate pre- dehydrated” (50%, n=7/14). Using the placement [11.6 mm ± 4.0 for LR pull participation examinations for division regression, we found UCa is a versus 8.4 mm ± 4.3 for LR push I and III collegiate football, cross significant predictor (R2=0.10, (p=0.014)]; and anteroposterior country, volleyball, and soccer teams. P<0.001) of planned hydration displacement [17.4 mm ± 7.6 for LR Participants: Athletes (n=315) behavior. Specifically, those with pull versus 15.3 mm ± 9.4 for LR push participated in a hydration station as UC≥4 (53.0%, n=167/315) were more (p=0.042)]. The amount of motion was part of the annual physical exam. likely to “Drink 4-5 cups (1L) of water/ not significantly different for: axial Members from each team sports drink” prior to starting their rotation LR pull (16.8º ± 6.7º) and LR (football=169, cross country=45, practice session (62.3%, n=104/167). push (15.1º ± 7.7º; p=0.389); lateral volleyball=28, soccer=73; male=230, Conclusions: Our objective was to bending LR pull (11.2º ± 2.5º) and LR female=85) signed informed consents determine the relationship between push (8.4º ± 3.4º; p=0.185); and prior to participation. Interventions: UCp and UCa and to gauge athletes’ medial-lateral displacement LR pull Athletes provided a urine sample and planned hydration behaviors. Results (13.4 mm ± 5.5) and LR push (12.2 completed a three-item online indicate that athletes are capable of mm ± 6.4; p=0.197). Conclusions: questionnaire. Four independent assessing their own UC, yet tend to When a patient is found in the prone underestimate their hydration status. practitioners evaluated UCp using a position and a thoracolumbar injury is standard urine color chart (Inter-rater However, athletes responded suspected, use of the LR push reliability ICC=0.88, P<0.001; Intra- appropriately when asked about their technique is recommended, instead of rater reliability ICC range=0.85-0.97, planned hydration behaviors. We the LR pull, to minimize spinal believe practitioners should continue P<0.001). For the UCa assessment, movement while transferring the the practitioners asked the athletes to to educate athletes about the meaning patient onto the long spine board. compare their UC to the same urine of UC and about the hydration color chart. The athletes were blind to behaviors that should follow self- assessment. UCp. Main Outcome Measures:

Dependent measures were UCp, and the

questionnaire results: UCa, description of hydration status, and planned

hydration behaviors (based on UCa). We used Lin’s concordance correlation coefficient (CCC) to

examine the relationship between UCp

and UCa. CCC is used to measure agreement between multiple raters for

S-186 Volume 46 • Number 3 (Supplement) May 2011 11264UOEX 11340UOEM Body Size And Fitness to-hip ratio. Results: NFL players Lacrosse Helmet Facemask Characteristics Of National exceed the normal values for BSA Removal Timeliness Using Football League Players: An (mean=2.33±.24, norm=1.73m2) and Cordless Screw Driver, FM Update BMI (mean= 31.35±4.70kg/m2, grade Extractor, And Combined Tool Vaal TL, Eberman LE, Yeargin SW, 1 obesity), have a smaller than normal Approach Kelly JL, Howder JR, Young KD, BSA-mass ratio (mean=0.022±0.002 Frick KA, Bradney DA, Aronson PA, Sibrel DL: Indiana State University, m2/kg, norm=0.026m2/kg), but Bowman TG: Lynchburg College, Terre Haute, IN according to the waist-to-hip ratio Lynchburg, VA (0.85±.05) are at a low health risk. We Context: The literature has described identified statistical differences Context: In the case of a catastrophic the physical characteristics of National between positions for BSA (F3,57= cervical spine injury during athletic

Football Players (NFL) since 1970; 93.22, p<0.001), BMI (F3,57=79.46, play, removal of the facemask is however, each edition of new data has p<0.001), BSA-mass ratio (F3,57= necessary to establish a patent airway articulated level of fitness using a 103.35, p<0.001), and waist-to-hip for the helmeted athlete. Current variety of variables. While body mass ratio (F3,57=13.52, p<0.001). For literature stresses the importance of index (BMI) has been criticized for its BSA, QB/RB/ST (2.22±0.14m2) and timely removal of the facemask from use among athletes, the measure is still TE/LB (2.34± 0.07m2) are statistically the helmet to provide appropriate care used to describe fitness. Other equal, while OL/DL (2.61±0.12m2) are to the athlete. No data to date has variables, besides body composition larger and WR/DB (2.09±0.08m2) are evaluated face mask removal and BMI are available for classifying smaller. For BMI, OL/DL (36.9± techniques on men’s lacrosse helmets. fitness among athletes. Objective: To 3.0kg/m2) are larger than all other Objective: To compare the speed of update body size and physical groups, but QB/RB/ST (27.9±1.9kg/ 3 methods of removing the facemask characteristic norms of NFL players m2) and WR/DB (27.2±1.4kg/m2) are of a men’s Cascade CPX lacrosse using several calculations of fitness. the smallest groups. BSA-mass ratio helmet. Design: 2 x 3 crossover trial. Design: We used a non-experimental, calculations reveal that QB/RB/ST Setting: Controlled laboratory descriptive research design to observe (0.023±0.001m2/kg) and WR/DB setting. Patients or Other Parti- the body size and physical (0.024±0.001m2/kg) are statistically cipants: We used 20 participants, 10 characteristics of NFL players. similar, and although TE/LB Certified Athletic Trainers (ATCs) and Setting: Preseason physical (0.021±0.005m2/kg) and OL/DL 10 Athletic Training Students (ATSs). examinations of one NFL team. (0.019±0.001m2/kg) are significantly Interventions: Our independent Participants: Sixty-one players different, they are smaller than both variables consisted of removal method (age=25±3yrs; height=1.86±0.07m; the other groups. Waist-to-hip ratio (cordless screw driver, CSD; FM body mass=109.2±21.5kg) partici- measurements were significantly Extractor, FMX; combined tool pated in data collection. Intervention: difference between OL/DL (0.90± approach, CTA) and group (ATC, ATS). We calculated descriptive statistics 0.05) and all other groups were smaller Each facemask removal technique was and frequencies for all dependent (QB/RB/ST=0.83±0.04, WR/DB= explained in detail to the participants measures. We compared players by 0.82 ±0.02, TE/LB=0.85±0.04). Data for specific cuts of loop straps or position using separate one-way suggest that BSA (r=0.86, p<0.001) screw(s) to unscrew. We counter- ANOVAs. We analyzed the relation- and waist-to-hip ratio (r=0.71, balanced the order of the removal tools ships (Pearson correlations) between p<0.001) are significantly correlated throughout the study. Main Outcomes BMI and the other dependent to BMI, while BSA-mass ratio (r= Measures: We measured the time to measures. Main Outcome Meas- -0.97, p<0.001) and BMI are inversely the nearest hundredth of a second from ures: Demographic data (age, correlated. Conclusions: Our results when the participants first picked up position) was acquired from the suggest that lineman are significantly the removal tool until the time when medical staff. Because of the smaller larger than the other position players, the facemask had been completely sample, we classified position by the but their smaller waist-to-hip ratio removed from the helmet. Participants following: quarterbacks/running demonstrates that they may distribute stated preference of method verbally backs/special teams (QB/RB/ST, n=8), adipose effectively. In addition, BMI on a 10 point scale, 0 being completely wide receivers/defensive backs (WR/ has been criticized in the literature, but unsatisfactory and 10 being DB, n=21), tight-ends/linebackers (TE/ it appears that this measure is still completely satisfactory. We analyzed LB, n=12), and lineman (OL/DL, highly correlated with other measures data using a factorial ANOVA for each n=20). We measured body mass, of morphology or level of fitness. dependent variable. Results: When we height, waist and hip circumference. analyzed the results, the interaction We calculated BMI, body surface area between removal method and group (BSA), BSA-to-mass ratio, and waist- was not significant for time

Journal of Athletic Training S-187 (F2,54=1.22, p=0.30) or preference

(F2,54=0.36, p=0.70). We did discover a main effect for method of removal on time (F2,54=15.27, p<0.01). Tukey post hoc tests indicated the use of the CSD (38.83±11.49) was significantly faster than the use of the FMX (207.92±143.20, p<0.001) or CTA (167.83±103.96, p=0.001). We also found a significant main effect for method of removal on preference scores (F2, 54=38.35, p<.001). Tukey post hoc tests revealed significant differences between the preference of the CSD (9.20±0.52) and the FMX (4.85±1.93; p<0.001), and between the CSD (9.20±0.52) and the CTA (6.05±1.90; p<0.001). We found no significant differences between the FMX (4.85±1.93) and the CTA (6.05±1.90; p=0.06). We observed no group differences for time (F1,54=1.99, p=0.16) or preference (F1,54=0.057, p=0.81). Conclusions: The CSD was the fastest and most preferred method to remove a facemask from a new men’s Cascade CPX lacrosse helmet. Also, we observed no significant differences in the amount of time it took ATCs and ATSs to remove facemasks.

S-188 Volume 46 • Number 3 (Supplement) May 2011 Free Communications, Poster Presentations: Professional Development Wednesday, June 22, 2011, 8:00AM - 12:00PM, Outside Hall A, authors present 11:00AM - 12:00PM 11134MOHE 11152FOHE What Influences Senior the data was analyzed inductively, Post Professional Athletic Undergraduate Athletic Training borrowing from the grounded theory Training Education: Attractors Students Career Decisions Post approach. Data analysis required And Career Intentions Graduation? independent coding by 2 athletic Mazerolle SM, Dodge TM: Gavin KE, Mazerolle SM, Pitney trainers for specific themes. University of Connecticut, Storrs, WA, Casa DJ: University of Credibility of the results was CT, and Springfield College, Connecticut, Storrs, CT, and confirmed via peer review, Springfield, MA Northern Illinois University, methodological and multiple analyst DeKalb, IL triangulation. Results: Two higher Context: Recent evidence suggests order themes emerged from the data students enter the athletic training Context: Career opportunities for analysis: Persistence in Athletic profession upon graduation due to athletic training students (ATSs) have Training (AT) and Decision to Leave support from faculty and clinical significantly increased over the past AT. Faculty and clinical instructor instructors. Students pursue graduate few years. However, it commonly support, improved marketability, and education in order to promote appears that ATSs are opting for a more professional growth were supporting professional development. Anec- diversified professional experience themes describing persistence in AT. dotally, we know students select after graduation. With the diversity in Additionally, the supporting theme of graduate programs based upon available options and no current professional growth was categorized location, finances, and future career recommendation for post-pro- by obtaining more real-world goals. A recent report suggests fessional study, an understanding of professional experience and to help satisfaction with post-professional career decision is imperative. obtain career goals through a matched athletic training (PPAT) program Objective: The purpose of our study work-experience. Shift of interest graduate studies, however empirically, was to investigate, using the theoretical away from AT, lack of respect for the we are lacking information on what framework of socialization, the AT profession, compensation, time attracts a student to these programs. influential factors behind the post commitment, and AT as a stepping Objective: To gain an appreciation for graduation decisions of the senior stone were themes sustaining an ATS’s the selection process of graduate study, ATSs. Design: Qualitative design reason to leave AT. The afore- focusing on the PPAT program and using internet-based, structured mentioned reasons to leave were often implications for selection. Design: interviews, as well as follow-up semi- discussed collectively by the Grounded theory study using semi- structured phone interviews. Setting: participants, rather than an isolated structured phone interviews. Setting: Web-based management system, reason for leaving; generating a Post professional athletic training HuskyCT, which is a secure program collective undesirable outlook of AT programs accredited by the NATA. that allows educators and researchers profession. Conclusions: The results Patients or Other Participants: to engage in asynchronous communi- of this study corroborate previous Nineteen first year PPAT students cation with individuals. Patients or literature on and highlight the participated and represented 13 of the Other Participants: 22 ATSs (16 importance of faculty support and early 16 accredited PPAT programs. The females; 6 males), who graduated in socialization to the AT profession. average age was 23 ± 1. Participants May 2010 from 13 different Professional growth and skill rated the dynamic nature of the Commission on Accreditation of development drive the ATS to seek profession, positively (9±1) and a Athletic Training Education (CAATE) additional experiences at the graduate majority of those who participated programs. The average age was 22+2 assistant level, while a myriad of were positively influenced to attend a and they represented 7 NATA districts. factors influence the ATS to choose PPAT program because of a mentor and Six ATSs agreed to participate in other career options. Socialization of the existence of a PPAT program at follow-up phone interviews. pre-athletic training students could their undergraduate institution. Data Recruitment was guided by data alter retention rates by providing in- Collection and Analysis: All saturation. Criterion sampling was depth information about the interviews were conducted via phone utilized to identify participants, while profession before students commit in and transcribed verbatim. Analysis of recruitment was done randomly by their undergraduate education, as well the interview data followed the emailing program directors of CAATE as helping reduce attrition prior to procedures as outlined by a grounded accredited programs. Data entrance into the workforce. theory approach. Trustworthiness of Collection and Analysis: All inter- the data was secured by: 1) participant views were transcribed verbatim and transcript checks, 2) participant

Journal of Athletic Training S-189 11260FOHE interpretative verification, and 3) College Athletic Trainers’ believe that ATs are knowledgeable multiple analyst triangulations. Perceived Knowledge And with regard to mental health conditions Results: Athletic training students Competence With Mental and issues affecting student athletes. select PPAT programs for 4 major Health Disorders Only 75% reported they are reasons: 1) career intentions, 2) Krause BA, Millspaugh S: Division knowledgeable about and competent in mentorship received from under- of Athletic Training, School of the management of mental health graduate faculty/clinical instructors, Applied Health Sciences and conditions affecting student athletes. 3) reputation of the program/faculty, Wellness, Interdisciplinary Institute Strikingly, 54.3% report they are not and 4) professional socialization. for Neuromusculoskeletal Research, knowledgeable about the medications Participants discussed long term College of Osteopathic Medicine, prescribed in the management of professional goals specifically Ohio University, Athens, OH mental health conditions. Similarly, working as an AT as the driving force two thirds (65.7%) of ATs state they behind wanting an advanced degree in Context: Literature suggests that are unaware of the adverse drug AT. Faculty and clinical instructor athletic populations are more prone to reactions (ADR) prescribed in the recommendations along with the mental health conditions. These management of mental health prestige of the program helped guide conditions are often clinically conditions. Conclusions: These pilot the decisions. Participants also misinterpreted and it is common for data indicate a discrepancy may exist expressed the need to gain more athletes to not recognize or between the perceived need for experience, which provided autonomy acknowledge the symptoms. Without establishing a knowledgeable and but also support while gaining real appropriate pharmacological and/or competent practice relative to mental work experience. Final selection of psychological management, symptoms health disorders and the actual the students’ PPAT program was based across the continuum of mental health perceived ability to actualize this upon academic offerings, the disorders likely will persist. outcome. This inconsistency is most assistantship offered, including Objective: The purpose of this study pronounced when reflecting upon financial support as well as advanced was to develop pilot data regarding psychodynamic medications and their knowledge in athletic training athletic trainers’ (ATs) perceived potential ADRs. Awareness and concepts and principles, and knowledge of and competence in the understanding of specific mental mentorship opportunities, both in management of mental health health disorders and issues that application of research and clinical conditions including depression, contribute to the mental health of the skills. Conclusions: Students who mood disorders and anxiety disorders. student athlete is an entry-level attend PPAT programs are attracted to Design and Setting: Online, competence. These results the pursuit of advancement of their electronic survey. Patients or Other demonstrate the importance of entry-level knowledge, are committed Participants: Athletic trainers increasing the profile of the to their professional development as (n=144) from NCAA colleges and psychosocial management and referral an AT, and view the profession of universities were emailed a link to an educational domain. There is an ever athletic training as a life-long career. online survey. Interventions: The increasing public awareness of mental These students are excited for the Athletic Trainers’ Perceived health issues in student athletes. future and the combination of balanced Competence with Mental Health Athletic trainers (ATs) must be at the academics, clinical experiences, Conditions and Issues Questionnaire forefront of the recognition and additional professional socialization was validated by content experts and management of these conditions. This and mentorship from the PPAT program approved by the Office of Research must include the continuum of mental experience will help them secure their Compliance Biomedical IRB prior to health disorders and issues, including desired position. Continued research its distribution. Main Outcome DSM-IV criteria, appropriate referral is necessary to determine the Measure(s): Frequencies and sources, and pharmacological and influence of mentorship both in a descriptive measures were calculated psychological intervention. positive and negative direction as preliminary evidence about athletic regarding pursuit of an advanced AT trainers’ knowledge of and degree. competence in the management of mental health conditions in collegiate student athletes. Results: The majority of respondents believe that ATs should have a competent level of knowledge of mental health conditions (89.5%) and mental health issues (94.7%). Respondents (80.2%)

S-190 Volume 46 • Number 3 (Supplement) May 2011 11307MOIN Athletic Trainers’ Comfort And mailed to participants through the Competence In Addressing automated NATAREF service. Main Psychological Issues Of Athletes Outcome Measure(s): Descriptive Biviano GM, Semerjian TZ, Butryn statistics including means, medians, TM, Brown HL, Douex AT: frequencies, and modes were used to Department of Kinesiology, Athletic analyze the AT’s demographic data. Training Research Laboratory, San Separate logistic regression analyses José State University, San José, CA were employed to determine the predictability of COM or PCO based Context: The amount of time Certified on demographics. Differences in Athletic Trainers (ATs) spend with their COM or PCO across practice settings athletes is conducive to certain roles. were identified using Analysis of Oftentimes, ATs are often the only Variance (ANOVA) procedures, where health care providers managing the P<.05 indicated significance. physical and psychological conse- Results: ATs reported “sometimes” quences of injury for athletes, yet it (54.4%, n=162) encountering remains unknown how often they psychological issues related to injury address non-injury related psy- and unrelated to injury (56.4%, n=167) chological issues that may predispose in their student-athletes. Respondents them to injury. Objective: To reported feeling slightly less determine the types of psychological competent and less comfortable in issues that ATs encounter, their dealing with non-injury related comfort (COM) and perceived psychological issues as compared to competence (PCO) in addressing injury related psychological issues. those issues, and referral patterns. Higher levels of the ATs perceived Design: Descriptive survey. Setting: comfort and competence could not be An online survey of current members predicted based on demographic of the National Athletic Trainers’ variables such as gender, age, years of Association (NATA). Patients or experience, highest degree achieved, Other Participants: One-thousand additional certifications, or amount of ATs were randomly selected by the psychological preparation. Addition- NATA Research and Education ally, there were no significant Foundation (REF) list service and differences between practice settings invited for participation via e-mail. A for injury-related issues and COM total of 311 ATs (155 male, 156 (F=.326, p>.05) or PCO (F=.522, female) responded to the invitation e- P>.05), nor for non-injury related mails sent, yielding a response rate of psychological issues and COM 31.1%. The sample was mainly (F=.900, p>.05) or PCO (F=.658, composed of respondents, ages 26-44 p>.05). Conclusions: Most ATs (68.7%, n=213), who were employed believe it is their role to address as ATs in Secondary Schools (38.7%, psychological issues with athletes; n=120), Colleges/Universities however it is remains unknown why (31.9%, n=99), and Clinics (9.35%, some ATs have more perceived comfort n=29). Interventions: The web-based or competence with psychological instrument was adapted from Mann et issues than their AT counterparts. al (2007) who examined COM, PCO, and referral patterns of Physicians managing psychological issues under their care. Modified to assess ATs, the instrument was examined for content validity using a pilot study (n=21 ATs). The 32 question survey was generated and managed using Survey- Monkey.com®. The invitations, web- link, and follow-up reminders were e-

Journal of Athletic Training S-191 Author Index Boling MC, S-28, S-29, S-116, Cooper E, S-77 S-122, S-164, S-172 Cordova ML, S-105 A Borland JF, S-57 Coris E, S-75 Borsa PA, S-138 Cormack S, S-163 Abbott MJ, S-157 Boucher AM, S-43, S-79 Cortes N, S-70, S-109, S-171 Abshire SM, S-48 Bowman TG, S-19, S-187 Cosby NL, S-102 Abt JP, S-170 Bowser B, S-99 Cosby Nl, S-96 Akehi K, S-165 Bradney DA, S-19, S-187 Cross K, S-82, S-133 Alvarez JL, S-157 Brattain Rogers N, S-59 Cross KM, S-85 Amar V, S-147 Brigle J, S-169 Croy T, S-12 Ambegaonkar JP, S-109 Broglio SP, S-15, S-151, S-159 D Ames B, S-145 Brooks MA, S-109 Amin M, S-104, S-108 Brown CN, S-35, S-61, S-99 Dale A, S-145 Aminaka N, S-37, S-40 Brown HL, S-41, S-191 Danov Z, S-92 An YW, S-44 Buckley TA, S-16 David S, S-149 Applegate KA, S-78 Burkholder R, S-74, S-75 Day C, S-46 Aragon VJ, S-25, S-80 Burningham DS, S-110, S-144 de la Motte SJ, S-174 Armentrout S, S-56 Burns M, S-96 De La Torre L, S-112 Armstrong CW, S-37, S-101, S-120, Burns MF, S-18 DeAngelis AI, S-172 S-168 Burrer JL, S-153 Decoster LC, S-18 Armstrong KJ, S-54 Burton LJ, S-57 Dee AE, S-140 Armstrong LE, S-21, S-77 Bush HM, S-30, S-32, S-80, S-159 Del Rossi G, S-18 Arnold BL, S-43, S-97, S-118, Buskirk GE, S-166 Deluzio JB, S-170 S-124, S-132, S-181 Butryn TM, S-41, S-191 DeMartini JK, S-75 Aronson PA, S-187 Butterfield TA, S-48, S-68, S-130, DeMont RG, S-67 B S-140 Detwiler K, S-91 Dicharry J, S-84, S-178 Baer D, S-75 C Diduch DR, S-103 Bain M, S-143 Califano KM, S-49 DiStefano LJ, S-70, S-71, S-173, Balasubramanian E, S-104, S-106, Callans TE, S-172 S-174 S-108 Cameron K, S-174 Docherty CL, S-39, S-40, S-52, Bamer M, S-60 Candelaria KA, S-163 S-127 Barbe MF, S-104, S-108 Carica CR, S-136 Dodge T, S-143 Barnard-Brak L, S-43, S-79 Carr KE, S-49 Dodge TM, S-40, S-189 Bartolozzi AR, S-27, S-74 Carson EW, S-103 Doeringer JR, S-166 Baumgartner TA, S-61 Carter AR, S-19 Donahue M, S-52, S-127 Bay RC, S-32, S-34, S-39, S-50, Casa DJ, S-21, S-75, S-77, S-78, Donovan L, S-126 S-51, S-61, S-63, S-89 S-189 Doster CM, S-136 Bazett-Jones DM, S-174, S-175 Cashin SE, S-174, S-175 Douex AT, S-41, S-191 Begalle RL, S-122 Cassidy RC, S-141 Dover GC, S-67, S-129, S-147 Bell DR, S-44, S-71, S-122, S-123 Cattano N, S-108 Draper DD, S-161 Belval LN, S-21 Cattano NM, S-104, S-106 Driban JB, S-106, S-108 Benson BA, S-115 Cavanaugh JT, S-132 Driban JD, S-104 Benson SB, S-64 Cavett HL, S-130 Drouin J, S-53 Bernhardt DT, S-91 Cayton SJ, S-34 DuBose DN, S-18 Berry DC, S-110, S-144, S-148 Chadburn JL, S-154 Dupont-Versteegden EE, S-48 Berry R, S-154 Chaffee A, S-50 Dwelly PM, S-24 Beutler AI, S-28, S-29, S-174 Cheatham CC, S-130 E Bezold L, S-92 Chhabra A, S-61, S-63 Biviano GM, S-191 Childress S, S-12 Earl JE, S-174, S-175 Blackburn JT, S-70, S-71, S-83, Chinn L, S-100, S-178, S-179 Earl-Boehm J, S-28 S-122, S-170, S-176 Christensen B, S-153 Eberman LE, S-21, S-22, S-24, S-56, Blair DF, S-139, S-157 Cleary MA, S-22, S-76 S-59, S-186, S-187 Bobo L, S-94 Cobb SC, S-174, S-175 Emerson CC, S-185 Bochicchio EB, S-144 Conaway M, S-85 Emery CA, S-28 Bolgla L, S-28 Conrad BP, S-18, S-185 Emmanuel H, S-21

S-192 Volume 46 • Number 3 (Supplement) May 2011

Boucher AM, S-43, S-79 Ericksen HM, S-36, S-107 Grooms D, S-31 Hobson S, S-149 Eusea J, S-129 Grow KK, S-41 Hoch JM, S-159 F Gurchiek LR, S-13, S-112 Hoch MC, S-72, S-182 Gurka KK, S-85 Hoche MC, S-180 Fairbrother B, S-156 Guskiewicz KM, S-15, S-16, S-35, Hochstuhl D, S-86 Falconer SK, S-186 S-70, S-120 Hoffman MA, S-166 Farquhar WB, S-183 Gustavsen G, S-13, S-111 Holcomb WR, S-130 Fayson SD, S-114 Guyer SM, S-109 Hollis JM, S-13, S-112 Fehring TK, S-105 Gyorkos AM, S-111 Holwerda SW, S-47 Feland JB, S-161 Hootman J, S-106 Ferber R, S-28, S-115, S-163 H Hopkins JT, S-161 Ferrara MS, S-35, S-61, S-77 Horodyski MB, S-18, S-185 Finn ME, S-21, S-22 Hackett TR, S-150 Horodyski N, S-18, S-185 Fliegelman M, S-149 Hagedorn EM, S-32 Hosey R, S-93, S-141 Ford KR, S-30, S-118 Hale SA, S-19 Hosey RG, S-141 Forsyth JL, S-163 Hall EA, S-173 House AJ, S-170 Foster TE, S-142 Hamstra-Wright KL, S-28 Housman JM, S-62 Fowkes Godek S, S-74 Han KM, S-173 Howder JR, S-187 Fowkes-Godek S, S-75 Hankemeier D, S-58 Howell D, S-136 Frank BS, S-122, S-132 Hankemeier DA, S-37, S-137 Hubbard TJ, S-105 Freed SD, S-157 Hansen ML, S-119 Huggins RA, S-106 Frick KA, S-187 Hansen PJ, S-93, S-153 Hunter I, S-161 Friedline AV, S-120 Hansen S, S-144 Huxel Bliven K, S-32, S-34, S-51, Fruechte B, S-133 Hardin SN, S-151 S-89 Harris KP, S-106 G Harrison BC, S-84, S-135 I Gage MJ, S-21, S-22, S-161 Hart CH, S-91 Ingersoll CD, S-103, S-106, S-178 Ganio MS, S-75 Hart J, S-84 Ingram RL, S-114 Gardner IK, S-67 Hart JA, S-103 Ireland ML, S-95 Garrett WE, S-70 Hart JM, S-82, S-102, S-103, S-134 Isham LL, S-18 Gaskill TR, S-69 Harter RA, S-97 Gatti JM, S-136 Hartley EM, S-116 J Gavin KE, S-189 Hashiwaki J, S-165 Jacobs D, S-95 Gentner NB, S-58 Hawkins JR, S-128 Jaric S, S-72 George SZ, S-138 Hawkins RJ, S-26 Jay O, S-75 Giuliani C, S-83 Haynes HL, S-39 Johns L, S-144 Glutting J, S-108 Haynes MB, S-110 Johnson KD, S-134, S-135 Glutting JJ, S-72 Hedderson W, S-44 Joshi M, S-174, S-175 Gobert DV, S-62, S-97 Heinerichs S, S-53 Joyner AB, S-58 Goerger BM, S-29, S-96, S-122, Heitman RJ, S-13, S-112 Jutte LS, S-46 S-132 Henning JM, S-54 K Goldberg JS, S-118, S-181 Herman D, S-82 Gordon JR, S-159 Hernandez AE, S-18 Kahanov L, S-56, S-66 Goto S, S-123 Hertel J, S-12, S-84, S-85, S-96, Kaminski TW, S-13, S-27, S-72, Gour-Provencal G, S-67 S-100, S-133, S-134, S-178, S-111, S-114, S-183 Gray MT, S-21 S-179 Kamphoff C, S-56 Greenwood LD, S-43, S-79 Hetzel SJ, S-49, S-109 Kanga J, S-93 Greenwood M, S-43, S-79 Hetzler RK, S-180 Kardun a AR, S-132 Grenz A, S-61 Hewett TE, S-30, S-118 Kavanaugh CK, S-141 Greska E, S-70, S-171 Hibberd EE, S-79 Keenan KA, S-170 Gribble PA, S-36, S-37, S-40, S-99, Hicks-Little CA, S-67, S-105 Keller DM, S-47 S-100, S-101, S-107, S-120, Higginson C, S-176 Kelly JL, S-186, S-187 S-166, S-167, S-168, S-169, Higginson JS, S-27 Kelly SE, S-167 S-182 Hilgendorf J, S-97 Kendall KD, S-163 Grindstaff TL, S-31, S-96, S-102, Hiller CE, S-167 Kim AS, S-176 S-134, S-135 Himes M, S-134 Kim KM, S-134, S-135, S-178

Journal of Athletic Training S-193 Kimura IF, S-180 M Minton DM, S-75, S-185 Kissenberth MJ, S-26 Montgomery MM, S-124 Macciocchi SN, S-61 Klau JF, S-21 Moody SA, S-97 MacDonald A, S-93 Klossner JC, S-40 Morrison KE, S-74, S-75 Mackey T, S-56 Klugman MF, S-30 Mueller FO, S-15 Manspeaker SA, S-58 Klykken LW, S-104 Mullineaux D, S-100 Marchese DL, S-185 Knight AC, S-183 Mullineaux DR, S-180 Maresh CM, S-78 Knight BD, S-111 Munkasy BA, S-16 Margulies KM, S-146 Knight KL, S-128 Murphy S, S-86 Marshall SW, S-15, S-26, S-28, S-29, Ko JP, S-99, S-100, S-182 Murthi DS, S-18 S-70, S-174 Kollock R, S-165 Musler J, S-87 Martin M, S-66 Kollock RO, S-171 Mutchler J, S-165 Martinez A, S-74 Kosior KA, S-146 Myer G, S-66 Martschinske JL, S-75 Kovaleski JE, S-13, S-112 Myer GD, S-30, S-85, S-118 Marty MC, S-54 Kowell SM, S-137 Myers JB, S-25, S-26, S-79, S-80 Mattacola CG, S-159, S-182 Krause BA, S-129, S-190 Myrer JW, S-161 Matus J, S-130 Kreiswirth E, S-66 Mays S, S-120 N Kreiswirth EM, S-85 Mazerolle SM, S-57, S-77, S-78, Kroskie RW, S-39 Nagai T, S-170 S-88, S-189 Kuenze C, S-82 Naguib SA, S-13 McCann J, S-74 Kuenze CM, S-103 Napolitano J, S-146 McCary L, S-94 Kyoungyu J, S-180 Nashed A, S-129 McClelland RI, S-151, S-152 Naugle KE, S-44 L McClure PW, S-33 Naugle KM, S-44 La Bounty P, S-43, S-79 McCurdy K, S-110 Nazarian L, S-27 Lacy DL, S-150 McDermott BP, S-21, S-22, S-75 Needle AR, S-14, S-72, S-111, Lam KC, S-32, S-49, S-50, S-61, McDevitt SM, S-162 S-114, S-183 S-63, S-89 McDowell LM, S-77 Nelson C, S-146 Landin D, S-24, S-158 McGinness CJ, S-139, S-157 Nguyen A, S-116, S-164, S-172 Langemaat J, S-127 McGrath ML, S-83, S-122 Nguyen AD, S-116 Larkin KA, S-138 McGriff SL, S-166 Nicollelo T, S-89 Lattermann C, S-159 McGuine TA, S-49, S-109 Niemann AJ, S-21, S-22 Laverty WK, S-97 McGuire B, S-133 Noonan TJ, S-26 Lavigne G, S-129 McIntosh ID, S-46 Norcross MF, S-122, S-170, S-176 Leach CA, S-39 McKeon JM, S-182 Norkus S, S-153 Leake M, S-69 McKeon PO, S-72, S-100, S-141, Norkus SA, S-146 S-180, S-182 Leal EW, S-159 O Lee HR, S-35 McLean SG, S-104 Leiting KA, S-65 McLeod M, S-100 O’Brien K, S-86 Lephart SM, S-170 McLeod MM, S-99, S-182 Odum SM, S-105 Lepley AL, S-107 McNeil M, S-156 Oliaro SM, S-25, S-80 Lepley AS, S-36 Medina McKeon JM, S-30, S-32, Onate JA, S-171 Letchford EC, S-118, S-181 S-141, S-160 Oñate JA, S-165 Lewek MD, S-83, S-176 Mensch JM, S-40 O’Neill M, S-72 Linens SW, S-43, S-97 Menzies A, S-74 Oney JR, S-111 Linnan L, S-15 Michael CL, S-139, S-157 Onofrio MC, S-129 Liu K, S-13 Michener LA, S-33, S-132 Ott BN, S-102 Liu T, S-110 Mihalik JP, S-16, S-35, S-120 Oyama S, S-25, S-26, S-79, S-80 Liu Z, S-46 Miles JD, S-35, S-77 Long BC, S-165 Miller HE, S-111 Lopes ME, S-172 Miller KC, S-93, S-153 Lopez RM, S-22, S-75, S-76 Miller MD, S-103 Lounsberry NL, S-72 Miller MG, S-111, S-130 Millett PJ, S-69 Millspaugh S, S-190 Milton AE, S-93

S-194 Volume 46 • Number 3 (Supplement) May 2011 P Resch J, S-77 Sigl J, S-49, S-109 Resch JE, S-35, S-61 Sikka R, S-75 Padilla RA, S-163 Rhee YS, S-93 Silkman CL, S-159 Padua DA, S-25, S-28, S-29, S-44, Ricard MD, S-173 Silkman CS, S-160 S-70, S-71, S-80, S-83, S-96, Rigby JH, S-62 Silvestri PG, S-67 S-122, S-123, S-132, S-174, Ringleb S, S-70 Simon J, S-52 S-176 Robbilard L, S-144 Sisson L, S-12 Page P, S-24 Roche R, S-75 Sitler MR, S-104, S-106, S-108 Pagnotta KD, S-57, S-75, S-77, S-78 Rogers KJ, S-86 Slye CA, S-116, S-164, S-172 Palmer T, S-31 Ronan KA, S-141 Smalley BW, S-170 Palmieri-Smith RM, S-102, S-104 Rose W, S-183 Smart MM, S-79 Parente W, S-96 Ross SE, S-97, S-118, S-124, S-181 Smith M, S-185 Parisi GL, S-116, S-164, S-172 Ross SE,, S-43 Snyder AR, S-33, S-49, S-50, S-63, Park CM, S-168 Rothbard M, S-145, S-146, S-149 S-89, S-119 Parr JJ, S-138 Rozzi SL, S-116, S-164, S-172 Snyder Valier AR, S-32, S-50 Parsons JT, S-50, S-63, S-89 Rupp KA, S-126 Sosnoff JJ, S-15, S-159 Patel R, S-92 Spang JT, S-79 Pecci M, S-154 S Spiers SN, S-43 Peindl RD, S-105 Sabin MJ, S-15, S-159 Springer BD, S-105 Peltier CE, S-139 Saladino HA, S-155 St Julian C, S-94 Perlsweig KA, S-180 Saliba E, S-126 Starkey C, S-60 Perrier ET, S-166 Saliba S, S-12, S-46, S-85, S-106, Starliper M, S-135 Petrillo R, S-146 S-126, S-134, S-135 Staton GS, S-182 Petron DJ, S-67 Sanchez Z, S-68 Stearns RL, S-21, S-75 Pfile KR, S-40, S-166, S-168, S-169 Sanders JJ, S-174, S-175 Stemmans CL, S-59 Pidcoe PE, S-124 Sanger RH, S-173 Stephenson DR, S-159 Pietrosimone BG, S-36, S-37, S-40, Sato A, S-40 Stephenson LJ, S-70, S-71 S-99, S-100, S-101, S-103, Sauer L, S-82, S-100, S-133, S-179 Stergiou N, S-83 S-106, S-107, S-120, S-166, Sauers EL, S-32, S-51 Stern AS, S-82 S-168, S-169, S-182 Sauret JJ, S-158 Stickley CD, S-180 Pitney WA, S-59, S-88, S-189 Scannell BP, S-105 Storvsed JR, S-151 Plato PA, S-41 Schaffner L, S-99, S-100, S-182 Straub SJ, S-149, S-156 Plos JM, S-65, S-155 Schlegel TF, S-26 Sudweeks RR, S-161 Polubinsky RL, S-65 Schmitz RJ, S-124, S-158, S-162 Sugarman ES, S-75 Pope M, S-100 Schneider GP, S-59 Sugimoto D, S-30 Potter TA, S-148 Schrader J, S-127 Sulewski AL, S-64 Prentice WE, S-79, S-120 Schwartz HS, S-95 Sullivan C, S-70 Q Schweitzer MS, S-127 Swanik CB, S-14, S-27, S-72, S-111, Scibek JS, S-136 Quada EJ, S-137 S-176, S-183 Scott JL, S-153 Quigg AS, S-142 Swanik KA, S-27 Scullin G, S-75 Quinn J, S-46 Swank EM, S-119 Seeley MK, S-161 Swartz EE, S-18, S-151 R Seiler BD, S-58 T Raab SA, S-87 Seitz SL, S-132 Ragan BG, S-60 Selkow NM, S-46, S-126, S-134, Takaoka A, S-112 Rainey J, S-136 S-135 Tate A, S-94 Ransone JW, S-112 Sell TC, S-170 Terada M, S-120 Rauh MJ, S-85 Semerjian TZ, S-191 Terhune W, S-92 Rechtine GR, S-18, S-185 Shah SA, S-86 Terilli P, S-185 Redmond CJ, S-109 Shanley E, S-26 Tevald MA, S-168 Refshauge KM, S-167 Shinew K, S-60 Thigpen CA, S-26, S-132 Regan M, S-149 Shinohara J, S-40, S-168 Thoens AL, S-151 Register-Mihalik JK, S-15, S-16, Shockey AK, S-19 Thomas AC, S-102, S-104 S-35, S-120 Shultz SJ, S-124, S-158, S-162, S- Thomas SJ, S-27, S-176 Reichard RL, S-80 176 Thompson B, S-109 Rendos N, S-84 Sibrel DL, S-187 Thompson MD, S-24, S-158

Journal of Athletic Training S-195 Tice M, S-155 Wikstrom EA, S-44, S-161 Timmons MK, S-132 Winter C, S-109 Toler JD, S-16, S-35 Winterstein AP, S-49 Torres-McGehee TM, S-185 Wojtys EW, S-102 Toy MG, S-22, S-76 Wright CJ, S-97, S-118, S-124, Treadwell KM, S-97 S-181 Tripp BL, S-24 Wyland DJ, S-26 Tripp PM, S-24 Y Trowbridge CA, S-47, S-127 Tsang KKW, S-163 Yeargin SW, S-21, S-22, S-186, Tucker WS, S-114, S-136 S-187 Yoder A, S-66 U Young AM, S-40 Uhl T, S-68 Young KD, S-187 Uhl TL, S-32, S-80 Yu BK, S-134, S-135 V Z Vaal TL, S-186, S-187 Zimmerman J, S-15 Vailas JC, S-18 Zinder SM, S-96 Valovich McLeod TC, S-15, S-34, S-39, S-49, S-50, S-61, S-63, S-89, S-119 Van Lunen B, S-70, S-165, S-171 Van Lunen BL, S-37, S-58, S-59, S-137, S-162 Vela L, S-53 Vela LI, S-50, S-53, S-62, S-74, S-97, S-110 Vesci BJ, S-142, S-152 Vetter AM, S-54 Vonada ME, S-19 VonHolten SL, S-51 W Waite T, S-153 Walker SE, S-54 Walpert KM, S-61 Walsh MC, S-122 Walter JM, S-162 Walz S, S-75 Warren AJ, S-165 Waters CM, S-48 Watt J, S-178 Webster KA, S-40, S-101, S-152, S-169 Wehring SP, S-58 Weidner TG, S-54 Weimar WH, S-183 Weinhandl J, S-175 Weinhandl JT, S-174 Weinhold PS, S-176 Welch CE, S-59 Weltman A, S-84, S-106, S-135 West AE, S-69 Wheeler R, S-179 Wikstrom AM, S-161

S-196 Volume 46 • Number 3 (Supplement) May 2011 Subject Index pelvic sagittal-plane motion visual observations, S-137 hip, knee biomechanics, S-122 A static hindfoot soft shell brace ankle instability, S-181 joint motion, S-112 Abdominal muscle training Allografts, tibial sprains vertical ground reaction forces, glenohumeral joint reconstruction, ankle laxity, S-111 S-161 S-69 fulcrum method, S-183 Acromiohumeral interval Anesthesia inversion strength, S-13 external rotation strength lidocaine phonophoresis, S-126 joint mobilization, S-96 female athletes, S-24 Ankle pain, S-110 Adolescent athletes angle perceived confidence, S-110 concussions gastrocnemius, S-158 plantar flexion, S-13 health-related quality of life, bracing postural control, S-110 S-63 motorized tester, S-13 stability female postural control, S-96 postural control, S-96 disc herniation, S-141 disability stabilizers football dynamic stability, S-100 agility, S-109 medial epicondyle avulsion mechanical laxity, S-100 balance, S-109 fracture, S-141 dorsiflexion vertical jump, S-109 health-related quality of life, S-50 directed exercise, S-44 stiffness fall, winter, spring sports, S-49 hip muscle activation, S-123 Kinesiotaping, S-114 patient reporting, S-119 instability resting muscle spindle activity, proxy reporting, S-119 active range of motion, S-118 S-183 lacrosse anterior stiffness, S-14 supports sidestep cutting, S-70 anterior tibial shear force, ankle laxity, S-111 male S-120 taping sidestep cutting, S-70 Cumberland Ankle Instability ankle sprains, S-110 synovial cell sarcoma, S-95 Tool, S-30, S-124 fulcrum method, S-183 maturation Hoffmann reflex, S-178 Ankle-knee coupling variability sidestep cutting, S-70 kinematics, S-178 walking gait, S-180 soccer lateral hop, S-101 Anterior cruciate ligament synovial cell sarcoma, S-95 lower extremity characteristics, reconstruction softball S-120 health-related quality of life, disc herniation, S-141 measures, S-52 S-49 Adolescents motor cortex excitability, S-182 neuromuscular fatigue, S-104 health-related quality of life, S-50 postural control, S-100 quadriceps atrophy, S-102 postural control, S-72 static hindfoot alignment, S-181 quadriceps cortical excitability, Adults stochastic resonance, S-97 S-36, S-107 postural control, S-72 vertical stop-jump, S-120 quadriceps spinal reflexes, Agility vestibular-ocular training, S-97 S-107 ankle stabilizers, S-109 inversion quadriceps weakness, S-102 Aging fulcrum method, S-183 tear postural-control alterations, S-72 taping, S-111 tibiofemoral osteoarthritis, Airway access kinematic variability S-106 immobilization, S-18 postural stability, S-99 Antihistamine Alignment laxity eccentric muscle damage, S-46 cervical spine assessment, S-12 Approved Clinical Instructors football helmet, S-18 mechanical stability perceptions knee dynamic stability, S-99 evidence-based practice imple- osteoarthritis, S-105 proprioception mentation, S-37 knee valgus Kinesiotaping, S-110 Aquatic training directed exercise, S-44 range of motion balance lower extremity ankle instability, S-182 recreational athletes, S-43 assessment reliability, S-116 postural control, S-182 landings, S-116

Journal of Athletic Training S-197 Architectural properties, muscles young, female B exercise-induced damage, S-130 challenges, S-57 Balance fiber strain magnitudes, S-130 Athletic training ankle instability Arthrometry gender bias, S-56 stochastic resonance, S-97 laxity assessment patient-rated outcomes, S-50 ankle stabilizers, S-109 healthy ankles, S-12 Athletic training education Kinesiotaping Assessment athletic trainers ankle stiffness, S-114 athletes' psychosocial intervention, S-58 postural control insoles, S-179 hydration, S-186 psychosocial referral, S-58 rehabilitation lower extremity alignment evidence-based practice imple- Wii, S-163 reliability, S-116 mentation Star Excursion Balance Test peer Approved Clinical Instructors' interrater reliability, S-167 feedback training, S-54 perceptions, S-37 training student feedback, S-54 evidence-based teaching postural control, S-43 Athletes, adolescent student outcomes, S-58 Wii Fit scores health-related quality of life, peer assessment reliability, validity, S-161 S-50 feedback training, S-54 Baseball players concussion knowledge student feedback, S-54 collegiate Korea, S-35 postprofessional glenohumeral joint range of Athletic injuries attractors, S-189 motion, S-24 pediatric hospital, S-86 career intentions, S-189 humeral retroversion, S-27 Athletic trainers program directors lower extremity postural awareness psychosocial intervention, S-58 control, S-109, S-133 clinical decision rules, S-60 psychosocial referral, S-58 pitching velocity, S-109, S-133 clinicians student retention posterior capsular thickness, evidence-based practice, S-59 District 4, S-40 S-27 collegiate Athletic training students high school mental health disorders compe- career decisions, S-189 humeral retrotorsion, S-26 tence, S-190 clinical reasoning skills injury mental health disorders knowl- learner-centered technique, sleeper stretch, S-41 edge, S-190 S-53 range of motion concussion management beliefs, student-centered technique, sleeper stretch, S-41 S-62 S-53 Basketball players high school confidence collegiate employment model, S-89 standardized patients, S-54 acute lymphoblastic leukemia, team physician supervision, evaluation skills S-145 S-89 standardized patients, S-54 anterior cruciate ligament injury intrarater reliability evidence-based practice prevention, S-166 Functional Movement Screen, perceptions, S-59 ovarian teratoma, S-144 S-169 self-reported behaviors, S-59 supraventricular tachycardia, labor force intrarater reliability S-94 occupational setting, S-56 Functional Movement Screen, female sex differences, S-56 S-169 anterior cruciate ligament injury professional socialization retention prevention, S-166 clinical context, S-88 District 4, S-40 ovarian teratoma, S-144 psychological skills Atrophy supraventricular tachycardia, comfort, S-191 quadriceps weakness S-94 competence, S-191 anterior cruciate ligament high school quality reconstruction, S-102 lower extremity injuries, S-40 constructs, S-87 Attention deficit disorder postural control, S-160 standard of care collegiate track athlete self-efficacy, S-160 case law, S-87 dizziness, tachycardia, S-91 Benign paroxysmal positional vertigo use collegiate male ice hockey player, clinical decision rules, S-60 S-156

S-198 Volume 46 • Number 3 (Supplement) May 2011 Biochemical environment motorized tester, S-13 Clinical context osteoarthritic knees, S-104 postural control, S-96 professional socialization Bioelectric impedance analysis sprains, S-111 athletic trainers, S-88 professional ice hockey players, Bruising, injury model Clinical decision rules S-185 tennis ball induced, S-128 athletic trainers' awareness, use, Biomarkers, synovial fluid C S-60 noneffused knees, S-108 Clinical education Biomechanics Cadets athletic training students foot exercise-related lower leg pain standardized patients, S-54 orthotics, S-115 risk factors, S-180 Clinical reasoning skills hip Caffeine athletic training students' 2-D measures, S-163 core temperature learner-centered technique, jump landings, S-122 during exercise, S-74 S-53 patellofemoral pain syndrome, Cardiovascular system student-centered technique, S-53 S-28 exercise in heat Clinically important difference- running, S-28 cooling, S-22 success knee supraventricular tachycardia shoulder impingement syndrome 2-D measures, S-163 collegiate female basketball patient-rated outcome tools, jump landings, S-122 player, S-94 S-33 landings, S-162 Career decisions Clinicians, athletic training patellofemoral pain syndrome, athletic trainers', S-189 evidence-based practice, S-59 S-28 Case law Cognitive loads running, S-28 athletic trainers reactive knee stiffening landing standard of care, S-87 sex differences, S-176 effect of instruction, S-71 Central activation failure Cognitive tasks energy absorption groups, S-176 quadriceps weakness unstable sitting sex differences, S-71 anterior cruciate ligament sex differences, S-132 youth soccer players, S-71 reconstruction, S-102 Coiling lower extremity Cervical spine upper extremity injuries ankle instability, S-120 alignment collegiate softball players, S-25 cutting task, S-70 football helmet removal, S-18 Cold-water immersion sex differences, S-70 disc herniation performance, S-126 vertical stop-jump, S-120 manual therapy, S-147 Collegiate athletes running therapeutic exercise, S-147 baseball triathletes, S-84 fracture glenohumeral joint range of sidestep cutting high school football player, motion, S-24 adolescent male lacrosse S-151 humeral retroversion, S-27 players, S-70 collegiate male wrestler, S-139 lower extremity postural Blisters, fracture Cheerleaders control, S-109, S-133 collegiate male football player, collegiate pitching velocity, S-109, S-133 S-153 radial collateral ligament posterior capsular thickness, Blood flow rupture, S-144 S-27 femoral artery ulnar impaction syndrome, basketball compression, S-47 S-149 acute lymphoblastic leukemia, cryotherapy, S-47 female S-145 muscular myelomeningocele, S-155 anterior cruciate ligament injury gastrocnemius, S-130 tethered cord syndrome, S-155 prevention, S-166 Body size ulnar impaction syndrome, ovarian teratoma, S-144 professional football players, S-149 supraventricular tachycardia, S-187 Chest S-94 Bracing chronic pain cheerleading ankle collegiate female soccer player, myelomeningocele, S-155 ankle laxity, S-111 S-146 radial collateral ligament joint motion, S-112 Circulation, gastrocnemius rupture, S-144 Kinesiotaping, S-39

Journal of Athletic Training S-199 tethered cord syndrome, S-155 upper extremity injuries, S-25, Contractile effort female S-80 anterior tibial translation 6th cranial nerve palsy, S-148 swimming sex differences, S-170 anterior cruciate ligament injury postural changes, S-79 hamstrings effort prevention, S-166 scapular kinematics, S-79 sex differences, S-170 bilateral ulnar variance, S-142 tennis hamstrings tightness costochondritis, S-146 popliteus tendinitis, S-67 sex differences, S-170 Hoffa disease, S-149 track Cooling inclusion cyst, S-154 attention deficit disorder, S-91 exercise in heat myelomeningocele, S-155 volleyball cardiovascular response, S-22 ovarian teratoma, S-144 liver laceration, S-93 thermoregulation, S-22 pectus excavatum, S-146 primary immune deficiency, Core temperatures popliteus tendinitis, S-67 S-155 caffeine primary immune deficiency, stress-induced dysfunction, during exercise, S-74 S-155 S-140 collegiate football players stress-induced dysfunction, wrestling ice slushie ingestion, S-74 S-140 clinical concussion measures, hydration supraventricular tachycardia, S-120 collegiate football players, S-75 S-94 laminal fracture, S-139 exercise intensity, S-75 tethered cord syndrome, S-155 long thoracic neuropathy, S-151 professional football players, S-75 field hockey Compartment syndrome Cortical excitability Hoffa disease, S-149 professional skier, S-150 fibularis longus football Compression ankle instability, S-182 biceps femoris tear, S-146 quadriceps temperature, S-47 quadriceps core temperatures, S-74, S-75 Concussions anterior cruciate ligament exercise intensity, S-75 acute impairment reconstruction, S-36, S-107 hydration, S-75 baseline tests, S-35 Costochondritis lateral collateral ligament tear, athletic trainers' management collegiate female soccer player, S-146 beliefs, S-62 S-146 posterior elbow dislocation, benign paroxysmal positional Cramps, muscle S-153 collegiate male ice hockey ice massage, S-129 posterolateral corner injury, player, S-156 Cranial nerves S-146 contact, noncontact sports in 6th, palsy, idiopathic psychosomatic-induced illness, Korea female collegiate softball S-153 athletes' knowledge, S-35 player, S-148 semimembranosus tear, S-146 health-related quality of life Cryotherapy ice hockey adolescent athletes, S-63 exercise in heat benign paroxysmal positional high school athletes perceptual responses, S-76 vertigo, S-156 concussion history, S-39 quadriceps function inclusion cyst, S-154 self-reported symptoms, S-39 anterior cruciate ligament lacrosse sex differences, S-39 deficiency, S-103 scapular dyskinesis, S-152 ImPACT quadriceps temperature, S-47 male reliability, S-61 skeletal muscle blood flow, benign paroxysmal positional impaired gait, S-16 volume, S-46 vertigo, S-156 knowledge Cubonavicular coalition laminal fracture, S-139 high school athletes', S-15 high school football player, S-64 posterior elbow dislocation, reporting Cutting tasks S-153 high school athletes', S-15 lower extremity kinematics radial collateral ligament self-reported symptoms hip muscle strength, S-164 rupture, S-144 reliability, S-61 lower extremity kinetics scapular dyskinesis, S-152 subconcussive impacts hip muscle strength, S-164 softball youth ice hockey players, S-16 trunk position 6th cranial nerve palsy, S-148 Contact sports knee loading, S-122 bilateral ulnar variance, S-142 concussion knowledge Cysts, inclusion pitch volume, S-80 Korean athletes, S-35 collegiate female ice hockey player, S-154

S-200 Volume 46 • Number 3 (Supplement) May 2011 Evidence-based teaching D Electric stimulation athletic training education Delayed-onset muscle soreness muscular blood flow student outcomes, S-58 recovery, S-129 gastrocnemius, S-130 Exercises sleep, S-129 Emergency management aerobic Disability airway access patellofemoral pain syndrome, ankle immobilization, S-18 S-102 dynamic stability, S-100 lacrosse face-mask removal, S-19 ankle taping, S-111 mechanical laxity, S-100 spine boarding core temperatures shoulder thoracolumbar injury, S-185 caffeine, S-74 pain, S-138 Emergency medical technicians directed Discs evidence-based practice ankle dorsiflexion, S-44 herniated heat stroke, S-78 knee valgus alignment, S-44 female adolescent softball Employment models fatiguing player, S-141 high school athletic trainers lower extremity movement, manual therapy, S-147 personal characteristics, S-89 S-83 therapeutic exercise, S-147 school characteristics, S-89 in heat Diseases Endurance cooling, S-22 acute lymphoblastic leukemia hip cryotherapy, S-76 collegiate basketball player, lateral step-down, S-175 intensity S-145 flexor tightness, S-165 core temperature, S-75 Dislocations knee hydration, S-75 posterior elbow lateral step-down, S-175 side bridges collegiate male football player, Endurance ratio low back pain, S-134 S-153 gastrocnemius transverse abdominis, S-135 posterior knee Kinesiotaping, S-39 sling therapy male rugby player, S-16, S-67 Energy absorption meniscectomy, S-106 Disorders landings, S-176 submaximal attention deficit strength measures, S-124 neuromuscular function, S-82 collegiate track athlete, S-91 Environmental conditions therapeutic Dizziness face-mask removal, S-19 cervical disc herniation, S-147 collegiate track athlete Environmental Symptoms Question- Exertional heat stroke attention deficit disorder, S-91 naire recognition Drop landings exercise-heat acclimation, S-21 team physicians, S-77 spinal reflex excitability Epidemiology, injury treatment sex differences, S-166 pediatric hospital, S-86 team physicians, S-77 Dyskinesis, scapular submission wrestlers, S-85 Eye collegiate male lacrosse player, Equipment, protective ocular toxoplasmosis S-152 face-mask removal, S-19 high school female soccer health-related quality of life, lacrosse helmet player, S-157 S-51 face-mask removal, S-19, S-187 E Evidence-based practice F athletic training clinicians Face-mask removal Eccentric muscle damage confidence, S-59 dry, wet conditions, S-19 antihistamine, S-46 knowledge, S-59 lacrosse, S-19 Elbow athletic training students timeliness, S-187 capitellar osteochondritis perceptions, S-59 Fatigue dissecans self-reported behaviors, S-59 lower extremity movement, S-83 high school football player, S-64 heat stroke neuromuscular medial epicondyle avulsion emergency medical technicians, anterior cruciate ligament fracture S-78 reconstruction, S-104 adolescent football player, implementation reach scores S-141 Approved Clinical Instructors' high school athletes, S-72 posterior dislocation perceptions, S-37 sex differences, S-72 collegiate male football player, S-153

Journal of Athletic Training S-201 Female athletes softball posterior elbow dislocation, adolescent disc herniation, S-141 S-153 disc herniation, S-141 Stevens-Johnson syndrome, posterolateral corner injury, anterior cruciate ligament recon- S-139 S-146 struction tennis psychosomatic-induced illness, health-related quality of life, popliteus tendinitis, S-67 S-153 S-49 track semimembranosus tear, S-146 basketball femoral neck stress fracture, high school ovarian teratoma, S-144 S-68 capitellar osteochondritis supraventricular tachycardia, triathlete dissecans, S-64 S-94 gluten intolerance, S-91 cervical spine fracture, S-151 cheerleading volleyball cubonavicular coalition, S-64 myelomeningocele, S-155 primary immune deficiency, Ewing sarcoma, S-94 tethered cord syndrome, S-155 S-155 professional ulnar impaction syndrome, stress-induced GI dysfunction, body size, S-187 S-149 S-140 core temperatures, S-75 collegiate youth fitness, S-187 anterior cruciate ligament injury landing technique, S-173 quarterbacks prevention, S-166 performance measures, S-173 horizontal adduction, S-26 bilateral ulnar variance, S-142 Field hockey players humeral retrotorsion, S-26 costochondritis, S-146 collegiate female shoulder internal rotation, S-26 femoral neck stress fracture, Hoffa disease, S-149 Forces S-68 Fitness vertical ground reaction Hoffa disease, S-149 professional football players, abdominal training, S-161 inclusion cyst, S-154 S-187 Fractures myelomeningocele, S-155 Flexor muscles alveolar mandibular ovarian teratoma, S-144 hip, tightness semiprofessional ice hockey pectus excavatum, S-146 endurance, S-165 player, S-143 popliteus tendinitis, S-67 muscle power, S-165 blisters primary immune deficiency, Fluid consumption collegiate male football player, S-155 fluid administration S-153 stress-induced GI dysfunction, hydration status, S-21 cervical spine S-140 water bottle fluid delivery, S-22 high school football player, supraventricular tachycardia, Foot S-151 S-94 biomechanics laminal tethered cord syndrome, S-155 orthotics, S-115 collegiate male wrestler, S-139 ulnar impaction syndrome, cubonavicular coalition medial epicondyle avulsion S-149 high school football player, S-64 adolescent football player, external rotation strength Football S-141 acromiohumeral interval, S-24 high school stress field hockey head impacts, S-15 femoral neck, S-68 Hoffa disease, S-149 Football equipment Fulcrum method high school helmet removal ankle inversion ocular toxoplasmosis, S-157 cervical spine alignment, S-18 taping, S-183 paradoxical vocal fold motion, Football players Functional activities S-92 adolescent ankle laxity ice hockey medial epicondyle avulsion ankle sprains, S-111 inclusion cyst, S-154 fracture, S-141 ankle supports, S-111 neuromuscular training collegiate Functional Arm Scale for Throwers anterior cruciate ligament, S-30 biceps femoris tear, S-146 (FAST) soccer core temperatures, S-74, S-75 scale development, S-32 costochondritis, S-146 exercise intensity, S-75 Functional Movement Screen landing technique, S-173 hydration, S-75 intrarater reliability ocular toxoplasmosis, S-157 lateral collateral ligament tear, athletic trainers, S-169 pectus excavatum, S-146 S-146 athletic training students, S-169 performance measures, S-173

S-202 Volume 46 • Number 3 (Supplement) May 2011 Functional performance concussions, S-63 football ankle instability fall, winter, spring sports, S-49 capitellar osteochondritis stochastic resonance, S-97 anterior cruciate ligament recon- dissecans, S-64 G struction cervical spine fracture, S-151 active females, S-49 cubonavicular coalition, S-64 Gait high school athletes Ewing sarcoma, S-94 ankle-knee coupling variability, concussion history, S-39 head impacts, S-15 S-180 self-reported symptoms, S-39 male impaired sex differences, S-39 heterotopic ossification, S-66 concussion, S-16 lower extremity pain, S-51 reach scores shod patient reporting fatigue, S-72 ankle instability, S-178 adolescent athletes, S-119 sex differences, S-72 Gastrocnemius muscles proxy reporting soccer Kinesiotaping adolescent athletes, S-119 ocular toxoplasmosis, S-157 circulation, S-39 scapular dyskinesis, S-51 softball endurance ratio, S-39 Heat acclimation Stevens-Johnson syndrome, plantar flexion torque Environmental Symptoms Ques- S-139 ankle and knee angles, S-158 tionnaire, S-21 volleyball Gastrointestinal system Heat illnesses heterotopic ossification, S-66 gluten intolerance evidence-based practice High schools female triathlete, S-91 emergency medical technicians, athletic trainers stress-induced dysfunction S-78 employment model, S-89 female collegiate volleyball recognition team physicians player, S-140 team physicians, S-77 athletic trainer supervision, S-89 Gender bias treatment Hindfoot, static alignment athletic training, S-56 team physicians, S-77 ankle instability, S-181 Glenohumeral joint Heating modalities Hip instability quadriceps temperature, S-127 biomechanics reconstruction, S-69 Hematology 2-D measures, S-163 range of motion acute lymphoblastic leukemia patellofemoral pain syndrome, collegiate baseball players, S-24 collegiate basketball player, S-28 shoulder rehabilitation S-145 running, S-28 scapular muscle ratios, S-34 Heterotopic ossification, hip endurance Glides high school male volleyball player, lateral step-down, S-175 lateral, medial patellar S-66 femoral neck stress fracture visual measure reliability, S-162 High school athletes collegiate track athletes, S-68 Gluten intolerance baseball flexor tightness female triathlete, S-91 humeral retrotorsion, S-26 endurance, S-165 H basketball muscle power, S-165 lower extremity injuries, S-40 heterotopic ossification Hamstrings muscles postural control, S-160 high school male volleyball strains self-efficacy, S-160 player, S-66 sex differences, S-85, S-161 concussions isometric strength soccer players, S-85, S-161 concussion history, S-39 torque, S-171 tightness knowledge, S-15 kinematics contractile effort, S-170 reporting, S-15 lower extremity alignment, Hand self-reported symptoms, S-39 S-116 radial collateral ligament rupture sex differences, S-39 muscle activation collegiate male cheerleader, female ankle dorsiflexion, S-123 S-144 ocular toxoplasmosis, S-157 neuromuscular function Head impacts paradoxical vocal fold motion, triple hop, S-172 football players, S-15 S-92 patellofemoral pain syndrome youth ice hockey players, S-16 Stevens-Johnson syndrome, aerobic exercise, S-102 Health-related quality of life S-139 strength adolescent athletes, S-50 cutting task, S-164

Journal of Athletic Training S-203 landings, S-172 professional baseball players lateral step-down, S-175 bioelectric impedance analysis, sleeper stretch, S-41 Hockey players S-185 incidence semiprofessional clinical hydration measures, submission wrestlers, S-85 alveolar mandible fracture, S-185 knee S-143 youth knee load, S-118 Hoffa disease subconcussive impacts, S-16 lower extremity collegiate female field hockey Ice massage soccer warm-up, S-31 player, S-149 muscle cramps, S-129 Star Excursion Balance Test, Hoffmann reflex Imaging, ultrasound S-40 ankle instability, S-178 ankle laxity, S-12 model Hop test anterior talofibular ligament tennis ball-induced bruising, learning effect, S-173 length, S-12 S-128 Humerus Immersion, cold water shoulder history horizontal adduction performance, S-126 return to play, S-32 professional pitchers, S-26 Immune system upper extremity professional quarterbacks, S-26 primary deficiency coiling, S-25 retrotorsion collegiate female volleyball trunk rotation flexibility, S-80 high school baseball players, player, S-155 Injury prevention S-26 ImPACT anterior cruciate ligament professional pitchers, S-26 reliabilty collegiate women's basketball professional quarterbacks, S-26 self-reported symptoms, S-61 players, S-166 retroversion Impaction syndrome, ulna neuromuscular training, S-30 collegiate baseball players, S-27 collegiate female cheerleader, Insoles posterior capsular thickness, S-149 postural control S-27 Impacts, head balance, S-179 shoulder internal rotation football players, S-15 Instability professional pitchers, S-26 Impingement syndrome ankle professional quarterbacks, S-26 shoulder active range of motion, S-118 Hydration clinically important difference- ankle range of motion, S-182 core temperature success, S-33 anterior stiffness, S-14 collegiate football players, S-75 patient-rated outcome tools, Hoffmann reflex, S-178 exercise intensity, S-75 S-33 kinematics, S-178 fluid administration scapular kinematics, S-132 lateral hop, S-101 fluid consumption, S-21 Inclinometer motor cortex excitability, S-182 professional ice hockey players, measurement reliability postural control, S-100, S-182 S-185 scapular rotation, S-114 self-reported, S-52 urine color Inclusion cysts static hindfoot alignment, S-181 athletes' assessment, S-186 collegiate female ice hockey stochastic resonance, S-97 water bottle fluid delivery, S-22 player, S-154 vestibular-ocular training, S-97 I Infections glenohumeral joint ocular toxoplasmosis reconstruction, S-69 Ice high school female soccer Instruction slushie ingestion player, S-157 landing biomechanics core temperatures, S-74 Inflammation sex differences, S-71 Ice hockey players cell infiltration youth soccer players, S-71 collegiate cyclic compressive load, S-48 Instruments benign paroxysmal positional lymphangiogenesis, S-48 Cumberland Ankle Instability Tool vertigo, S-156 Infrapatellar fat pad cutoff score, S-30, S-124 inclusion cyst, S-154 Hoffa disease Environmental Symptoms Ques- female collegiate female field hockey tionnaire inclusion cyst, S-154 player, S-149 exercise-heat acclimation, S-21 male Injuries Inversion, ankle benign paroxysmal positional athletic fulcrum method, S-183 vertigo, S-156 pediatric hospital, S-86 taping, S-111

S-204 Volume 46 • Number 3 (Supplement) May 2011 Isometric activities shoulder, S-112 meniscectomy strength Kinetics, lower extremity sling exercise therapy, S-106 torque, S-171 cutting task, S-164 vibration, S-106 J Knee noneffused alignment synovial fluid biomarker Joint mobilizations osteoarthritis, S-105 analysis, S-108 posterior talocrural angle osteoarthritis ankle sprain, S-96 gastrocnemius, S-158 biochemical environment, S-104 Jump landings anterior cruciate ligament patellofemoral pain syndrome anterior cruciate ligament injury neuromuscular training, S-30 aerobic exercise, S-102 prevention anterior cruciate ligament defi- lower extremity strength, S-28 collegiate women's basketball cient neuromuscular alterations, S-37 players, S-166 quadriceps function, S-103 pain, S-37 hip biomechanics rehabilitation, S-103 running, S-28 ankle motion, S-122 anterior cruciate ligament injury popliteus tendinitis knee biomechanics prevention collegiate female tennis player, ankle motion, S-122 jump landings, S-166 S-67 Landing Error Scoring System, anterior cruciate ligament recon- posterior dislocation S-174 struction, S-107 male rugby player, S-16, S-67 Jumps health-related quality of life, posterolateral corner injury postural control S-49 collegiate football player, S-146 5-toed socks with rubber bits on neuromuscular fatigue, S-104 reactive stiffening sole, S-168 quadriceps cortical excitability, cognitive loads, S-176 vertical stop S-36 sex differences, S-176 ankle instability, S-120 quadriceps weakness, S-102 sagittal-plane restraints, S-158 anterior tibial shear force, biceps femoris tendon tear semimembranosus tendon tear S-120 collegiate football player, S-146 collegiate football player, S-146 lower extremity characteristics, biomechanics valgus alignment S-120 2-D measures, S-163 directed exercise, S-44 K anterior cruciate ligament L reconstruction, S-104 Kinematics landings, S-162 Lacerations, liver ankle patellofemoral pain syndrome, collegiate volleyball player, S-93 postural stability, S-99 S-28 Lacrosse players shod gait, S-178 running, S-28 adolescent hip external valgus moment sidestep cutting, S-70 lower extremity alignment, neuromuscular factors, S-29 collegiate S-116 sex differences, S-29 scapular dyskinesis, S-152 knee Hoffa disease face-mask removal, S-19, S-187 lower extremity alignment, collegiate female field hockey male S-116 player, S-149 scapular dyskinesis, S-152 lower extremity internal abduction moment sidestep cutting, S-70 cutting task, S-164 running, S-174 Laminal fracture scapula isometric strength collegiate male wrestler, S-139 collegiate swimmers, S-79 torque, S-171 Landing Error Scoring System subacromial impingement, kinematics jump landings, S-174 S-132 lower extremity alignment, Landings Kinesiotaping S-116 biomechanics ankle lateral collateral ligament tear effect of instruction, S-71 dynamic balance, S-114 collegiate football player, S-146 energy absorption groups, S-176 proprioception, S-110 laxity sex differences, S-71 stiffness, S-114 osteoarthritis, S-105 tibial geometry, S-162 gastrocnemius load youth soccer players, S-71 circulation, S-39 cutting task, S-122 energy absorption, S-124 endurance ratio, S-39 injuries, S-118

Journal of Athletic Training S-205 hip strength anterior cruciate injury prevention kinematics lower extremity joint excur- jump landings, S-166 cutting task, S-164 sions, S-172 neuromuscular training, S-30 kinetics jump anterior cruciate reconstruction cutting task, S-164 anterior cruciate ligament injury health-related quality of life, movement patterns prevention, S-166 S-49 fatiguing exercise, S-83 Landing Error Scoring System, neuromuscular fatigue, S-104 muscle strength S-174 quadriceps atrophy, S-102 patellofemoral pain syndrome, lower extremity alignment quadriceps cortical excitability, S-28 hip, knee kinematics, S-116 S-36, S-107 neuromuscular function postural control quadriceps spinal reflexes, submaximal exercise, S-82 5-toed socks with rubber bits on S-107 pain sole, S-168 quadriceps weakness, S-102 health-related quality of life, technique anterior talofibular length S-51 female youth soccer players, ultrasound imaging, S-12 pitching velocity S-173 lateral collateral tear collegiate baseball players, tibiofemoral forces collegiate football player, S-146 S-109, S-133 passive restraints, S-158 radial collateral rupture postural control Lateral hop task collegiate male cheerleader, collegiate baseball players, ankle instability S-144 S-109, S-133 plantar pressure, S-101 Liver laceration Lymphangiogenesis Lateral step-down task collegiate volleyball player, S-93 cyclic compressive load, S-48 hip, trunk Loads M endurance, S-175 cyclic compressive strength, S-175 inflammatory cell infiltration, Male athletes Laxity S-48 adolescent ankle lymphangiogenesis, S-48 synovial cell sarcoma, S-95 sprains, S-111 knee collegiate supports, S-111 cutting task, S-122 benign paroxysmal positional arthrometry Long thoracic nerve vertigo, S-156 healthy ankles, S-12 neuropathy posterior elbow dislocation, knee collegiate wrestler, S-151 S-153 osteoarthritis, S-105 Low back pain scapular dyskinesis, S-152 mechanical disc herniation football ankle disability, S-100 female adolescent softball posterior elbow dislocation, ultrasound player, S-141 S-153 healthy ankles, S-12 transverse abdominis activation high school Learning effect side bridges, S-134, S-135 heterotopic ossification, S-66 hop test, S-173 Lower extremities ice hockey Legal issues alignment benign paroxysmal positional athletic trainers assessment reliability, S-116 vertigo, S-156 standard of care, S-87 landings, S-116 lacrosse Leukemia biomechanics scapular dyskinesis, S-152 acute lymphoblastic cutting task, S-70 rugby collegiate basketball player, sex difference, S-70 posterior knee dislocation, S-145 exercise-related pain S-16, S-67 Lidocaine phonophoresis cadets, S-180 soccer anesthetic effect, S-126 injury prediction synovial cell sarcoma, S-95 Ligaments Star Excursion Balance Test, volleyball anterior cruciate deficiency S-40 heterotopic ossification, S-66 quadriceps function, S-103 injury rates wrestling tibiofemoral osteoarthritis, soccer warm-up, S-31 laminal fracture, S-139 S-106 joint excursions landings, S-172

S-206 Volume 46 • Number 3 (Supplement) May 2011 Malignancies range of motion Muscles acute lymphoblastic leukemia thoracic spine, S-134 abdominal collegiate basketball player, scapular anterior-posterior tilt vertical ground reaction forces, S-145 reliability, S-136 S-161 Ewing sarcoma strength cramping high school football player, S-94 energy absorption in landings, ice massage, S-129 synovial cell sarcoma S-124 delayed-onset soreness adolescent male soccer player, visual recovery, S-129 S-95 lateral, medial patellar glide, sleep, S-129 Mandible S-162 eccentric damage alveolar fracture Medications antihistamine, S-46 semiprofessional ice hockey antihistamine exercise-induced damage player, S-143 eccentric muscle damage, S-46 architectural properties, S-130 Manual therapy Meniscectomy fiber strain magnitudes therapeutic exercise sling exercise therapy architectural properties, S-130 cervical disc herniation, S-147 vibration, S-106 gastrocnemius Martial arts Mental health disorders blood flow, S-130 submission wrestling perceived competence, knowledge electric stimulation, S-130 injury incidence, S-85 collegiate athletic trainers, Hoffmann reflex, S-178 Maturation S-190 Kinesiotaping, S-39 adolescent athletes psychosomatic-induced illness plantar-flexion torque, S-158 sidestep cutting, S-70 collegiate football player, S-153 hamstrings Measurements Mobilization, soft tissue strains, S-85, S-161 2-D measures instrument assisted, S-127 hip hip, knee biomechanics, S-163 Modalities ankle dorsiflexion, S-123 ankle braces compression cutting task, S-164 motorized tester, S-13 quadriceps temperature, S-47 endurance, S-165 ankle instability cryotherapy muscle power, S-165 self-reported, S-52 anterior cruciate ligament patellofemoral pain syndrome, bioelectric impedance analysis deficiency, S-103 S-102 professional ice hockey players, quadriceps temperature, S-47 induced pain S-185 skeletal muscle blood flow, shoulder disability, S-138 clinical concussion volume, S-46 knee collegiate wrestlers, S-120 electric stimulation anterior cruciate ligament clinical hydration gastrocnemius, S-130 reconstruction, S-104 professional ice hockey players, heating patellofemoral pain syndrome, S-185 quadriceps temperature, S-127 S-102 inclinometer ice massage lower extremity strength scapular rotation, S-114 muscle cramps, S-129 patellofemoral pain syndrome, knee load TENS S-28 injuries, S-118 anterior cruciate ligament quadriceps laxity deficiency, S-103 anterior cruciate ligament ankles, S-12 Models, injury deficiency, S-103 patient-rated measures tennis ball-induced bruising, cortical excitability, S-36 athletic training, S-50 S-128 strength, S-168 pelvic alignment Moments temperature, S-47, S-127 PALpation Meter, S-137 external valgus scapular ratios visual observations, S-137 neuromuscular factors, S-29 shoulder rehabilitation, S-34 performance sex differences, S-29 skeletal muscle blood flow, female youth soccer players, internal knee abduction volume S-173 running, S-174 cryotherapy, S-46 landing technique, S-173 Movement patterns soleus quadriceps strength lower extremity Hoffmann reflex, S-178 interlimb deficits, S-168 fatiguing exercise, S-83 spindles ankle stiffness, S-183

Journal of Athletic Training S-207 resting activity, S-183 O scapular dyskinesis transverse abdominis health-related quality of life, Occipital padding side bridges, S-135 S-51 cervical spine alignment, S-18 trapezius soft tissue mobilization Occupational settings activation, S-136 instrument assisted, S-127 athletic training, S-56 Myelomeningocele PALpation Meter Ocular toxoplasmosis collegiate female cheerleader, pelvic alignment, S-137 high school female soccer player, S-155 Palsy S-157 6th cranial nerve, idiopathic N Orthotics, foot female collegiate softball biomechanics, S-115 Nail-patella syndrome player, S-148 Osteoarthritis range of motion, S-65 Paradoxical vocal fold motion knee Neuromuscular function female high school athlete, S-92 alignment, S-105 central Patella biochemical environment, S-104 submaximal exercise, S-82 lateral, medial glide laxity, S-105 external knee valgus moment visual measure reliability, S-162 tibiofemoral sex differences, S-29 quadrant test anterior cruciate ligament tear, hip reliability, S-162 S-106 triple hop, S-172 Patellofemoral pain syndrome Osteochondritis dissecans lower extremities hip muscle function capitellar submaximal exercise, S-82 aerobic exercise, S-102 high school football player, S-64 peripheral knee muscle function Outcomes sex differences, S-82 aerobic exercise, S-102 athletic training students' submaximal exercise, S-82 neuromuscular alterations evidence-based teaching, S-58 Neuromuscular system stair ambulation, S-37 patient-rated measures fatigue pain athletic training, S-50 anterior cruciate ligament stair ambulation, S-37 patient-rated tools reconstruction, S-104 running shoulder impingement syn- lower extremity hip biomechanics, S-28 drome, S-33 ankle instability, S-120 knee biomechanics, S-28 Ovarian teratoma vertical stop-jump, S-120 Peak torque collegiate basketball player, S-144 patellofemoral pain syndrome, internal-external rotation S-37 P stretching, S-79 Neuromuscular training Pain Pectus excavatum anterior cruciate ligament injury ankle sprains collegiate female soccer player, young female athletes, S-30 ankle taping, S-110 S-146 Neuropathy joint mobilization, S-96 Peer assessment 6th cranial palsy chronic chest feedback training, S-54 female collegiate softball collegiate female soccer player, student feedback, S-54 player, S-148 S-146 Pelvic alignment long thoracic exercise-related pain visual observations, S-137 collegiate wrestler, S-151 cadets, S-180 Perceptual responses Neuropsychological tests induced exercise in heat ImPACT shoulder disability, S-138 cryotherapy, S-76 reliability, S-61 low back Performance Noncontact sports side bridges, S-135 cold-water immersion, S-126 concussion knowledge transverse abdominis activation, landing technique Korean athletes’, S-35 S-134 female youth soccer players, lower extremity S-173 health-related quality of life, physical S-51 postural control, S-165 patellofemoral syndrome Peroneal muscles neuromuscular alterations, S-37 Hoffmann reflex pain, S-37 ankle instability, S-178

S-208 Volume 46 • Number 3 (Supplement) May 2011 Phonophoresis, lidocaine Preadolescents Q anesthetic effect, S-126 postural control, S-72 Quadriceps muscles Pitching Pressure pain threshold activation velocity soft tissue mobilization, S-127 meniscectomy, S-106 collegiate baseball players, Primary immune deficiency anterior cruciate ligament defi- S-109, S-133 collegiate female volleyball player, ciency volume S-155 rehabilitation, S-103 collegiate softball, S-80 Professional athletes atrophy Plantar pressure football anterior cruciate ligament ankle instability body size, S-187 reconstruction, S-102 lateral hop, S-101 core temperatures, S-75 cortical excitabiity Plantar-flexion torque fitness, S-187 anterior cruciate ligament gastrocnemius, S-158 ice hockey reconstruction, S-36, S-107 Popliteus tendinitis bioelectric impedance analysis, spinal reflexes collegiate female tennis player, S-185 anterior cruciate ligament S-67 clinical hydration measures, reconstruction, S-107 Postprofessional education S-185 strength athletic training pitchers, quarterbacks interlimb deficits, S-168 attractors, S-189 horizontal adduction, S-26 temperature career intentions, S-189 humeral retrotorsion, S-26 compression, S-47 Postural control shoulder internal rotation, S-26 cryotherapy, S-47 5-toed socks with rubber bits on skiing heating modalities, S-127 sole compartment syndrome, S-150 weakness jumps, S-168 Professional socialization anterior cruciate ligament landings, S-168 athletic trainers reconstruction, S-102 alterations clinical context, S-88 Questionnaires age related, S-72 Proprioception Environmental Symptoms ankle bracing, S-96 Kinesiotaping exercise-heat acclimation, S-21 ankle instability, S-96, S-100 ankle, S-110 ankle range of motion shoulder impingement syn- R ankle instability, S-182 drome, S-112 Radial collateral ligament rupture ankle taping Protective equipment collegiate male cheerleader, S-144 ankle sprains, S-110 face-mask removal Radiographs balance training dry, wet conditions, S-19 cervical spine alignment recreational athletes, S-43 football helmet football helmet removal, S-18 collegiate swimmers cervical spine alignment, S-18 Range of motion swimming training, S-79 lacrosse helmet ankle high school basketball players, face-mask removal, S-19, S-187 ankle instability, S-118, S-182 S-160 Proteins hip muscle activation, S-123 insoles serum cartilage oligomeric matrix postural control, S-182 balance, S-179 protein, S-159 baseball players lower extremities Psychology sleeper stretch, S-41 collegiate baseball players, athletic trainers' skills glenohumeral joint S-109, S-133 comfort, S-191 collegiate baseball players, S-24 physical performance, S-165 competence, S-191 horizontal adduction Postural stability Psychosocial intervention, referral professional pitchers, S-26 ankle kinematics, S-99 athletic trainers', S-58 professional quarterbacks, S-26 Power Psychosomatic-induced illness nail-patella syndrome, S-65 hip flexor tightness, S-165 collegiate football player, S-153 reliability Preadolescent athletes thoracic spine, S-135 lower extremity biomechanics shoulder internal-external rotation cutting task, S-70 stretching, S-79 sex differences, S-70 thoracic spine clinical measures, S-134

Journal of Athletic Training S-209 Reach scores visual measures muscle ratios high school athletes lateral, medial patellar glide, shoulder rehabilitation, S-34 fatigue, S-72 S-162 rotation sex differences, S-72 Wii Fit balance scores, S-161 measurement, S-114 Recreational athletes Restraints, knee SCAT2 balance training sagittal plane, S-158 reliability aquatic, S-43 Retrotorsion, humeral self-reported symptoms, S-61 land based, S-43 high school baseball players, S-26 Self-efficacy postural control, S-43 professional pitchers, S-26 role of sex Reflexes professional quarterbacks, S-26 high school basketball players, Hoffmann Retroversion, humeral S-160 ankle instability, S-178 posterior capsular thickness, S-27 Semiprofessional athletes, hockey vestibular-ocular Return to play alveolar mandible fracture, S-143 ankle instability, S-97 shoulder injury history, S-32 Serum cartilage oligomeric matrix Rehabilitation Risk factors proteins anterior cruciate ligament defi- exercise-related lower leg pain soccer players, S-159 ciency cadets, S-180 Sex differences quadriceps function, S-103 Role congruity theory athletic training labor force, S-56 balance young, female athletic trainers concussions Wii, S-163 challenges, S-57 high school athletes, S-39 low back pain Rugby players, male contractile effort side bridges, S-134, S-135 posterior knee dislocation, S-16, anterior tibial translation, S-170 shoulder S-67 hamstrings tightness, S-170 scapular muscle ratios, S-34 Running cutting task sling exercise biomechanics lower extremity biomechanics, meniscectomy, S-106 triathletes, S-84 S-70 Reliability hip, knee biomechanics drop landings assessment 2-D measures, S-163 spinal reflex excitability, S-166 lower extremity alignment, internal knee abduction moment, external knee valgus moment S-116 S-174 neuromuscular function, S-29 concussion symptoms S hamstrings strains self-reported, S-61 soccer players, S-85, S-161 ImPACT, S-61 Sarcomas landing biomechanics inclinometer Ewing effect of instruction, S-71 scapular rotation, S-114 high school football player, S-94 sex differences, S-71 interrater synovial cell youth soccer players, S-71 Star Excursion Balance Test, adolescent male soccer player, neuromuscular function S-167 S-95 submaximal exercise, S-82 intrarater Scales reach scores Functional Movement Screen, Functional Arm Scale for Throwers high school athletes, S-72 S-169 (FAST) reactive knee stiffening measurement development, S-32 cognitive loads, S-176 scapular anterior-posterior tilt, Scapula strength S-136 anterior-posterior tilt soldiers, S-170 modified Sensory Star Excursion measurement, S-136 trapezius activation Balance Test, S-159 dyskinesis manual muscle testing, S-136 patellar quadrant test collegiate male lacrosse player, unstable sitting lateral, medial patellar glide, S-152 sex differences, S-132 S-162 health-related quality of life, Shoulder range of motion S-51 acromiohumeral interval thoracic spine, S-135 kinematics female athletes, S-24 theory of planned behavior collegiate swimmers, S-79 disability instrument, S-62 subacromial impingement, pain, S-138 S-132

S-210 Volume 46 • Number 3 (Supplement) May 2011 glenohumeral joint instability Sleeper stretches Spinal cord reconstruction, S-69 injury tethered syndrome glenohumeral joint range of baseball players, S-41 collegiate female cheerleader, motion range of motion S-155 collegiate baseball players, S-24 baseball players, S-41 Spinal reflexes horizontal adduction Soccer players excitability professional pitchers, S-26 adolescent drop landings, S-166 professional quarterbacks, S-26 synovial cell sarcoma, S-95 sex differences, S-166 humeral retrotorsion collegiate quadriceps professional pitchers, S-26 costochondritis, S-146 anterior cruciate ligament professional quarterbacks, S-26 pectus excavatum, S-146 reconstruction, S-107 humeral retroversion female Spine collegiate baseball players, S-27 costochondritis, S-146 cervical posterior capsular thickness, landing technique, S-173 laminal fracture, S-139 S-27 ocular toxoplasmosis, S-157 low back pain impingement syndrome pectus excavatum, S-146 side-bridge exercises, S-134, clinically important difference- performance measures, S-173 S-135 success, S-33 hamstrings strains myelomeningocele Kinesiotaping, S-112 sex differences, S-85, S-161 collegiate female cheerleader, patient-rated outcome tools, high school S-155 S-33 ocular toxoplasmosis, S-157 tethered cord syndrome proprioception, S-112 male collegiate female cheerleader, injury history synovial cell sarcoma, S-95 S-155 return to play, S-32 serum cartilage oligomeric matrix thoracic internal rotation protein, S-159 range of motion, S-134, S-135 professional pitchers, S-26 warm-up Spine boarding professional quarterbacks, S-26 lower extremity injuries, S-31 log roll pull internal-external rotation youth thoracolumbar injury, S-185 stretching, S-79 landing biomechanics, S-71 log roll push rehabilitation landing technique, S-173 thoracolumbar injury, S-185 scapular muscle ratios, S-34 performance measures, S-173 Sprains, ankle scapular dyskinesis Soft tissue mobilization ankle laxity, S-111 collegiate male lacrosse player, instrument assisted ankle supports, S-111 S-152 pain, S-127 ankle taping, S-110 subacromial impingement Softball players fulcrum method, S-183 scapular kinematics, S-132 adolescent inversion strength, S-13 synovial cell sarcoma disc herniation, S-141 joint mobilization, S-96 adolescent male soccer player, collegiate plantar flexion, S-13 S-95 6th cranial nerve palsy, S-148 Stability Side bridge exercises bilateral ulnar variance, S-142 ankle transverse abdominis muscles pitch volume, S-80 postural control, S-96 low back pain, S-134, S-135 upper extremity injuries, S-25, ankle bracing Sidestep cutting tasks S-80 joint motion, S-112 biomechanics high school dynamic adolescent male lacrosse Stevens-Johnson syndrome, ankle, S-99 players, S-70 S-139 ankle disability, S-100 Sitting, unstable Soldiers mechanical cognitive task, S-132 strength ankle, S-99 sex differences, S-132 sex differences, S-170 Standard of care, athletic training Skiers, professional Soleus muscles case law, S-87 compartment syndrome, S-150 Hoffmann reflex Standardized patients Skills, athletic trainers' ankle instability, S-178 students' confidence, S-54 psychological, S-191 students' evaluation skills, S-54 Sleep Star Excursion Balance Test delayed-onset soreness, S-129 interrater reliability, S-167

Journal of Athletic Training S-211 lower extremity injuries Stretching Synovial cell sarcoma high school basketball players, shoulder internal-external rotation adolescent male soccer player, S-40 peak torque, S-79 S-95 modified Sensory range of motion, S-79 Synovial fluid biomarkers reliability, S-159 sleeper noneffused knees, S-108 Stevens-Johnson syndrome baseball players, S-41 T female softball player, S-139 Students high school softball player, S-139 athletic training Tachycardia Stiffening career decisions, S-189 collegiate track athlete reactive knee retention, District 4, S-40 attention deficit disorder, S-91 cognitive loads, S-176 Subacromial impingement supraventricular sex differences, S-176 scapular kinematics, S-132 collegiate female basketball Stiffness Supraventricular tachycardia player, S-94 ankle collegiate female basketball player, Talocrural-subtalar joint motion Kinesiotaping, S-114 S-94 ankle bracing, S-112 resting muscle spindle activity, Swimmers Taping S-183 collegiate ankle, S-111 anterior ankle postural changes, S-79 ankle laxity, S-111 instability, S-14 scapular kinematics, S-79 ankle sprains, S-110 Stochastic resonance Symptoms Kinesiotaping, S-110 ankle instability concussion ankle inversion balance, S-97 ImPACT, S-61 fulcrum method, S-183 functional performance, S-97 SCAT2, S-61 Kinesiotaping Strains self-reported, S-39 ankle proprioception, S-110 hamstrings muscles Syndromes ankle stiffness, S-114 sex differences, S-85, S-161 compartment dynamic balance, S-114 soccer players, S-85, S-161 professional skier, S-150 gastrocnemius, S-39 Strength nail-patella shoulder impingement syn- hip range of motion, S-65 drome, S-112 cutting task, S-164 patellofemoral pain Tasks landing, S-172 hip biomechanics, S-28 cutting lateral step-down, S-175 hip muscle function, S-102 knee loading, S-122 inversion knee biomechanics, S-28 lower extremity biomechanics, sprained ankles, S-13 knee muscle function, S-102 S-70 lower extremity lower extremity strength, S-28 lower extremity kinematics, patellofemoral pain syndrome, neuromuscular alterations, S-37 S-164 S-28 pain, S-37 lower extremity kinetics, S-164 maximum isometric shoulder impingement sex differences, S-70 torque, S-171 clinically important difference- trunk position, S-122 measures success, S-33 jump landing energy absorption in landings, Kinesiotaping, S-112 Landing Error Scoring System, S-124 patient-rated outcome tools, S-174 plantar flexion S-33 lateral hop sprained ankles, S-13 Stevens-Johnson ankle instability, S-101 quadriceps female softball player, S-139 lateral step-down interlimb deficits, S-168 high school softball player, hip endurance, S-175 sex differences S-139 hip strength, S-175 soldiers, S-170 tethered cord trunk endurance, S-175 shoulder external rotation collegiate female cheerleader, trunk strength, S-175 female athletes, S-24 S-155 sidestep cutting trunk ulnar impaction biomechanics, S-70 lateral step-down, S-175 collegiate female cheerleader, Teaching, evidence based Stress fractures S-149 student outcomes, S-58 femoral neck collegiate track athletes, S-68

S-212 Volume 46 • Number 3 (Supplement) May 2011 Team physicians Star Excursion Balance Tightness athletic trainer supervision interrater reliability, S-167 hip flexor tightness high schools, S-89 lower extremity injury predic- endurance, S-165 exertional heat stroke tion, S-40 muscle power, S-165 recognition, S-77 timed crossover hop Torque treatment, S-77 learning effect, S-173 development rate Techniques, clinical reasoning triple hop torque, S-171 athletic training students, S-53 hip neuromuscular function, plantar flexion Temperatures S-172 gastrocnemius, S-158 core Tethered cord syndrome Track athletes caffeine, S-74 collegiate female cheerleader, collegiate exercise intensity, S-75 S-155 attention deficit disorder, S-91 hydration, S-75 Theory of planned behavior femoral neck stress fracture, ice slushie ingestion, S-74 instrument reliability, validity, S-68 professional football players, S-62 female S-75 Therapy, manual femoral neck stress fracture, quadriceps cervical disc herniation, S-147 S-68 compression, S-47 Thermoregulation Training cryotherapy, S-47 exercise in heat abdominal muscles heating modalities, S-127 cooling, S-22 vertical ground reaction forces, Tendinitis, popliteus Thoracic spine S-161 collegiate female tennis player, range of motion balance S-67 reliability, S-135 aquatic, S-43 Tendons rotation land based, S-43 biceps femoris tear clinical measures, S-134 feedback collegiate football player, S-146 Thoracolumbar injuries peer assessment, S-54 semimembranosus tear spine boarding neuromuscular collegiate football player, S-146 log roll pull, log roll push, anterior cruciate ligament injury, Tennis players S-185 S-30 collegiate female Throwing athletes swimming popliteus tendinitis, S-67 collegiate postural changes, S-79 TENS upper extremity injuries, S-25 scapular kinematics, S-79 quadriceps function pitchers vestibular-ocular anterior cruciate ligament horizontal adduction, S-26 ankle instability, S-97 deficiency, S-103 humeral retrotorsion, S-26 Transverse abdominis muscles Teratomas, ovarian shoulder internal rotation, S-26 side bridge exercises collegiate basketball player, S-144 softball low back pain, S-134, S-135 Tests upper extremity injuries, S-25 Trapezius muscles baseline concussion, S-35 Tibia activation ImPACT allograft manual muscle testing, S-136 reliability, S-61 glenohumeral joint reconstruc- sex differences, S-136 manual muscle tion, S-69 Triathletes trapezius activation, S-136 anterior shear force female modified Sensory Star Excursion ankle instability, S-120 gluten intolerance, S-91 Balance Test vertical stop-jump, S-120 running biomechanics, S-84 reliability, S-159 anterior translation Triple-hop test motorized contractile effort, S-170 neuromuscular function ankle braces, S-13 plateau slope geometry hip, S-172 patellar quadrant knee biomechanics, S-162 Trunk reliability, S-162 Tibiofemoral joint endurance reach forces lateral step-down, S-175 fatigue, S-72 landings, S-158 position high school athletes, S-72 osteoarthritis cutting task, S-122 sex differences, S-72 anterior cruciate ligament tear, rotation flexibility S-106 upper extremity injuries, S-80

Journal of Athletic Training S-213 strength Vocal cords Y lateral step-down, S-175 paradoxical motion Youth athletes female high school athlete, S-92 U female Volleyball players landing technique, S-173 Ulna collegiate performance measures, S-173 bilateral variance liver laceration, S-93 ice hockey female collegiate softball primary immune deficiency, subconcussive impacts, S-16 player, S-142 S-155 neuromuscular training impaction syndrome female anterior cruciate ligament, S-30 collegiate female cheerleader, primary immune deficiency, soccer S-149 S-155 landing biomechanics, S-71 Ultrasound imaging stress-induced GI dysfunction, landing technique, S-173 ankle laxity, S-12 S-140 performance measures, S-173 anterior talofibular ligament high school length, S-12 heterotopic ossification, S-66 Upper extremities male injuries heterotopic ossification, S-66 coiling, S-25 trunk rotation flexibility, S-80 W Urine color Walking hydration assessment, S-186 ankle-knee coupling variability, V S-180 Warm-ups, soccer Validity lower extremity injuries, S-31 2-D measures Weakness, quadriceps hip, knee biomechanics, S-163 anterior cruciate ligament recon- Cumberland Ankle Instability Tool struction, S-102 cutoff score, S-30, S-124 Weight cutting theory of planned behavior collegiate wrestlers instrument, S-62 clinical concussion measures, Wii Fit balance scores, S-161 S-120 Vascular conductance Wii Fit femoral artery balance rehabilitation, S-163 compression, S-47 balance scores cryotherapy, S-47 reliability, validity, S-161 Vertical ground reaction forces Wrestlers abdominal training, S-161 collegiate Vertical jump clinical concussion measures, ankle stabilizers, S-109 S-120 Vertical stop-jump laminal fracture, S-139 lower extremity characteristics long thoracic neuropathy, S-151 ankle instability, S-120 submission tibial anterior shear force injury incidence, S-85 ankle instability, S-120 Wrist Vertigo bilateral ulnar variance benign paroxysmal positional female collegiate softball collegiate male ice hockey player, S-142 player, S-156 Vestibular-ocular reflex training ankle instability, S-97 Vibration meniscectomy, S-106 Visual analog scale pain soft tissue mobilization, S-127

S-214 Volume 46 • Number 3 (Supplement) May 2011 Notes

Journal of Athletic Training S-215